自体骨髓干细胞移植治疗重度下肢缺血性疾病的疗效分析

目的观察自体骨髓干细胞移植治疗慢性下肢缺血的临床疗效。方法观察山东大学附属省立医院血管外科自2004年9月至2012年9月接受自体干细胞移植的下肢重度缺血患者79例,评定患者自体骨髓干细胞移植前、移植后1个月及6个月时患肢疼痛评分、踝肱指数、间跛距离的改变情况来评价临床疗效。结果治疗后1个月及6个月,患肢疼痛评分由术前的7.51±1.18缓解至术后4.03±1.12,3.38±1.32,与术前比较差异均有统计学意义(P0.05)。移植后1个月与移植后6个月评分比较,差异无统计学意义(P0.05)。间跛距离由术前的(65±15)m,增加至术后的(165±105)m,(195±95)m,与术前比较差异均有统计学意义(P0.05)。移植后1个月与移植后6个月评分比较,差异无统计学意义(P0.05)。踝肱指数由术前的0.22±0.10,提高至术后的0.31±0.05,0.34±0.09,与术前比较差异均有统计学意义(均P0.05)。移植后1个月与移植后6个月评分比较,差异无统计学意义(P0.05)。结论自体骨髓干细胞移植对缓解肢体疼痛,提高间跛距离,加快溃疡面愈合疗效确切。     

骨髓干细胞动员在心脑血管疾病中的研究进展

心脑血管的相关缺血性疾病如心梗、脑卒中及严重肢体周围血管疾病,已经成为对人类健康和生命威胁最大的一类疾病.临床传统治疗手段主要包括药物治疗、血管旁路重建、血管腔内成形或支架术等,治疗方法无实质性改进,疗效并不理想."治疗性血管生成"的提出为心脑血管缺血损伤疾病的治疗提出新策略,通过干细胞动员药物大量动员自体骨髓干细胞归巢至病损血管及缺血损伤组织,促进血管新生、缺血组织再生与功能修复,为心脑血管缺血性疾病的治疗提供了新的思路.本文对近年来干细胞动员药物在治疗心脑血管缺血性疾病的研究进展做简要阐述.     

骨髓间充质干细胞和内皮祖细胞移植促进血流重建的比较

目的:比较骨髓间充质细胞(Bone Marrow Mesenchymal Stem Cells,BM/MSC)和骨髓源内皮祖细胞(Bone Marrow Endothelialprogenitor cells,BM/EPC)移植促进血流重建的效果,为进一步优化骨髓干细胞移植治疗肢体缺血提供理论基础。方法:获取Lewis大鼠骨髓单个核细胞,在体外培养分化为MSC和EPC。采用Lewis大鼠建立单侧后肢缺血模型。在模型建立后3天,将0.8mlD-Hanks液注入大鼠缺血侧后肢,为对照组(n=6);将8×106个骨髓MSC植入大鼠缺血侧后肢,为MSC组(n=6);将体外培养的8×106个EPC植入大鼠缺血侧后肢,为EPC组(n=6)。细胞移植后3周行缺血大鼠后肢动脉造影,检测缺血侧后肢侧支血管数;获取缺血侧后肢腓肠肌,分别行CD31和α-SMA免疫组化染色,计算毛细血管密度和小动脉密度。结果:MSC组与EPC组侧支血管数无显著性差异,二者均高于对照组;EPC组毛细血管密度明显高于MSC组,二者均高于对照组;MSC组与EPC组小动脉密度无显著性差异,二者均高于对照组。结论:骨髓间充质干细胞移植和内皮祖细胞移植均能够明显促进血流重建,而且骨髓间充质干细胞在治疗肢体缺血性疾病中的优势应该受到重视。     

自体骨髓间充质干细胞移植治疗股骨头无菌性坏死的临床观察

目的:观察自体骨髓间充质干细胞移植治疗股骨头无菌性坏死的临床效果及安全性.方法:对2012年9月至2013年1月期间在我院骨科住院治疗的55例患者随机分成两组,对照组接受常规治疗,治疗组接受自体骨髓间充质干细胞移植治疗治疗.结果:治疗组的临床疗效优于对照组,与对照组相比差异有统计学意义(P＜0.01);治疗组治疗后的DSA检查结果与对照相比,差异有统计学意义(P＜0.05);两组不良反应相互比较,无统计学意义(P＞0.05).结论:自体骨髓间充质干细胞移植治疗股骨头无菌性坏死效果显著,优于常规治疗.     

