Seeing What We Build--The Need for New Imaging Techniques in Myocardial Regeneration.
Seeing What We Build--The Need for New Imaging Techniques in Myocardial Regeneration.
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看看我们构建了什么——心肌再生对新成像技术的需求。
DOI：
10.1161/jaha.115.002306
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发表时间：
2015
影响因子：
5.4
通讯作者：
Sosnovik,DavidE
中科院分区：
文献类型：
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作者：
Sosnovik,DavidE
心脏干细胞治疗的最大经验是骨髓单核细胞（BMMC）。几项单中心研究表明，再灌注心肌梗死患者注射 BMMC 后射血分数 (EF) 略有增加，在某些情况下是短暂的。 1 虽然这一经验清楚地证明了 BMMC 注射的安全性，但这些 1 至 2 期研究中使用的成像读数并未提供明确的“停止或继续”信号作为进一步决策的依据。因此进行了多项 BMMC 注射的多中心 3 期研究，结果均为阴性，显示 EF 没有显着变化。 2, 3 因此，显然需要更精细的成像工具来指导心脏再生疗法的发展。心脏的成功再生需要注射的细胞被输送到心肌的正确区域，在宿主微环境中存活，发挥有益的旁分泌作用，分化并与宿主心肌整合。已经开发出先进的成像技术来表征许多这些过程（图），并且有几种技术准备用于人类。在最新一期的 JAHA 中，Dash 和同事用一种优雅的方法添加了这个武器库，其中包括报告探针的双对比磁共振成像 (MRI) 和正电子发射断层扫描 (PET)。 4 这种方法和其他先进成像方法的价值将在下面讨论。
The largest experience with stem cell therapy in the heart has been with bone marrow mononuclear cells (BMMCs). Several single-center studies have shown modest, and in some cases transient, increases in ejection fraction (EF) following BMMC injection in patients with reperfused myocardial infarction. 1 While this experience clearly demonstrated the safety of BMMC injection, the imaging readouts used in these phase 1 to 2 studies did not provide a clear “stop or go” signal on which to base further decisions. Several multicenter phase 3 studies of BMMC injection were thus conducted and have been negative, showing no significant changes in EF. 2, 3 A clear need, therefore, exists for more refined imaging tools to guide the development of regenerative therapies in the heart. Successful regeneration in the heart requires the injected cell to be delivered to the correct zone of the myocardium, survive in the host microenvironment, exert beneficial paracrine effects, differentiate, and integrate with the host myocardium. Advanced imaging techniques to characterize many of these processes have been developed (Figure) and several are poised for use in humans. In the current issue of JAHA, Dash and colleagues add to this armamentarium with an elegant approach involving dual-contrast magnetic resonance imaging (MRI) and positron emission tomography (PET) of a reporter probe. 4 The value of this and other advanced imaging approaches is discussed below.