脐带间充质干细胞移植治疗脊髓损伤的临床研究

目的:探讨脐带间充质干细胞移植治疗脊髓损伤的疗效及安全性。方法:40例脊髓损伤患者给予脐带间充质干细胞移植治疗,移植方法采用静脉输注联合腰穿鞘内注射的方法。术后随访1年余定期观察患者临床症状及各项指标的变化并进行综合分析。移植过程中为促进干细胞的生长和分化,根据患者病情及身体状况给予相应的康复功能锻炼。结果:与入院时比较,脐带间充质干细胞移植治疗3、6、12个月后,不完全性脊髓损伤患者针刺觉评分、轻触觉评分、运动评分均有明显改善(P<0.05或0.01),完全性脊髓损伤患者针刺觉评分、轻触觉评分、运动评分均无明显变化(P>0.05),两组残损分级均无明显改善(P>0.05)。移植后各项生化指标正常,未出现严重的并发症和明显的不良反应。结论:脐带间充质干细胞移植治疗脊髓损伤近期疗效明显,可以改善患者的临床症状,提高患者的生存质量,是一种值得借鉴的治疗方法。     

Neural Stem Cell Transplantation in Experimental Contusive Model of Spinal Cord Injury

Spinal cord injury is a devastating clinical condition, characterized by a complex of neurological dysfunctions. Animal models of spinal cord injury can be used both to investigate the biological responses to injury and to test potential therapies. Contusion or compression injury delivered to the surgically exposed spinal cord are the most widely used models of the pathology. In this report the experimental contusion is performed by using the Infinite Horizon (IH) Impactor device, which allows the creation of a reproducible injury animal model through definition of specific injury parameters. Stem cell transplantation is commonly considered a potentially useful strategy for curing this debilitating condition. Numerous studies have evaluated the effects of transplanting a variety of stem cells. Here we demonstrate an adapted method for spinal cord injury followed by tail vein injection of cells in CD1 mice. In short, we provide procedures for: i) cell labeling with a vital tracer, ii) pre-operative care of mice, iii) execution of a contusive spinal cord injury, and iv) intravenous administration of post mortem neural precursors. This contusion model can be utilized to evaluate the efficacy and safety of stem cell transplantation in a regenerative medicine approach.     

脊髓损伤的基因治疗

基因治疗脊髓损伤（SCI）既不存在胎儿神经组织移植的组织来源问题,且比外周神经组织移植引起的排异性低,是目前脊髓损伤治疗中最有前途的方法.基因治疗的转基因方式有两种：一是将目的基因直接导入体内靶细胞令其表达;二是将基因在体外导入适当的细胞内,并筛选出高效表达的移植细胞作为转基因中介移植到体内靶组织.不论采用何种方式,将基因导入细胞又可用多种手段实现：如微注射、脂质体等物理或化学手段;利用缺陷病毒作为载体感染细胞的生物学手段.因为用生物学手段转基因的细胞移植方法空间定位明确,所以目前最常采用它作为基因治疗效果的研究.虽然SCI基因治疗目前仍停留在实验探索阶段,一些问题尚待解决,但随着基因治疗技术方法的不断提高,它的临床应用前景可以预见.     

干细胞治疗脊髓损伤研究进展

脊髓损伤后的常规治疗手段是在有效时间内进行手术缓减外力压迫,防止脊髓神经进一步受损。细胞替代治疗理论上可治愈脊髓损伤,不同类型细胞可从各角度产生治疗作用,包括损伤后的脊髓轴突再生、神经元再建和轴突髓鞘化等,进而促进功能恢复。对近年来干细胞治疗脊髓损伤研究中的最新结果进行了概述,以期为干细胞治疗脊髓损伤的研究提供参考。     

Transplants of Human Mesenchymal Stem Cells Improve Functional Recovery After Spinal Cord Injury in the Rat