骨髓和脐带间充质干细胞联合移植治疗杜氏型肌营养不良1例并文献复习

目的:研究自体骨髓和脐带间充质干细胞联合移植治疗杜氏型肌营养不良(DMD)的疗效和安全性方法对经临床表现、血清酶学、肌电图、基因分析、肌肉活检、肌肉核磁共振成像(MRI)确诊的1例DMD患者采用自体骨髓和脐带间充质干细胞联合移植的方案进行治疗.术后第3、6、9、12个月定期观察患者临床症状及各项疗效指标的变化并结合国内外文献进行综合分析.结果随访12个月,该患者肌力提高,动作灵活.血清肌酸激酶和乳酸脱氢酶较前明显下降,活动能力评分和徒手肌力较前增加,肌电图运动单位电位波幅减低及时限缩短较前改善,肌肉MRI复查显示肌肉病变程度较前减轻、肌肉轮廓较前清晰.结论自体骨髓和脐带间充质干细胞联合移植是一种治疗DMD的有效治疗方法.     

菲立磁标记食蟹猴骨髓间充质干细胞的脑内移植示踪研究

中枢神经系统损伤后的再生修复问题一直是神经科学领域关注的重点之一,骨髓间充质干细胞移植治疗拓宽了人类中枢神经系统损伤的治疗前景,而非侵入性的磁共振成像能活体追踪移植细胞,评价移植效果。应用菲立磁标记食蟹猴骨髓来源的间充质干细胞,在脑立体定位仪引导下,自体脑内移植。结果显示,菲立磁标记间充质干细胞的有效率高达90%以上,移植区磁共振影像呈明显的低信号改变。标记的间充质干细胞移植后在脑内存活,并向周围的脑实质内迁移。移植8周后,发现移植细胞通过血管向对侧脑部迁移,但并未发现移植细胞向神经细胞分化。这些结果提示,菲立磁可用于标记、追踪脑内移植的食蟹猴骨髓间充质干细胞,标记的移植细胞可在脑内存活、迁移。     

粒细胞集落刺激因子对失代偿期肝硬化患者骨髓干细胞的动员效果及安全性观察

目的观察失代偿期肝硬化患者行自体骨髓干细胞移植前粒细胞集落刺激因子（G-CSF）对骨髓干细胞的动员效果及安全性。方法在51例失代偿期肝硬化患者行自体骨髓干细胞经肝动脉移植术前,连续2 d给予G-CSF 4μg/（kg·d）动员骨髓干细胞。抽取骨髓的当日化验血常规、肝肾功等指标;从患者髂后上棘抽取骨髓150-200 ml,分离收集骨髓单个核细胞并计数,应用流式细胞仪检测CD34＋细胞并计数,观察应用G-CSF期间不良反应的类型和发生率。患者治疗前后比较采用配对t检验进行统计学分析。结果G-CSF皮下注射后,外周血白细胞由术前（3.31±0.96）×10^9/L升至（11.35±1.92）×10^9/L（P〈0.01）,骨髓单个核细胞数（1.91±0.83）×10^9/kg,CD34＋细胞为（2.02±1.29）×10^7/kg;患者皮下注射后,发热率17.6﹪,体温最高38℃,停药后降至正常;腹部胀痛3例,四肢皮肤散发皮疹2例,均未给予特殊处理,2-3 d后恢复正常。结论给予G-CSF皮下注射后提取骨髓干细胞移植治疗失代偿期肝硬化的是一种临床确切有效的、安全的干细胞动员方法。     

自体骨髓间充质干细胞治疗雷诺氏病一例

雷诺氏病属上肢缺血性疾病,治疗手段包括药物、血管旁路移植术和介入手术等,疗效常不理想,致残率高。再生医学的发展使细胞治疗成为近年尝试的一项新技术。动物实验及临床研究均表明人体外周血、脐血及骨髓问充质干细胞有修复病变血管和促进血管新生的功能。我院近来用自体骨髓间充质干细胞治疗雷诺氏病1例。     

