干祖细胞与缺血性心脏病治疗北大核心CSCD

最近十几年,多种类型的干细胞,包括胚胎干细胞、诱导多能干细胞、骨骼肌干细胞、心脏干细胞和骨髓来源的干祖细胞等,可用于缺血性心脏病诱导的损伤修复和再生医学中,并且逐渐显示出广阔的发展前景。在此本文将介绍几种不同来源的干细胞在治疗缺血性心脏病中的研究概况,为进一步的基础研究和临床试验提供参考。     

诱导骨髓间充质干细胞向心肌细胞分化研究进展

骨髓间充质干细胞(one marrow mesenchymal stem cells, BMSCs)是骨髓内的一类非造血干细胞,具有自我更新和多向分化的潜能。心肌细胞本身不能再生,受损伤的心肌细胞无法通过自身的增殖和分化完成修复。BMSCs在体内外不同的诱导条件下可分化为心肌细胞,应用于缺血性心脏病的治疗,是目前心肌再生治疗的理想种子细胞。本文主要从外界干预诱导、缺氧条件影响、基因转染、临床自体移植方面将近年诱导BMSCs向心肌细胞分化的研究进行综述,以期为今后临床应用BMSCs治疗心肌梗死等心脏疾病提供理论依据。     

脂肪来源间充质干细胞体外定向诱导分化血管细胞的研究进展

脂肪来源的间充质干细胞具有较强的体外增殖能力,因具有生物学特性稳定、来源充足、体外培养条件低等优势已引起各国学者的关注。脂肪间充质干细胞凭借其多向分化潜能,是人体干细胞库潜在的重要来源之一。目前,研究人员已成功地在体外将其诱导为内皮细胞,成骨细胞、成软骨细胞、脂肪前体细胞、平滑肌细胞,心肌细胞、神经样细胞等。就脂肪来源的间充质干细胞体外定向诱导分化血管细胞的研究进展作一综述。     

间充质干细胞源性外泌体microRNA在心脏缺血性损伤修复中的研究进展

心脏缺血性损伤是危害人类健康的重要原因,过去的干细胞疗法具有重要的功能缺陷,如免疫排斥、致瘤性和输注毒性等问题。大量研究表明,间充质干细胞的主要治疗作用是由旁分泌因子所介导。最新研究发现,间充质干细胞来源的外泌体microRNA从移植的干细胞转移至缺血损伤的心脏细胞,调节细胞的增殖、凋亡、炎症和血管生成。本文对来源于间充质干细胞的外泌体及其内部microRNA在心脏缺血性损伤修复中的分子机制进行综述。     

胰高血糖素样肽1与干细胞定向分化

糖尿病已经成为21世纪严重威胁人类健康的疾病之一。胰岛移植被认为是治疗Ⅰ型和部分Ⅱ型糖尿病的最有效方法。然而,供体组织来源的匮乏限制了其应用。随着细胞移植和组织工程的日益发展,干细胞研究为新型胰岛的来源开辟了新的途径。干细胞定向诱导分化的关键是筛选合适的诱导剂以及优化诱导微环境,使干细胞培养微环境尽可能接近体内正常细胞发育分化的微环境,从而有利于干细胞适宜生长及定向分化。最近研究证实,胰高血糖素样肽1（Glucagon- Like PeptideⅠ,GLP-1）在干细胞向胰岛样细胞诱导分化中具有显著作用。因此,为了更好地应用GLP-1在干细胞定向分化中的潜能、促进应用干细胞治疗糖尿病新疗法研究的进程及干细胞定向分化技术逐渐成熟,本文就胰高血糖素样肽-1及它诱导干细胞定向分化胰岛样细胞的研究进展作一阐述。     

心脏干细胞研究新进展

随着近年干细胞的研究发展,心脏中心脏干细胞(CSCs)被证实存在,并发现CSCs具有自我更新及多向分化能力,负责维持心脏内环境稳态,许多学者已经从CSCs着手研究治疗终末期心脏病的新途径。本文就CSCs以及其为基础的心脏病治疗进展作一综述,尤其对中药诱导CSCs在治疗心脏病中的前景进行展望。     