Human mesenchymal stem cells (hMSCs) derived from adult bone marrow represent a potentially useful source of cells for cell replacement therapy after nervous tissue damage. They can be expanded in culture and reintroduced into patients as autografts or allografts with unique immunologic properties. The aim of the present study was to investigate (i) survival, migration, differentiation properties of hMSCs transplanted into non-immunosuppressed rats after spinal cord injury (SCI) and (ii) impact of hMSC transplantation on functional recovery. Seven days after SCI, rats received i.v. injection of hMSCs (2×10⁶ in 0.5 mL DMEM) isolated from adult healthy donors. Functional recovery was assessed by Basso–Beattie–Bresnahan (BBB) score weekly for 28 days. Our results showed gradual improvement of locomotor function in transplanted rats with statistically significant differences at 21 and 28 days. Immunocytochemical analysis using human nuclei (NUMA) and BrdU antibodies confirmed survival and migration of hMSCs into the injury site. Transplanted cells were found to infiltrate mainly into the ventrolateral white matter tracts, spreading also to adjacent segments located rostro-caudaly to the injury epicenter. In double-stained preparations, hMSCs were found to differentiate into oligodendrocytes (APC), but not into cells expressing neuronal markers (NeuN). Accumulation of GAP-43 regrowing axons within damaged white matter tracts after transplantation was observed. Our findings indicate that hMSCs may facilitate recovery from spinal cord injury by remyelinating spared white matter tracts and/or by enhancing axonal growth. In addition, low immunogenicity of hMSCs was confirmed by survival of donor cells without immunosuppressive treatment.     

骨髓间充质干细胞移植修复大鼠半横断脊髓损伤

目的初步探讨骨髓间充质干细胞诱导为神经细胞,及其移植对大鼠脊髓半横断损伤神经功能恢复和运动的影响。方法贴壁培养法分离培养大鼠骨髓间充质干细胞(mesenchymal stem cells,MSCs),大鼠脊髓匀浆上清诱导第3代向神经细胞分化,经免疫组化鉴定分化后细胞的性质。制备大鼠半横断脊髓损伤模型,脊髓损伤局部注射BrdU标记诱导后的神经细胞。细胞移植5周后观察移植细胞在脊髓内存活分布情况。结果倒置显微镜下可见MSCs呈纺锤形和多角形,有1~2个核仁,经脊髓匀浆上清诱导后,发出数个细长突起,并交织成网,诱导后的细胞表达Nestin,可推测诱导后的细胞为MSCs源神经细胞。5周后移植的MSCs在宿主损伤脊髓内聚集并存活,表达MAP-2、NF、GFAP与对照组比较有统计学意义(P0.05)。大鼠运动功能较移植前有所改善。结论MSCs经脊髓匀浆上清诱导后移植治疗大鼠半横断脊髓损伤可使运动功能得到改善。     

Mesenchymal Stem Cells in the Treatment of Human Spinal Cord Injury: The Effect on Individual Values of pNF-H,GFAP, S100 Proteins and Selected Growth Factors,Cytokines and Chemokines

At present, there is no effective way to treat the consequences of spinal cord injury (SCI). SCI leads to the death of neural and glial cells and widespread neuroinflammation with persisting for several weeks after the injury. Mesenchymal stem cells (MSCs) therapy is one of the most promising approaches in the treatment of this injury. The aim of this study was to characterize the expression profile of multiple cytokines, chemokines, growth factors, and so-called neuromarkers in the serum of an SCI patient treated with autologous bone marrow-derived MSCs (BM-MSCs). SCI resulted in a significant increase in the levels of neuromarkers and proteins involved in the inflammatory process. BM-MSCs administration resulted in significant changes in the levels of neuromarkers (S100, GFAP, and pNF-H) as well as changes in the expression of proteins and growth factors involved in the inflammatory response following SCI in the serum of a patient with traumatic SCI. Our preliminary results encouraged that BM-MSCs with their neuroprotective and immunomodulatory effects could affect the repair process after injury.     

