Cell-based therapy for pediatric traumatic brain injury: not (yet) an update to the traumatic brain injury guidelines.
Cell-based therapy for pediatric traumatic brain injury: not (yet) an update to the traumatic brain injury guidelines.
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儿科创伤性脑损伤的细胞疗法：（尚未）更新创伤性脑损伤指南。
DOI：
10.1097/pcc.0000000000000347
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Kernie,StevenG
中科院分区：
文献类型：
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作者：
Kernie,StevenG
短短几年前，很难想象有人会建议骨髓移植治疗小儿创伤性脑损伤（TBI）。然而，骨髓源性细胞疗法的概念并不是一个新概念。近150年前，Cohnheim(1)观察到动物静脉注射染料导致远端损伤部位出现染料标记的疤痕组织。这一惊人的发现表明，骨髓中的祖细胞可以变成循环中的红细胞、白细胞和血小板以外的东西。尽管自骨髓源性细胞的多能性“潜能”首次被描述以来已经过去了一个多世纪，但在许多方面，我们对这一令人兴奋的现象的机制和相关性的理解仍然非常初级。廖等(2)在本刊《儿科危重医学》（Pediatric Critical Care Medicine）上的研究中，对10例急性中重度TBI患儿（初始格拉斯哥昏迷评分5-8分）进行了骨髓采集，分离、鉴定、纯化、浓缩细胞单核部分，并在损伤后48小时内静脉给药。这些患者的入组时间为2006-2008年，此前曾在2011年作为一项安全性研究报道，该研究表明，没有与治疗相关的严重不良事件，根据格拉斯哥预后评分（Glasgow Outcome Scores），入组的10名患者中有7名预后良好(3)。目前的报告研究了这10名患者与回顾性对照的情况。作者得出结论，通过儿科治疗强度水平（PILOT）量表测量，细胞治疗患者需要降低治疗强度来控制颅内高压(4)。此外，他们发现治疗组的颅内压（ICP）监测时间较短。虽然治疗组和对照组的人数很少，但作者发现了一些令人信服的关联，表明治疗患者可能受益。由于结果测量仅限于早期治疗和ICP管理，对照组需要尽可能相似。在
A few short years ago it would have been hard to imagine that anyone might suggest a bone marrow transplant for pediatric traumatic brain injury (TBI). The concept of bone marrow–derived cell-based therapies is, however, not a new concept. Nearly 150 years ago, Cohnheim (1) observed that IV dye delivery in animals resulted in dye-labeled scar tissue at distal injury sites. This startling discovery suggested that progenitor cells within the bone marrow could become something other than circulating RBCs, leukocytes, and platelets. Although more than a century has passed since this pluripotent “potential” of bone marrow–derived cells was first described, in many ways, our understanding of the mechanisms and relevance of this exciting phenomenon remain surprisingly rudimentary. In the study by Liao et al (2) in this issue of Pediatric Critical Care Medicine, 10 children who acutely suffered from a moderately severe TBI (initial Glasgow Coma Score, 5–8) had their bone marrow harvested and the mononuclear fraction of cells isolated, characterized, purified, concentrated, and then delivered back to them IV within 48 hours of injury. Enrollment of these patients occurred in 2006–2008 and was previously reported in 2011 as a safety study demonstrating that there were no severe adverse events associated with the therapy and that seven of 10 patients enrolled had good outcomes as measured by Glasgow Outcome Scores (3). The current report examines how these same 10 patients fared in comparison with retrospectively obtained controls. The authors concluded that the cell-treated patients required a reduced treatment intensity to manage their intracranial hypertension as measured by the Pediatric Intensity Level of Therapy (PILOT) scale (4). In addition, they found a shorter duration of intracranial pressure (ICP) monitoring in the treated group. Although the treatment and control groups were small, the authors identify some compelling associations that suggest possible benefit in the treated patients. Because the outcome measures are limited to early therapy and ICP management, the comparison groups needed to be as similar as possible. In