超选择性股动脉内骨髓单个核细胞移植治疗股骨头坏死187例

目的 研究自体骨髓单个核细胞移植对股骨头坏死患者缺血状态的改善程度和治疗效果.方法 选取2004 年7 月至2010 年11 月期间187 例252 髋股骨头坏死患者,应用自体骨髓单个核细胞移植治疗,分别采集 187 例患者骨髓200 -360 ml,采用 Ficoll 密度梯度离心法分离单个核细胞,单个核细胞总数为（2.4 ~ 7.8）× 108 个,流式细胞仪检测 CD34＋ 细胞和 CD133＋ 细胞在所分离出的干细胞悬液中的含量分别为2.47﹪± 0.58﹪和1.29﹪± 0.35﹪,然后将单个核细胞用生理盐水制备成细胞悬液 20 - 30 ml,使用数字减影血管造影技术（DSA）行超选择性股骨头供血动脉内干细胞移植术.按世界骨循环研究学会（ARCO）对骨坏死分期,设自身前后对照观察疗效.移植术后第 3、6、12、24、36 和48 个月,根据髋关节 Harris 评分评价疗效,移植术后6 个月通过复查患者股骨头供血动脉 DSA,观察其新生血管形成情况,以后每隔 6 个月采用影像学方法观察股骨头形态学变化.结果 （1）临床疗效：对接受自体骨髓单个核细胞移植治疗的187 例患者随访 3 ~ 48（24.2 ± 4.5）个月,其中髋关节疼痛缓解者 158 例（占患者总数的 84.5﹪）,髋关节功能改善者 146 例（占患者总数的 78.1﹪）,行走间距延长者 149 例（占患者总数的 79.7﹪）;（2）影像学检查：干细胞移植术后 6 个月187 例患者中54 例行股骨头供血动脉 DSA 检查,48 例显示供血动脉较移植术前明显增多、增粗,血流速度增快,12 ~ 24个月后 72 例患者股骨头区骨质病变获得改善.结论 超选择性动脉内骨髓单个核细胞移植方法简便、安全有效,对因缺血导致坏死的股骨头无再次损伤,能够有效治疗缺血性股骨头坏死.     

骨髓间充质干细胞移植治疗牙周组织再生

本研究利用骨髓间充质干细胞经细胞培养用于牙周病的治疗,验证其在牙髓、牙周炎、牙槽骨等骨缺损处再生可行性,同时利用形态观察等手段对比实验组和对照组治疗过程中牙周组织的变化,确定干细胞培养增殖代数以及最佳移植数量。研究发现,骨髓间充质干细胞迭代3代后,5×10~6细胞/m L和2×10~7细胞/m L组的新牙骨质长度百分比和2×10~7细胞/mL组的新骨面积百分比显著高于对照组(p0.01)。本研究表明,骨髓间充质干细胞的自体移植是牙周组织再生的新选择。     

Bone-marrow haematopoietic-stem-cell niches

Adult stem cells hold many promises for future clinical applications and regenerative medicine. The haematopoietic stem cell (HSC) is the best-characterized somatic stem cell so far, but in vitro expansion has been unsuccessful, limiting the future therapeutic potential of these cells. Here we review recent progress in characterizing the composition of the HSC bone-marrow microenvironment, known as the HSC niche. During homeostasis, HSCs, and therefore putative bone-marrow HSC niches, are located near bone surfaces or are associated with the sinusoidal endothelium. The molecular crosstalk between HSCs and the cellular constituents of these niches is thought to control the balance between HSC self-renewal and differentiation, indicating that future successful expansion of HSCs for therapeutic use will require three-dimensional reconstruction of a stem-cell-niche unit.     

Low angiogenic potency induced by the implantation of ex vivo expanded CD117(+) stem cells

Ex vivo expansion of stem cells might be a feasible method of resolving the problem of limited cell supply in cell-based therapy. The implantation of expanded CD34(+) endothelial progenitor cells has the capacity to induce angiogenesis. In this study, we tried to induce angiogenesis by implanting expanded CD117(+) stem cells derived from mouse bone marrow. After 2 wk of culture with the addition of several growth factors, the CD117(+) stem cells expanded approximately 20-fold and had an endothelial phenotype with high expression of CD34 and vascular endothelial-cadherin. However, >70% of these ex vivo expanded cells had a senescent phenotype by beta-galactosidase staining, and their survival and incorporation were poor after implantation into the ischemic limbs of mice. Compared with the PBS injection only, the microvessel density and the percentage of limb blood flow were significantly higher after the implantation of 2 x 10(5) freshly collected CD117(+) cells (P < 0.01) but not after the implantation of 2 x 10(5) expanded CD117(+) cells (P > 0.05). These data indicate that ex vivo expansion of CD117(+) stem cells has low potency for inducing therapeutic angiogenesis, which might be related to the cellular senescence during ex vivo expansion.     