移植BMMSCs-蚕丝蛋白生物支架对急性大鼠脊髓半切损伤修复的影响

目的:以蚕丝蛋白支架(silk fibroin porous scaffolds SFPS)接种骨髓基质干细胞(bone marrow mesenchymal stem cells,BMMSCs)移植入SD大鼠脊髓半切损伤模型内,观察BMMSCs-SFPS复合生物支架对损伤脊髓的修复作用.方法:密度梯度离心法提取、贴壁法培养BMMSCs,取第三代对数生长期细胞,采用注射法制备BMMSCs-SFPS复合支架,复合14天进行生物相容性检测.40只SD大鼠复制脊髓半切损伤模型后随机分配为四组(n=10):A组BMMSCs-SFPS联合移植、B组单独移植BMMSCs、C组单独移植SFPS、D组为空白对照组,移植后分别于1、2、3、4周进行运动功能评分和术后4周进行HE染色观察、免疫荧光检测.结果:BMMSCs-SFPS复合支架体外培养14天后,扫描电镜可见BMMSCs附于SFPS支架内表面生长,细胞贴附良好并互有接触.移植入脊髓半切损伤模型后4周进行HE染色,结果显示A组脊髓空洞较其余三组小,免疫荧光检测结果示A组NF200、Nestin阳性表达高于B、C、D组,A组GFAP表达则明显低于其余三组.A组术后2～4周Basso-Beattie-Bresnahan (BBB)评分均高于同期B、C、D组,比较差异有统计学意义(P＜0.01),D组评分明显低于同期其他3组,差异有统计学意义(P＜0.05).结论:BMMSCs-SPFS具有良好生物相容性,复合支架保证BMMSCs的存活数量、能抑制胶质瘢痕.BMMSCS-SFPS复合生物支架能发挥协同作用,促进脊髓半切损伤的大鼠运动功能恢复.     

炎性小体在诱导脊髓损伤神经炎症中的作用

脊髓损伤的治疗与康复一直是医学领域的重大难题,尤其是在改善损伤的神经功能方面进展甚微。继发性损伤是造成脊髓损伤后神经功能障碍的主要原因,炎症反应是继发性损伤阶段最重要的病理过程。急性期通过抑制神经炎症来减轻继发性损伤被认为可减轻神经功能损害而达到神经保护作用。炎性小体是一类蛋白质复合体,由模式识别受体中的NLRs家族和PHYIN家族的受体蛋白质作为主要框架组装并命名,常见的炎性小体包括NLRP1、NLRP3、NLRC4(IPAF)、AIM2等。在感染或受到损伤刺激时,炎性小体在细胞质内组装,并激活促炎症蛋白酶胱天蛋白酶1(caspase-1),活化的胱天蛋白酶1一方面促进促炎症细胞因子IL-1β和IL-18的前体成熟和分泌,另一方面介导细胞焦亡。细胞焦亡以细胞肿胀破裂并释放细胞内容物为特征,是在炎症和应激的病理条件下诱导的程序性细胞死亡方式。促炎症细胞因子和焦亡释放的胞内物质都可作为促炎信号引发炎症反应。近期发现,炎性小体通过诱导促炎因子释放以及介导细胞焦亡等途径, 参与激活脊髓损伤后的炎症级联反应,加重继发性神经炎症。靶向抑制炎性小体的激活可减轻炎症反应,促进神经细胞存活,达到神经保护作用。因此,炎性小体有望成为脊髓损伤治疗的新靶点。本文拟从炎性小体的结构及其在脊髓损伤中的作用、激活机制和治疗前景进行综述,以期为后续研究提供思路。     

脊髓损伤治疗中的细胞移植策略及预处理研究进展

急性脊髓损伤是骨科常见的严重疾患,伤后神经功能恢复及重建是近年来研究的热点,其中细胞移植的研究得到广泛的关注并取得较大的研究进展。本文介绍了细胞移植治疗脊髓损伤治疗的研究现状,其中对移植细胞的来源,移植的时机,移植的途径以及细胞移植存活的问题及应对策略做了重点阐述。同时对增加移植细胞存活率的预处理方法做了简要综述。     

A Radio-telemetric System to Monitor Cardiovascular Function in Rats with Spinal Cord Transection and Embryonic Neural Stem Cell Grafts

High thoracic or cervical spinal cord injury (SCI) can lead to cardiovascular dysfunction. To monitor cardiovascular parameters, we implanted a catheter connected to a radio transmitter into the femoral artery of rats that underwent a T4 spinal cord transection with or without grafting of embryonic brainstem-derived neural stem cells expressing green fluorescent protein. Compared to other methods such as cannula insertion or tail-cuff, telemetry is advantageous to continuously monitor blood pressure and heart rate in freely moving animals. It is also capable of long term multiple data acquisitions. In spinal cord injured rats, basal cardiovascular data under unrestrained condition and autonomic dysreflexia in response to colorectal distension were successfully recorded. In addition, cardiovascular parameters before and after SCI can be compared in the same rat if a transmitter is implanted before a spinal cord transection. One limitation of the described telemetry procedure is that implantation in the femoral artery may influence the blood supply to the ipsilateral hindlimb.     