人胚胎干细胞向神经上皮祖细胞的诱导分化

人胚胎干细胞具有自我更新和多向分化潜能,是研究早期胚胎发育和细胞替代治疗的重要细胞来源.采用一种与小鼠成纤维细胞共培养的方法进行人胚胎干细胞的神经诱导,可产生高纯度的神经上皮祖细胞,其神经上皮特异性基因的表达有一定的时空性;诱导生成的神经上皮祖细胞具有增殖潜能并可分化为神经元和星型胶质细胞,是潜在的神经干细胞.人胚胎干细胞来源的神经上皮祖细胞为研究神经发育和神经诱导提供了新材料,也为神经系统疾病的细胞替代治疗提供了新的细胞来源.     

体细胞直接转化为多能干细胞的新方法

胚胎干细胞具有自我复制、高度增殖、多向分化潜能、可植入性和重建能力等特征.对于诸如青少年糖尿病、帕金森综合症和心脏病等需要通过细胞移植来治疗的疾病而言,从人的囊胚内细胞团获得胚胎干细胞系是最理想的供体来源.然而,目前实验和医疗还要考虑到利用人类胚胎的一些伦理问题和组织排异反应.避免这些问题的可能途径就是通过已分化体细胞的重新编程来直接转化为诱导性多能干细胞,它们具有类似ES细胞的功能.目前,获得诱导性多能干细胞的设想已初步实现了从老鼠到人的突破.以下主要对体细胞直接转化为诱导性多能干细胞的研究现状、方法和转录因子在诱导体细胞重新编程中发挥的作用等内容进行了概述,以期为干细胞研究者进行更深入的研究提供一定的借鉴.     

干细胞体外定向分化为雌性生殖细胞的研究进展

如今女性卵子不足所致不孕的患者日渐增多,却尚无治愈的方法。干细胞作为高度未分化的细胞,其体外定向分化为雌性生殖细胞为治疗这类不孕患者提供了新途径。随着干细胞的研究不断发展,不同来源的干细胞诱导生成雌性生殖细胞的研究也越来越多,目前研究者们能够在体外条件下获得类卵母样细胞,不过其诱导的机制、生物学功能仍需进一步研究探讨。本文对不同来源的干细胞体外定向分化为雌性生殖细胞的研究进行综述,以期为从事该方面的研究者提供一定的借鉴帮助。     

干细胞诱导分化为产胰岛素细胞的研究进展

I型糖尿病(胰岛素依赖型糖尿病)主要是由于自身免疫反应导致胰岛β细胞损伤所致。目前,临床上主要通过口服降糖药物和胰岛素替代疗法等内科措施治疗I型糖尿病,但只能延缓疾病的发展,并不能彻底治愈。迄今为止,已有研究报道利用胚胎干细胞和成体干细胞成功诱导分化为产胰岛素细胞(IPCs),这给I型糖尿病的治疗带来了新的希望。从干细胞诱导成IPCs的诱导方法都是多阶段的,因干细胞来源不同,诱导所需时间从几天到几个月差异很大,不同诱导方法中所用诱导因子也有所不同,主要包括表皮生长因子、碱性成纤维细胞生长因子、激活素A、β细胞素、尼克酰胺、Exendin-4、肝细胞生长因子、胃泌素、葡萄糖和胎牛血清等。目前,尚无统一标准诱导方法可大量并稳定的获得IPCs,并使之分泌的胰岛素量可满足临床治疗。因此,在IPCs临床应用前,关于来源干细胞的选择、诱导方法和诱导所需因子的选用仍需进一步深入探讨。本文主要就干细胞诱导分化为产胰岛素细胞的研究进展进行了综述。     

Molecular basis of functional myogenic specification of Bona Fide multipotent adult cardiac stem cells