Autologous bone marrow cell implantation as therapeutic angiogenesis for ischemic hindlimb in diabetic rat model

The angiogenic effect induced by autologous bone marrow cell implantation (BMCI) was examined in the ischemic hindlimbs of diabetic and nondiabetic rats. Diabetes mellitus was induced by the systemic administration of streptozotocin. We investigated the production of angiogenic factors and endothelial differentiation from bone marrow cells and the native recovery of blood flow in the ischemic hindlimbs. To observe the angiogenic effect induced by BMCI treatment, 6 x 10(7) bone marrow cells were injected intramuscularly at six points into the ischemic limbs, and regional perfusion recovery was evaluated with colored microspheres 2 wk later. No difference was found between diabetic and nondiabetic rats in the release of angiogenic factors or endothelial differentiation from bone marrow cells in vitro. The levels of nitric oxide in plasma were significantly lower, and native perfusion recovery in the ischemic hindlimbs was significantly slower in the diabetic rats than in the nondiabetic rats. However, although perfusion recovery was achieved in the ischemic hindlimbs, there was no significant increase in systemic VEGF after BMCI treatment in either the diabetic or nondiabetic rats. Therefore, therapeutic angiogenesis induced by BMCI could be a safe and effective treatment for ischemic limb disease in diabetic patients.     

Improved angiogenic potency by implantation of ex vivo hypoxia prestimulated bone marrow cells in rats

Therapeutic angiogenesis can be induced by local implantation of bone marrow cells. We tried to enhance the angiogenic potential of this treatment by ex vivo hypoxia stimulation of bone marrow cells before implantation. Bone marrow cells were collected and cultured at 33 degrees C under 2% O(2)-5% CO(2)-90% N(2) (hypoxia) or 95% air-5% CO(2) (normoxia). Cells were also injected into the ischemic hindlimb of rats after 24 h of culture. Hypoxia culture increased the mRNA expression of vascular endothelial growth factor (VEGF), vascular endothelial (VE)-cadherin, and fetal liver kinase-1 (Flk-1) from 2.5- to fivefold in bone marrow cells. The levels of VEGF protein in the ischemic hindlimb were significantly higher 1 and 3 days after implantation with hypoxia-cultured cells than with normoxia-cultured or noncultured cells. The microvessel density and blood flow rate in the ischemic hindlimbs were also significantly (P < 0.001) higher 2 wk after implantation with hypoxia-cultured cells (89.7 +/- 5.5%) than with normoxia-cultured cells (67.0 +/- 9.6%) or noncultured cells (70.4 +/- 7.7%). Ex vivo hypoxia stimulation increased the VEGF mRNA expression and endothelial differentiation of bone marrow cells, which together contributed to improved therapeutic angiogenesis in the ischemic hindlimb after implantation.     

Bone marrow and bone marrow derived mononuclear stem cells therapy for the chronically ischemic myocardium

Bone marrow stem cells have been shown to differentiate into various phenotypes including cardiomyocytes, vascular endothelial cells and smooth muscle. Bone marrow stem cells are mobilized and home in to areas of injured myocardium where they are involved in tissue repair. In addition, bone marrow secretes multiple growth factors, which are essential for angiogenesis and arteriogenesis. In some patients, these processes are not enough to avert clinical symptoms of ischemic disease. Therefore, in vivo administration of an adequate number of stem cells would be a significant therapeutic advance. Unfractionated bone marrow derived mononuclear stem cells, which contain both hematopoietic and nonhematopoietic cells may be more appropriate for cell therapy. Studies in animal models suggest that implantation of different types of stem cells improve angiogenesis and arteriogenesis, tissue perfusion as well as left ventricular function. Several unanswered questions remain. For example, the optimal delivery approach, dosage and timing of the administration of cell therapy as well as durability of improvements need to be studied. Early clinical studies have demonstrated safety and feasibility of various cell therapies in ischemic disease. Randomized, double blind and placebo-controlled clinical trials need to be completed to determine the effectiveness of stem cell.     

