干细胞来源外泌体在心肌损伤修复中的作用

目前普遍认为干细胞在心肌损伤修复中的旁分泌作用是其发挥疗效的重要途径之一。外泌体是旁分泌的重要介质,是由细胞分泌的具有磷脂双分子层结构的囊性小泡,可以转运蛋白质、脂质和核酸分子到受体细胞,介导生理和病理条件下细胞间通讯。多种干细胞,包括胚胎干细胞、诱导多能干细胞、心脏祖细胞、间充质干细胞和心肌球细胞等来源的外泌体对受损心脏的保护作用已被广泛证实,其在心肌损伤修复中的治疗效果备受关注。本综述总结了目前关于不同干细胞来源的外泌体在心肌损伤修复研究中的最新进展,包括治疗潜力和作用机制。     

心肌梗死细胞治疗的临床试验进展

干细胞移植治疗心肌梗死已有10余年历史,目的在于增加支架介入或冠脉搭桥治疗基础上的获益。细胞种类的选择是决定疗效的关键,大致可分为"第一代"和"第二代"干细胞。"第一代"是谱系非选择性干细胞,分自体和异体,早期阳性结果居多,近年多为中性结果。"第二代"是纯化干细胞,通过细胞表面标记分选出特定细胞谱系,即心脏干细胞,进行定向分化,在II期临床试验中展现获益。另外,近来诱导多能干细胞i PSC成为研究热点。目前干细胞直接心肌再生的证据很少,越来越多的研究肯定其旁分泌作用。     

脂肪干细胞治疗心肌梗死的机制与新策略

介绍脂肪干细胞（ADSCs）治疗心肌梗死机制及用于提高心肌梗死治疗效果的新策略。广泛查阅近年关于ADSCs用于治疗心肌梗死的基础与临床实验研究文献,并进行整理、综合与分析。ADSCs移植治疗心肌梗死的机制研究取得了一定的进展,其机制主要包括分化为心肌细胞、参与梗死区血管形成、通过旁分泌功能改善梗死区微环境等。对ADSCs进行缺氧耐受预处理、使用新型生物材料、联合细胞因子以及药物等,可以大大提高移植细胞的存活率,促进细胞的增殖与分化,改善心肌梗死治疗效果,加快心脏功能的恢复。ADSCs可能通过多种机制发挥治疗心肌梗死的作用,进一步提高移植细胞成活率和性能稳定性是增加ADSCs治疗心肌梗死效果的关键。随着研究的不断深入,ADSCs可能为未来心肌梗死的临床治疗带来新的希望。     

胚胎干细胞的心脏应用

心肌梗死期间死亡的心肌细胞将由没有收缩功能的疤痕组织替代,因而极可能引起心力衰竭。对治疗心衰来说,修复死亡或损伤的心肌以及改善心功能仍面临着极大挑战。干细胞移植已在近年来的实验中用于修复损失的心肌。本文总结了近期在心肌损伤动物中实施胚胎干细胞移植的实验结果,并着重介绍对这类特定细胞的研究进展。胚胎干细胞取源于早期哺乳类胚胎的胚芽细胞,属于多功能干细胞。这类细胞具有长期增殖而不分化的能力,或台色够在培养过程中分化成包括心肌细胞在内的所有特殊体细胞。由于胚胎干细胞具有极大的增殖和分化为成熟组织的能力,它们可能成为一种潜在的很有实用价值的细胞来源,可用于对病态心脏的功能心肌再生的细胞治疗。新近的研究表明,在心肌梗死动物模型中,心肌内移植胚胎干细胞或由其分化成的心肌样细胞,能导致已损伤心肌的再生,并改善心脏功能。另外,在病毒性心肌炎小鼠中,静脉输入胚胎干细胞可明显提高生存率和减轻心肌损伤。有关人类胚胎干细胞在体外分化成心肌细胞以及这些细胞的特性,近来已有报道。然而,要在临床能应用人类胚胎干细胞或由其分化成的心肌细胞来治疗晚期心脏疾病,还必须越过大量的伦理、法律和科学上的障碍。     