Ischemic Heart Disease (IHD) remains the developed world’s number one killer. The improved survival from Acute Myocardial Infarction (AMI) and the progressive aging of western population brought to an increased incidence of chronic Heart Failure (HF), which assumed epidemic proportions nowadays. Except for heart transplantation, all treatments for HF should be considered palliative because none of the current therapies can reverse myocardial degeneration responsible for HF syndrome. To stop the HF epidemic will ultimately require protocols to reduce the progressive cardiomyocyte (CM) loss and to foster their regeneration. It is now generally accepted that mammalian CMs renew throughout life. However, this endogenous regenerative reservoir is insufficient to repair the extensive damage produced by AMI/IHD while the source and degree of CM turnover remains strongly disputed. Independent groups have convincingly shown that the adult myocardium harbors bona-fide tissue specific cardiac stem cells (CSCs). Unfortunately, recent reports have challenged the identity and the endogenous myogenic capacity of the c-kit expressing CSCs. This has hampered progress and unless this conflict is settled, clinical tests of repair/regenerative protocols are unlikely to provide convincing answers about their clinical potential. Here we review recent data that have eventually clarified the specific phenotypic identity of true multipotent CSCs. These cells when coaxed by embryonic cardiac morphogens undergo a precisely orchestrated myogenic commitment process robustly generating bona-fide functional cardiomyocytes. These data should set the path for the revival of further investigation untangling the regenerative biology of adult CSCs to harness their potential for HF prevention and treatment.     

The therapeutic potential of stem cells in heart disease

Abstract.  Coronary heart disease and chronic heart failure are common and have an increasing frequency. Although interventional and conventional drug therapy may delay ventricular remodelling, there is no basic therapeutic regime available for preventing or even reversing this process. Chronic coronary artery disease and heart failure impairs quality of life and are associated with subsequent worsening of the cardiac pump function. Numerous studies within the past few years have been demonstrated, that the intracoronary stem cell therapy has to be considered as a safe therapeutic procedure in heart disease, when destroyed and/or compromised heart muscle must be regenerated. This kind of cell therapy with autologous bone marrow cells is completely justified ethically, except for the small numbers of patients with direct or indirect bone marrow disease (e.g. myeloma, leukaemic infiltration) in whom there would be lesions of mononuclear cells. Several preclinical as well as clinical trials have shown that transplantation of autologous bone marrow cells or precursor cells improved cardiac function after myocardial infarction and in chronic coronary heart disease. The age of infarction seems to be irrelevant to regenerative potency of stem cells, since stem cells therapy in old infarctions (many years old) is almost equally effective in comparison to previous infarcts. Further indications are non-ischemic cardiomyopathy (dilative cardiomyopathy) and heart failure due to hypertensive heart disease.     

Mesenchymal stem cells from ischemic heart disease patients improve left ventricular function after acute myocardial infarction

Mesenchymal stem cells (MSCs) from healthy donors improve cardiac function in experimental acute myocardial infarction (AMI) models. However, little is known about the therapeutic capacity of human MSCs (hMSCs) from patients with ischemic heart disease (IHD). Therefore, the behavior of hMSCs from IHD patients in an immune-compromised mouse AMI model was studied. Enhanced green fluorescent protein-labeled hMSCs from IHD patients (hMSC group: 2 x 10(5) cells in 20 microl, n = 12) or vehicle only (medium group: n = 14) were injected into infarcted myocardium of NOD/scid mice. Sham-operated mice were used as the control (n = 10). Cardiac anatomy and function were serially assessed using 9.4-T magnetic resonance imaging (MRI); 2 wk after cell transplantation, immunohistological analysis was performed. At day 2, delayed-enhancement MRI showed no difference in myocardial infarction (MI) size between the hMSC and medium groups (33 +/- 2% vs. 36 +/- 2%; P = not significant). A comparable increase in left ventricular (LV) volume and decrease in ejection fraction (EF) was observed in both MI groups. However, at day 14, EF was higher in the hMSC than in the medium group (24 +/- 3% vs. 16 +/- 2%; P < 0.05). This was accompanied by increased vascularity and reduced thinning of the infarct scar. Engrafted hMSCs (4.1 +/- 0.3% of injected cells) expressed von Willebrand factor (16.9 +/- 2.7%) but no stringent cardiac or smooth muscle markers. hMSCs from patients with IHD engraft in infarcted mouse myocardium and preserve LV function 2 wk after AMI, potentially through an enhancement of scar vascularity and a reduction of wall thinning.     