CD117+ stem cells play a key role in therapeutic angiogenesis induced by bone marrow cell implantation

Therapeutic angiogenesis can be induced by the implantation of bone marrow mononuclear cells. We investigated the roles of mature mononuclear cell and stem cell fractions in bone marrow in this treatment. Although CD34 is the most popular marker for stem cell selection for inducing therapeutic angiogenesis, we separated CD117-positive cells (CD117+) from mature bone marrow mononuclear cells [CD117-negative cells (CD117-)] from mice using the antibody to the stem cell receptor, because some of the bone marrow stem cells that express CD117+ and CD34- might generate angiogenic cytokines and differentiate into endothelial cells. The angiogenic potency of CD117+ and CD117- cells was investigated in vitro and in vivo. Significantly higher levels of VEGF were secreted from the CD117+ cells than from the CD117- cells (P < 0.001). Most of the CD117- cells died, but the CD117+ cells grew well and differentiated into endothelial cells within 14 days of culture. The CD117+ cells survived and were incorporated in microvessels within 14 days of being implanted into the ischemic hindlimbs of mice, but the CD117- cells did not. The microvessel density and blood perfusion of the ischemic hindlimbs were significantly higher in the CD117+ cell-implanted mice than in the CD117- cell-implanted mice (P < 0.01). The microvessel density in ischemic hindlimbs was also significantly higher in the CD117+ cell-implanted mice than in the total bone marrow cell-implanted mice (P < 0.05). Thus CD117+ stem cells play a key role in the therapeutic angiogenesis induced by bone marrow cell implantation.     

Regeneration of the intestinal epithelia: Regulation of bone marrow-derived epithelial cell differentiation towards secretory lineage cells

The intestinal epithelia consists of four lineages of differentiated cells, all of which arise from stem cells residing in the intestinal crypt. For proper regeneration from epithelial damage, both expansion of the epithelial cell number and appropriate regulation of lineage differentiation from the remaining stem cells are thought to be required. In a series of studies, we have shown that bone-marrow derived cells could promote the regeneration of damaged epithelia in the human intestinal tract. Donor-derived epithelial cells substantially repopulated the gastrointestinal tract of bone-marrow transplant recipients during epithelial regeneration after graft-versus-host disease. Furthermore, precise analysis of epithelial cell lineages revealed that during epithelial regeneration, secretory lineage epithelial cells that originated from bone-marrow significantly increased in number. These findings may lead to a novel therapy to repair damaged intestinal epithelia using bone marrow cells, and provide an alternative therapy for refractory inflammatory bowel diseases.     

Bone marrow-thymus axis in senescence

This presentation offers a brief review of the bone marrow-thymus axis in senescence, a putative model for thymocyte differentiation, and recent results of our work on the status of pre-thymic stem cells in aged mice. The data presented here provide further evidence for a thymus endocrine influence on the bone marrow stem cells, specifically lymphocyte precursors. It has been postulated that the thymic hormones may act on lymphocyte precursors in the bone marrow and that the loss of thymic factors during senescence may be a contributing factor to the decreased cellular immune function. This study used Haar's in vitro model to investigate the bone marrow-thymus axis in aged mice. Erythroid-depleted bone-marrow cells from 3-month- and 24-month-old CBA (Thy 1.2) mice were placed in the upper half of a blind-well chamber with thymus supernatant in the lower half. Experimental cells were treated with thymus supernatant for 1 hr prior to migration. This study confirmed that pre-thymic stem cells in aged bone marrow are deficient in their ability to migrate to the thymus supernatant. It also revealed that treatment of the old bone marrow with thymus supernatant, made from neonatal thymus cultures, could dramatically improve the thymus migrating ability of the aged bone-marrow stem cells.     

阿司匹林对骨髓间充质干细胞移植治疗缺血性脑卒中的影响研究进展

阿司匹林是缺血性脑卒中患者急性期治疗药物及卒中再发的二级预防常用药物,骨髓间充质干细胞(BMSCs)移植是治疗缺血性脑血管疾病的新的新兴技术。已证实阿司匹林可抑制骨髓间充质干细胞的增殖及影响骨髓间充质干细胞的分化。本文就阿司匹林对骨髓间充质干细胞移植治疗缺血性脑卒中的影响等进行综述。