Stem Cell Considerations for the Clinician.
Stem Cell Considerations for the Clinician.
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临床医生的干细胞注意事项。
DOI：
10.1016/j.pmr.2016.06.004
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发表时间：
2016-11
影响因子：
1.7
通讯作者：
Cho H
中科院分区：
文献类型：
--
作者：
Hasty KA;Cho H
虽然有充分的证据表明，使用MSC可以获得有益的结果，但关于其使用的几个问题仍有待回答。需要更好地定义MSC引起其使用的积极结果的机制，无论其是否在于MSC产生的影响先天性或适应性免疫或影响驻留细胞代谢的旁分泌因子，还是其作为前体细胞产生更分化的修复细胞的贡献。如果需要旁分泌效应，同种异体MSC的商业来源可以为临床医生提供一种易于获得、表征良好的试剂。在其作为修复细胞的功能中，同种异体MSC的寿命和命运需要在更长期的基础上进一步评估。自体细胞的使用既有优点，也有其自身固有的缺点，涉及用于MSC的收集、制备和表征的额外程序。很明显，临界数量的MSC对于植入的最佳结果是必要的。仍有待确定的是，组织如脂肪组织是否比骨髓提供更多的MSC，以及分化能力是否等同。还需要更好地了解个体患者因素，如年龄，性别，药物治疗方案和合并症如何影响MSC人群。对于这些问题中的许多问题，临床前模型将是有帮助的，但评估和实施这些研究结果的骨科患者福尔斯的任务落在临床研究人员的肩上。评价这些问题是一个艰巨的任务，但这样的挑战符合当今医学个性化医疗的概念。
While there is ample evidence that beneficial results can be obtained from the use of MSC, several questions regarding their use remain to be answered. A better definition is needed for the mechanism/s by which the MSC are eliciting the positive outcome of their use whether it lies in the paracrine factors that are made by the MSC that affect the innate or adaptive immunity or impact the metabolism of resident cells, or their contribution as precursor cells giving rise to more differentiated reparative cells. If paracrine effects are desirable, commercial sources of allogeneic MSC could provide an easily obtainable, well-characterized reagent for the clinician. In their function as reparative cells, the longevity and fate of allogeneic MSC needs to be further evaluated on longer-term basis. The use of autologous cells has both advantages and its own inherent disadvantages involving additional procedures for collection, preparation and characterization of the MSC. It is apparent that a critical number of MSC are necessary for an optimal outcome for implantation. It remains to be determined if tissues such as adipose tissue provide more MSC than bone marrow and if the capability for differentiation is equivalent. A better understanding is also needed for how individual patient factors such as age, sex, drug regimens and co-morbidities influence the MSC population. For many of these questions, preclinical models will be helpful, but the task of evaluating and implementing these findings for orthopaedic patients falls onto the shoulders of clinical researchers. Evaluation of these questions is a daunting, but such a challenge fits the concept of personalized medicine in today’s medicine.