Stem cell engineering for treatment of heart diseases: Potentials and challenges

Heart disorders are a major health concern worldwide responsible for millions of deaths every year. Among the many disorders of the heart, myocardial infarction, which can lead to the development of congestive heart failure, arrhythmias, or even death, has the most severe social and economic ramifications. Lack of sufficient available donor hearts for heart transplantation, the only currently viable treatment for heart failure other than medical management options (ACE inhibition, beta blockade, use of AICDs, etc.) that improve the survival of patients with heart failure emphasises the need for alternative therapies. One promising alternative replaces cardiac muscle damaged by myocardial infarction with new contractile cardiomyocytes and vessels obtained through stem cell-based regeneration.We report on the state of the art of recovery of cardiac functions by using stem cell engineering. Current research focuses on (a) inducing stem cells into becoming cardiac cells before or after injection into a host, (b) growing replacement heart tissue in vitro, and (c) stimulating the proliferation of the post-mitotic cardiomyocytes in situ. The most promising treatment option for patients is the engineering of new heart tissue that can be implanted into damaged areas. Engineering of cardiac tissue currently employs the use of co-culture of stem cells with scaffold microenvironments engineered to improve tissue survival and enhance differentiation. Growth of heart tissue in vitro using scaffolds, soluble collagen, and cell sheets has unique advantages. To compensate for the loss of ventricular mass and contractility of the injured cardiomyocytes, different stem cell populations have been extensively studied as potential sources of new cells to ameliorate the injured myocardium and eventually restore cardiac function. Unresolved issues including insufficient cell generation survival, growth, and differentiation have led to mixed results in preclinical and clinical studies. Addressing these limitations should ensure the successful production of replacement heart tissue to benefit cardiac patients.     

成体心脏干细胞经静脉移植后在心梗小鼠体内的分布研究

目的：观察心肌梗死小鼠静脉移植成体心脏干细胞后,细胞在小鼠体内各器官的分布情况。明确心梗后静脉移植成体心脏干 细胞在小鼠体内的分布和归巢情况。方法：分离培养小鼠心脏成体干细胞,采用流式细胞仪鉴定细胞,通过亲脂性染料CM-DiI标 记细胞后行小鼠急性心肌梗死模型建立和细胞移植,分别在细胞移植后7、14、8 天取小鼠心脏、肝脏、脑、脊髓、肺脏,行冰冻切 片,在荧光显微镜下观察移植细胞在各组织器官存活和分布情况。结果：成体心脏干细胞分离培养后呈贴壁生长,流式细胞仪检 测显示细胞纯度>80%。CM-DiI标记后荧光显微镜下观察可见标记的细胞胞浆胞核均被染成呈明亮的红色。心肌梗死后经静脉 移植成体心脏干细胞,细胞在各组织中分布呈变化过程,7 天时,在肺脏和肝脏分布较多,至14 天和28 天时,肺脏和肝脏分布减 少,心脏分布逐渐增多,表现出向心脏的" 归巢" 现象,而脑和脊髓在28 天的观察时间内分布较少。结论：采用CM-DiI标记心 脏成体干细胞,操作简单,标记效果好,可用于短期的细胞体内追踪。小鼠心肌梗死后行经静脉成体心脏干细胞移植,28 天后细胞 在心脏的分布逐渐增多,表现出向心脏的" 归巢" 现象。     

Cell therapy for ischaemic heart disease: focus on the role of resident cardiac stem cells

Myocardial infarction results in loss of cardiomyocytes, scar formation, ventricular remodelling, and eventually heart failure. In recent years, cell therapy has emerged as a potential new strategy for patients with ischaemic heart disease. This includes embryonic and bone marrow derived stem cells. Recent clinical studies showed ostensibly conflicting results of intracoronary infusion of autologous bone marrow derived stem cells in patients with acute or chronic myocardial infarction. Anyway, these results have stimulated additional clinical and pre-clinical studies to further enhance the beneficial effects of stem cell therapy. Recently, the existence of cardiac stem cells that reside in the heart itself was demonstrated. Their discovery has sparked intense hope for myocardial regeneration with cells that are obtained from the heart itself and are thereby inherently programmed to reconstitute cardiac tissue. These cells can be detected by several surface markers (e.g. c-kit, Sca-1, MDR1, Isl-1). Both in vitro and in vivo differentiation into cardiomyocytes, endothelial cells and vascular smooth muscle cells has been demonstrated, and animal studies showed promising results on improvement of left ventricular function. This review will discuss current views regarding the feasibility of cardiac repair, and focus on the potential role of the resident cardiac stem and progenitor cells. (Neth Heart J 2009;17:199–207.)     