MicroRNAs参与调控中枢神经系统的发育及脊髓损伤修复

microRNAs（miRNAs）不仅参与神经系统的生长发育、功能完善,还参与脊髓损伤病理及损伤后修复过程。miRNAs能使中枢神经系统按正确的时序性和空间性顺序进行发育和分化,在维持生物体记忆及生物钟方面起着重要作用。miRNAs异常表达同脊髓损伤病理过程相关。目前,体内及体外实验均已证实,miRNAs不仅能够维持神经干细胞增殖,而且可以促进神经元轴突伸长,从而为脊髓损伤的治疗带来新的治疗策略。     

Novel Therapeutic Effects in Rat Spinal Cord Injuries: Recovery of the Definitive and Early Spinal Cord Injury by the Administration of Pentadecapeptide BPC 157 Therapy

Recently, marked therapeutic effects pertaining to the recovery of injured rat spinal cords (1 min compression injury of the sacrocaudal spinal cord (S2-Co1) resulting in tail paralysis) appeared after a single intraperitoneal administration of the stable gastric pentadecapeptide BPC 157 at 10 min post-injury. Besides the demonstrated rapid and sustained recovery (1 year), we showed the particular points of the immediate effect of the BPC 157 therapy that began rapidly after its administration, (i) soon after injury (10 min), or (ii) later (4 days), in the rats with a definitive spinal cord injury. Specifically, in counteracting spinal cord hematoma and swelling, (i) in rats that had undergone acute spinal cord injury, followed by intraperitoneal BPC 157 application at 10 min, we focused on the first 10–30 min post-injury period (assessment of gross, microscopic, and gene expression changes). Taking day 4 post-injury as the definitive injury, (ii) we focused on the immediate effects after the BPC 157 intragastric application over 20 min of the post-therapy period. Comparable long-time recovery was noted in treated rats which had definitive tail paralysis: (iii) the therapy was continuously given per orally in drinking water, beginning at day 4 after injury and lasting one month after injury. BPC 157 rats presented only discrete edema and minimal hemorrhage and increased Nos1, Nos2, and Nos3 values (30 min post-injury, (i)) or only mild hemorrhage, and only discrete vacuolation of tissue (day 4, (ii)). In the day 4–30 post-injury study (iii), BPC 157 rats rapidly presented tail function recovery, and no demyelination process (Luxol fast blue staining).     

胎鼠脊髓源性神经干细胞分离培养与鉴定

目的:研究胎鼠的脊髓源性神经干细胞的分离培养方法并观察其增殖和分化能力。方法:利用显微操作技术分离获得胎鼠脊髓组织、无血清培养技术和酶消化法结合机械法传代培养神经干细胞、免疫细胞化学方法鉴定神经干细胞和分化情况。结果:建立了胎鼠脊髓源性神经干细胞的分离、培养和鉴定的方法,观察到了脊髓源性神经干细胞具有较强的增殖能力,在添加有5ng／mlEGF和5ng／mlbFGF的无血清培养液中可贴壁分化为神经元、少突细胞和星形胶质细胞。结论:在体外培养条件下分离培养的胎鼠脊髓源性神经干细胞具有干细胞的特性即较强的增殖能力和多向分化潜能。     

大鼠放射性脊髓损伤脊髓血流量变化规律

目的:放射性脊髓损伤(Radiation spinal cord injury,RSCI)是头颈部、胸部及上腹部肿瘤放射治疗和射线意外照射时的常见并发症,一般认为,白质坏死、脱髓鞘为其主要的病理学变化.然而,越来越多的证据表明血-脊髓屏障破裂和血管通透性增加等血管损伤远早于白质坏死和脱髓鞘改变.所以本文阐明大鼠放射性脊髓损伤病理生理过程中脊髓血流量变化规律.方法:将60只Sprague-Dawley (SD)大鼠随机分为12组,1组为对照,其余11组采用60Co放射治疗机行30 Gy大鼠颈髓C2-T2单次照射,剂量率为153 cGy/min,源皮距为80 cm,照射时长为1153 s,照射范围为2.0× 1.0 cm,对照组大鼠于麻醉后置于60Co放射治疗机下,佯照,照射前及照射后分别采用激光多普勒法测量脊髓血流量,11组大鼠于照射前以及照射后1、3、7、14、21、30、60、90、120、150、180天进行测量,以照射前测量值为基数,各时间点以基数的百分比表示该时间点脊髓血流量.结果:大鼠放射性脊髓损伤后,脊髓血流量在照射早期即有降低,照射后90天达到最低,随后脊髓血流量进入平台期.结论:阐明了大鼠放射性脊髓损伤后脊髓血流量的变化规律.大鼠放射性脊髓损伤可影响脊髓血流量,导致脊髓长期处于持续低灌流、缺血缺氧状态,最终导致脊髓不可逆性损伤.临床上放射性脊髓损伤的病人感到疲乏无力,出现神经系统的症状体征,通常死于脑疝.本文为临床上疲乏无力,出现神经系统的症状体征,死于脑疝放射性脊髓损伤的病人的早期防治提供病理生理基础.     

