[Stem cell therapy in cardiovascular diseases].
[Stem cell therapy in cardiovascular diseases].
复制标题
干细胞治疗心血管疾病。
作者：
M. Vértesaljai;Z. Piróth;G. Fontos;G. Andréka;G. Font;G. Szantho;M. Réti;T. Masszi;P. Andréka
心肌梗死是工业化国家充血性心力衰竭的主要原因。目前的治疗未能解决潜在的疤痕和细胞损失，这是缺血性心力衰竭的原因。最近的兴趣集中在干细胞，这是未分化的和多能细胞，可以增殖，潜在的自我更新，并分化为心肌细胞和内皮细胞。心肌再生是干细胞可塑性研究最广泛和争论最多的例子。来自动物和临床研究的早期报告不同意成人心肌更新的程度，但证据表明，心肌细胞产生于以前被认为是有丝分裂后的器官。到目前为止，心脏干细胞治疗的候选者仅限于急性心肌梗死和慢性缺血性心力衰竭患者。目前，骨髓干细胞似乎是对这些患者最有吸引力的细胞类型。细胞可以通过直接手术注射、冠状动脉内输注、逆行静脉输注和经血管内输注的方式递送。干细胞可以直接增加心肌收缩力或被动地限制梗死扩展和重塑。早期I期临床研究表明，干细胞移植是可行的，并可能对心肌梗死后心室重构有有益的影响。未来的随机临床试验将确定干细胞治疗后的获益程度和对死亡率的影响。
Myocardial infarction is the leading cause of congestive heart failure in the industrialized world. Current treatments fail to address the underlying scarring and cell loss, which are the causes of ischaemic heart failure. Recent interest has focused on stem cells, which are undifferentiated and pluripotent cells that can proliferate, potentially self-renew, and differentiate into cardiomyocytes and endothelial cells. Myocardial regeneration is the most widely studied and debated example of stem cell plasticity. Early reports from animal and clinical investigations disagree on the extent of myocardial renewal in adults, but evidence indicates that cardiomyocytes were generated in what was previously considered a postmitotic organ. So far, candidates for cardiac stem cell therapy have been limited to patients with acute myocardial infarction and chronic ischaemic heart failure. Currently, bone marrow stem cells seem to be the most attractive cell type for these patients. The cells may be delivered by means of direct surgical injection, intracoronary infusion, retrograde venous infusion, and transendocardial infusion. Stem cells may directly increase cardiac contractility or passively limit infarct expansion and remodeling. Early phase I clinical studies indicate that stem cell transplantation is feasible and may have beneficial effects on ventricular remodeling after myocardial infarction. Future randomized clinical trials will establish the magnitude of benefit and the effect on mortality after stem cell therapy.