间充质干细胞的生物学特性及心血管修复潜能的研究进展

间充质干细胞存在于成体组织中,来源于骨髓、脂肪组织等,在体外易分离和培养,是具有塑料粘附性的一群非均质细胞。它们具有分化的潜能,在适当的条件下可分化为心肌和血管。临床前期研究显示,在心脏损伤模型中移植间充质干细胞有利于心肌修复和心血管形成。其作用机制与间充质干细胞再生和旁分泌能力密切相关。在临床应用中,间充质干细胞具有免疫抑制作用,也可用于异体移植。总之,虽然间充质干细胞的研究尚有许多问题亟待解决,但是它在心脏疾病的细胞治疗和组织工程中已显示出广阔的前景。     

有氧运动与干细胞动员的缺血心脏血管新生研究进展

有氧运动具有明确的血管新生效应,包括缺血心脏,但其机制尚未完全阐明。心肌梗死(MI)后冠脉微血管新生是心脏修复的前提。新近研究表明,血管新生来源于体内干/祖细胞的动员与参与,并以旁分泌效应影响内皮细胞(EC)功能及微血管分布效果,运动可以动员、激活内源性干细胞因子和血管生成因子的表达与分泌,并能从表观遗传学角度影响心脏血管新生。探索不同运动方式及强度对缺血心脏血管新生的作用及其分子机制,对缺血心脏的预防及术后康复具有重要意义。本文从心脏血管新生及其调控机制、自体干细胞动员参与缺血心脏的血管新生和运动通过干细胞动员促进缺血心脏血管新生等方面综述运动促进缺血心脏血管新生的主要机制、存在问题及相关研究进展。     

有氧运动与干细胞动员的心肌细胞增殖研究进展

适宜运动是防治心脏疾病的有效方式,其作用机制尚未完全阐明,安全有效的运动处方需要系统研究。运动可使正常心肌细胞发生生理性肥大与增殖以及多种细胞因子的分泌和干细胞的有效动员,促进心肌细胞增殖分化。成体心肌细胞增殖的来源包括存活的心肌细胞、心肌干/祖细胞以及外周的骨髓间充质干细胞等。干细胞的动员、趋化归巢并分化为心肌细胞是心肌损伤修复的细胞基础。本文从心肌细胞增殖潜力、心肌梗死(MI)的干细胞治疗和运动促进MI心肌细胞增殖等三个方面综述运动促进干细胞动员,诱导内源性心肌细胞再生对MI心肌修复和心功能改善的可能机制、存在问题及相关研究进展。     

心肌干细胞与心脏再生的研究进展及展望

以心肌梗死为代表的心血管疾病是目前世界上的主要致死疾病,它是由于心脏的主要功能细胞——心肌细胞的大量死亡造成的,因此如何再生心肌细胞从而促进心脏再生是心脏领域急需解决的一个重要科学问题.寻找能够分化形成心肌细胞的干细胞——心肌干细胞来再生心脏成为近20年来研究的热点问题.近年来,多种类型的干细胞,如c-Kit~+, Sca1~+, Abcg2~+, Bmi1~+等干细胞被报道是内源性的成体心肌干细胞,其中以"c-Kit~+心肌干细胞"的相关研究最为广泛,众多基础研究和临床试验纷纷展开.然而近年来,随着体内遗传谱系示踪技术的发展,越来越多的实验结果表明,成年哺乳动物心脏缺乏具有生物学意义的内源性心肌干细胞.本文主要介绍了成体心肌干细胞的相关研究,并展望了今后心脏再生策略的发展方向.     