A Contusion Model of Severe Spinal Cord Injury in Rats

The translational potential of novel treatments should be investigated in severe spinal cord injury (SCI) contusion models. A detailed methodology is described to obtain a consistent model of severe SCI. Use of a stereotactic frame and computer controlled impactor allows for creation of reproducible injury. Hypothermia and urinary tract infection pose significant challenges in the post-operative period. Careful monitoring of animals with daily weight recording and bladder expression allows for early detection of post-operative complications. The functional results of this contusion model are equivalent to transection models. The contusion model can be utilized to evaluate the efficacy of both neuroprotective and neuroregenerative approaches.     

间充质干细胞-透明质酸-多聚赖氨酸治疗脊髓损伤的实验研究

目的研究间充质干细胞—透明质酸—多聚赖氨酸复合物治疗脊髓损伤的可行性,评价其治疗效果并探讨其可能机制。方法从人骨髓中分离、培养人骨髓间充质干细胞（human bone marrow mesenchymal stem cell,hBMSC）;制作大鼠脊髓半横断模型,按照实验分组分别将hBMSC、透明质酸-多聚赖氨酸（hyaluronic acid-poly-L-lysine,HA-PLL）、hBMSC-HA-PLL复合物注入损伤区域,单纯损伤组作为对照。术后按照不同时间点评价损伤和移植后的大鼠运动功能。8周后杀死大鼠,观察不同移植组体内轴突和血管生长的情况,对不同细胞、材料及复合物移植对大鼠脊髓损伤修复效果进行评估。结果 hBMSC移植组和hBMSC-HA-PLL移植组的大鼠运动功能的改善显著好于单纯损伤及HA-PLL移植组。电镜结果证实复合物移植组可显著促进轴突和血管生长,新生的轴突和血管结构较为完整。结论 hBMSC具有促进神经功能恢复的作用,将其与HA-PLL相结合,可以促进大鼠脊髓损伤修复,其机制可能包括材料框架作用和hBMSC在体内对大鼠神经细胞的营养作用以及促进微血管的生成。     

京尼平苷酸通过稳定微管促进脊髓损伤后轴突生长

脊髓损伤（spinal cord injury, SCI）是中枢神经系统最严重的创伤之一,其可造成患者感觉和运动功能障碍,并且引发一系列严重的并发症。促进轴突再生是修复脊髓损伤后功能恢复的关键因素。京尼平苷酸（geniposidic acid, GA）具有神经保护作用,但其在脊髓损伤后轴突生长的作用及机制方面尚未见报道。本研究通过提取原代神经元,并建立糖氧剥夺模型(oxygen glucose deprivation, OGD)。通过RT-PCR、Western印迹、免疫荧光等方法,探讨GA对神经元轴突的促进作用及其机制。结果发现,GA可以显著促进神经元轴突生长,并呈剂量依赖性。与OGD组神经元轴突长度（22±5.788 μm）相比,给予10 μmol/L的GA可使神经元轴突长度显著增加（68±17.73 μm）。同时,轴突生长相关蛋白（GAP43,MAP2）的基因和蛋白质水平都显著上升。不仅如此,我们发现,GA促进轴突生长与稳定神经元轴突微管相关,可使A/T的比值增加约1.5倍。同时,通过建立大鼠急性脊髓损伤模型评价GA在体内的效果,与对照组相比,每天腹腔注射GA（10 mg/kg）的大鼠在术后28 d的BBB评分（11.8分）和斜板试验（41.7°）均显著增高。上述结果表明,GA可能通过稳定微管从而促进轴突再生,最终促进脊髓损伤后运动功能的恢复。因此,GA 可能成为治疗脊髓损伤的有前景的候选药物。