New Paradigms of Myocardial Regeneration Post-Infarction Tissue Preservation, Cell Environment, and Pluripotent Cell Sources
New Paradigms of Myocardial Regeneration Post-Infarction Tissue Preservation, Cell Environment, and Pluripotent Cell Sources
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DOI：
10.1016/j.jcin.2008.10.010
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发表时间：
2009-01-01
影响因子：
11.3
通讯作者：
Makkar, Raj R.
中科院分区：
文献类型：
--
作者：
Forrester, James S.;White, Anthony J.;Makkar, Raj R.
急性心肌梗死患者冠状动脉内自体骨髓细胞输注的荟萃分析证实该手术是安全的。尽管如此，射血分数的典型小幅增加的临床意义尚不确定，几乎没有心肌再生的证据。在本文中，我们描述了3种新的心肌保存和再生的范例，为实现心肌再生的目标提供了合理的希望。第一个范例是，即使在冠状动脉闭塞和立即再灌注期间，在旨在心肌再生的干预之前，心肌的实质性保护也是可能的。诱导心肌保存的因素也可能创造一个更容易接受随后心肌再生的环境。第二个范例是局部环境可以调节缺血/梗死区域中细胞的行为。例如，成年细胞可以被诱导重新进入细胞周期并在适当的环境修饰下增殖。最后一个范例是自体心脏干细胞或诱导多能干细胞可以产生新的心肌细胞和心肌。总的来说，这些新的想法，每一个都有待证实，表明再生功能性新心肌的目标仍然可以实现。（J Am科尔Cardiol Intv 2009;2：1-8）（C）美国心脏病学会基金会2009年
Meta-analyses of intracoronary autologous bone marrow cell infusion in patients with acute myocardial infarction establish the procedure as safe. Nonetheless, the typical small increase in ejection fraction is of uncertain clinical significance, with little if any evidence of myocardial regeneration. In this paper, we describe 3 new paradigms of myocardial preservation and regeneration that provide reasonable hope that the goal of myocardial rejuvenation can be achieved. The first paradigm is that substantial preservation of myocardium is possible even during the period of coronary occlusion and immediate reperfusion, before interventions aimed at myocardial regeneration. The factors that induce myocardial preservation may also create an environment more receptive to subsequent myocardial regeneration. The second paradigm is that the local environment may regulate the behavior of cells in the ischemic/infarct region. For instance, adult cells may be induced to re-enter the cell cycle and proliferate with appropriate environmental modification. The final paradigm is that autologous cardiac stem cells or induced pluripotent stem cells can create new myocytes and myocardium. Taken together, these new ideas, each still to be proven, suggest that the, goal of regenerating functioning new myocardium can still be achieved. (J Am Coll Cardiol Intv 2009;2:1-8) (C) 2009 by the American College of Cardiology Foundation