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。     

心脏内肾素-血管紧张素系统

由于肾素、血管紧张素及血管紧张素受体在心脏及心肌细胞内的检出,有充分证据说明心脏内存在肾素-血管紧张素系统(R-AS)。心脏内R-AS可能通过心脏神经的旁分泌(paracrine)功能或直接对心肌细胞的自分泌功能(autocrine function)调节心肌收缩力;心脏内R-AS的内分泌功能(intracrine role)对心肌细胞内肾素系统的调节和心脏肥厚的发生可能起着重要作用。     

Pluripotent stem cell‐based heart regeneration: From the developmental and immunological perspectives

Heart diseases such as myocardial infarction cause massive loss of cardiomyocytes, but the human heart lacks the innate ability to regenerate. In the adult mammalian heart, a resident progenitor cell population, termed epicardial progenitors, has been identified and reported to stay quiescent under uninjured conditions; however, myocardial infarction induces their proliferation and de novo differentiation into cardiac cells. It is conceivable to develop novel therapeutic approaches for myocardial repair by targeting such expandable sources of cardiac progenitors, thereby giving rise to new muscle and vasculatures. Human pluripotent stem cells such as embryonic stem cells and induced pluripotent stem cells can self‐renew and differentiate into the three major cell types of the heart, namely cardiomyocytes, smooth muscle, and endothelial cells. In this review, we describe our current knowledge of the therapeutic potential and challenges associated with the use of pluripotent stem cell and progenitor biology in cell therapy. An emphasis is placed on the contribution of paracrine factors in the growth of myocardium and neovascularization as well as the role of immunogenicity in cell survival and engraftment. (Part C) 96:98–107, 2012. © 2012 Wiley Periodicals, Inc.     

Stem cell therapy: A novel approach for myocardial infarction

Myocardial infarction (MI) is a major cause of morbidity and mortality worldwide. Until recently, it was thought that myocardium was not able to repair itself, but studies have now shown that resident cardiac stem cells have regenerative capacity, and stem cell therapy may be a novel approach for cardiac muscle repair and regeneration. Stem cell-derived paracrine factors have been shown to regulate ventricular remodeling, inflammation, apoptosis, cardiomyocytes regeneration, and neovascularization in regions of infarcted cardiac tissue. In this review, we summarize the evidence from cellular, animal, and clinical studies supporting the potential clinical significance of stem cell therapy as a novel therapeutic approach for the treatment of MI.     

Stem cell-derived exosomes as a therapeutic tool for cardiovascular disease

Mesenchymal stem cells(MSCs) have been used to treat patients suffering from acute myocardial infarction(AMI) and subsequent heart failure. Although it was originally assumed that MSCs differentiated into heart cells such as cardiomyocytes, recent evidence suggests that the differentiation capacity of MSCs is minimal and that injected MSCs restore cardiac function via the secretion of paracrine factors. MSCs secrete paracrine factors in not only naked forms but also membrane vesicles including exosomes containing bioactive substances such as proteins, messenger RNAs, and microR NAs. Although the details remain unclear, these bioactive molecules are selectively sorted in exosomes that are then released from donor cells in a regulated manner. Furthermore, exosomes are specifically internalized by recipient cells via ligand-receptor interactions. Thus, exosomes are promising natural vehicles that stably and specifically transport bioactive molecules to recipient cells. Indeed, stem cell-derived exosomes have been successfully used to treat cardiovascular disease(CVD), such as AMI, stroke, and pulmonary hypertension, in animal models, and their efficacy has been demonstrated. Therefore, exosome administration may be a promising strategy for the treatment of CVD. Furthermore, modifications of exosomal contents may enhance their therapeutic effects. Future clinical studies are required to confirm the efficacy of exosome treatment for CVD.     

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.     

