Stem cells as a therapeutic modality in pediatric malformations
Stem cells as a therapeutic modality in pediatric malformations
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DOI：
10.1016/j.transproceed.2007.01.060
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发表时间：
2007-04-01
影响因子：
0.9
通讯作者：
Dattagupta, S.
中科院分区：
文献类型：
--
作者：
Gupta, D. K.;Sharma, S.;Dattagupta, S.
瞄准本研究的目的是探讨干细胞在先天性畸形中的应用。在2005年7月至2006年7月期间，自体干细胞用于29例患者：12例肝硬化患者和17例脊髓脊膜膨出患者。肝硬化患者行肝动脉、门静脉内或肝胆根内注射干细胞，脊髓脊膜膨出患者行脊髓、尾侧间隙内注射干细胞。术前状态作为对照条件。肝硬化患者的年龄为1.5 ~ 9个月，平均4.12个月。病因为肝外胆道闭锁（EHBA）8例，新生儿胆汁淤积2例，胆总管囊肿2例。5例患者死于持续肝硬化。3 - 12个月随访（N = 7）显示无胆管炎（4/7）、黄便（5/7）、肝硬度降低（3/7）、肝功能改善（6/7）和食欲改善（6/7）。7例中6例肝胆扫描呈排泄性，4例摄取改善。组织学检查显示3例患者的纤维化有相对改善。脊髓脊膜膨出0 ~ 1个月5例，1-5个月8例，1-4年2例。其中五人有破裂史。其中3例曾因神经功能缺损接受过脊膜膨出修复术。1例患者因脊髓栓系再次手术。14例随访3 ~ 11个月，7例动力改善，3例（22%）动力恢复，7例（50%）动力恢复正常。肝硬化和脊髓脊膜膨出的初始干细胞使用已显示出有益的结果。然而，在随机对照试验中进行长期评价对于得出进一步的结论至关重要。
Aim. The aim of this study was to explore stem cell use in congenital anomalies.Patients and Methods. During July 2005 through July 2006, autologous stem cells were used in 29 patients: 12 with liver cirrhosis and 17 with meningomyelocele. Stem cells were injected into the hepatic artery and the portal vein or into the hepatobiliary radicals for liver cirrhosis, or into the spinal cord and caudal space for meningomyelocele. Preoperative status served as the control condition.Observations and Results. The ages of patients with liver cirrhosis ranged between 1.5 and 9 months (mean, 4.12 months). The etiology was extra hepatic biliary atresia (EHBA) versus neonatal cholestasis and choledochal cyst in 8; 2 and 2 patients, respectively. Five patients died due to ongoing cirrhosis. Follow-up at 3 to 12 months (N = 7) showed absence of cholangitis (4/7), yellow stools (5/7), decreased liver firmness (3/7), improved liver function (6/7), and better appetite (6/7). Hepatobiliary scan was excretory in 6 of 7 with improved uptake in 4 of 7. Histopathology demonstrated comparative improvement in fibrosis among 3 patients. Meningomyelocele patients were between 0 and 1 month, 1-5 months, and 1-4 years in 5, 8, and 2 cases respectively. Five had a history of rupture. Three had undergone meningocele repair in the past with neurological deficits. Redo surgery for a tethered cord was performed in 1 patient. Follow-up at 3 to 11 months in 14 cases showed improved power in 7 with dramatic recovery in 3 (22%) and status quo in 7 (50%).Conclusion. Initial stem cell use in liver cirrhosis and meningomyelocele has suggested beneficial results. However, long-term evaluation in randomized controlled trials is essential to draw further conclusions.