Local activation of cardiac stem cells for post‐myocardial infarction cardiac repair

The prognosis of patients with myocardial infarction (MI) and resultant chronic heart failure remains extremely poor despite continuous advancements in optimal medical therapy and interventional procedures. Animal experiments and clinical trials using adult stem cell therapy following MI have shown a global improvement of myocardial function. The emergence of stem cell transplantation approaches has recently represented promising alternatives to stimulate myocardial regeneration. Regarding their tissue‐specific properties, cardiac stem cells (CSCs) residing within the heart have advantages over other stem cell types to be the best cell source for cell transplantation. However, time‐consuming and costly procedures to expanse cells prior to cell transplantation and the reliability of cell culture and expansion may both be major obstacles in the clinical application of CSC‐based transplantation therapy after MI. The recognition that the adult heart possesses endogenous CSCs that can regenerate cardiomyocytes and vascular cells has raised the unique therapeutic strategy to reconstitute dead myocardium via activating these cells post‐MI. Several strategies, such as growth factors, mircoRNAs and drugs, may be implemented to potentiate endogenous CSCs to repair infarcted heart without cell transplantation. Most molecular and cellular mechanism involved in the process of CSC‐based endogenous regeneration after MI is far from understanding. This article reviews current knowledge opening up the possibilities of cardiac repair through CSCs activation in situ in the setting of MI.     

脐血干细胞移植治疗缺血性心脏病的临床疗效及安全性分析

目的:探讨脐血干细胞移植治疗缺血性心脏病(IHD)的临床效果和安全性。方法:选择2011年1月至2013年1月在我院接受治疗的IHD患者130例。随机分为观察组和对照组,各65例。其中对照组应用常规药物治疗,观察组应用脐血干细胞移植方法进行治疗。观察对比两组患者治疗前以及治疗后3个月的左室舒张末容量(LVEDV)、右室舒张末容量(RVEDV)、左室射血分数(LVEF)及治疗后临床疗效及生活质量改善状况。结果:观察组治疗后显效率和总有效率为49.23%,90.77%,显著高于对照组的30.77%,70.77%,差异均有统计学意义(均P0.05)。两组在治疗前LVEDV、RVEDV以及LVEF比较无差异。在治疗后观察组这三个指标得到明显改善,其中LVEDV和RVEDV减小、LVEF提高均较对照组显著,差异均有统计学意义(均P0.05)。观察组在治疗后身体功能、运动限制和总体健康评分均高于对照组,差异均有统计学意义(均P0.05)。结论:应用脐血干细胞移植治疗IHD效果好,能显著改善心功能,提高生活质量,安全性高,值得临床使用。     

Repair mechanisms of bone marrow mesenchymal stem cells in myocardial infarction

The prognosis of patients with myocardial infarction (MI) and resultant chronic heart failure remains extremely poor despite advances in optimal medical therapy and interventional procedures. Animal experiments and clinical trials using adult stem cell therapy following MI have shown a global improvement of myocardial function. Bone marrow-derived mesenchymal stem cells (MSCs) hold promise for cardiac repair following MI, due to their multilineage, self-renewal and proliferation potential. In addition, MSCs can be easily isolated, expanded in culture, and have immunoprivileged properties to the host tissue. Experimental studies and clinical trials have revealed that MSCs not only differentiate into cardiomyocytes and vascular cells, but also secrete amounts of growth factors and cytokines which may mediate endogenous regeneration via activation of resident cardiac stem cells and other stem cells, as well as induce neovascularization, anti-inflammation, anti-apoptosis, anti-remodelling and cardiac contractility in a paracrine manner. It has also been postulated that the anti-arrhythmic and cardiac nerve sprouting potential of MSCs may contribute to their beneficial effects in cardiac repair. Most molecular and cellular mechanisms involved in the MSC-based therapy after MI are still unclear at present. This article reviews the potential repair mechanisms of MSCs in the setting of MI.