Stem cells as therapy for cardiac disease - a review

Acute myocardial infarction (AMI) is one of the most significant causes of morbidity and mortality worldwide. Stem cells represent an enormous chance to rebuild damaged heart tissue. Correct definition of the cardiac progenitors is necessary to understand heart development, and would pave the way for the use of cardiac progenitors in the treatment of heart disease. Identifying, purifying and differentiating native cardiac progenitor cells are indispensable if we are to overcome congenital and adult cardiac diseases. To understand their functions, physiology and action, cells are tested in animal models, and then in clinical trials. But because clinical trials yield variable results, questions about proper cardiac stem cells remain unanswered. Transplanted stem cells release soluble factors, acting in a paracrine fashion, which contributes to cardiac regeneration. Cytokines and growth factors have cytoprotective and neovascularizing functions, and may activate resident cardiac stem cells. Understanding all these mechanisms is crucial to overcoming heart diseases.     

Mesenchymal stem cell therapy: A promising cell‐based therapy for treatment of myocardial infarction

For decades, mesenchymal stem (MSCs) cells have been used for cardiovascular diseases as regenerative therapy. This review is an attempt to summarize the types of MSCs involved in myocardial infarction (MI) therapy, as well as its possible mechanisms effects, especially the paracrine one in MI focusing on the studies (human and animal) conducted within the last 10 years. Recently, reports showed that MSC therapy could have infarct‐limiting effects after MI in both experimental and clinical trials. In this context, various types of MSCs can help cardiac regeneration by either revitalizing the cardiac stem cells or revascularizing the arteries and veins of the heart. Furthermore, MSCs could produce paracrine growth factors that increase the survival of nearby cardiomyocytes, as well as increase angiogenesis through recruitment of stem cell from bone marrow or inducing vessel growth from existing capillaries. Recent research suggests that the paracrine effects of MSCs could be mediated by extracellular vesicles including exosomes. Exosomal microRNAs (miRNAs) released by MSCs are promising therapeutic hotspot target for MI. This could be attributed to the role of miRNA in cardiac biology, including cardiac regeneration, stem cell differentiation, apoptosis, neovascularization, cardiac contractility and cardiac remodeling. Furthermore, gene‐modified MSCs could be a recent promising therapy for MI to enhance the paracrine effects of MSCs, including better homing and effective cell targeted tissue regeneration. Although MSC therapy has achieved considerable attention and progress, there are critical challenges that remains to be overcome to achieve the most effective successful cell‐based therapy in MI.     

VEGF is critical for stem cell-mediated cardioprotection and a crucial paracrine factor for defining the age threshold in adult and neonatal stem cell function

Bone marrow mesenchymal stem cells (MSCs) may be a novel treatment modality for organ ischemia, possibly through the release of beneficial paracrine factors. However, an age threshold likely exists as to when MSCs gain their beneficial protective properties. We hypothesized that 1) VEGF would be a crucial stem cell paracrine mediator in providing postischemic myocardial protection and 2) small-interfering (si)RNA ablation of VEGF in adult MSCs (aMSCs) would equalize the differences observed between aMSC- and neonatal stem cell (nMSC)-mediated cardioprotection. Female adult Sprague-Dawley rat hearts were subjected to ischemia-reperfusion injury via Langendorff-isolated heart preparation (15 min equilibration, 25 min ischemia, and 60 min reperfusion). MSCs were harvested from adult and 2.5-wk-old neonatal mice and cultured under normal conditions. VEGF was knocked down in both cell lines by VEGF siRNA. Immediately before ischemia, one million aMSCs or nMSCs with or without VEGF knockdown were infused into the coronary circulation. The cardiac functional parameters were recorded. VEGF in cell supernatants was measured via ELISA. aMSCs produced significantly more VEGF than nMSCs and were noted to increase postischemic myocardial recovery compared with nMSCs. The knockdown of VEGF significantly decreased VEGF production in both cell lines, and the pretreatment of these cells impaired stem cell-mediated myocardial function. The knockdown of VEGF in adult stem cells equalized the myocardial functional differences observed between adult and neonatal stem cells. Therefore, VEGF is a critical paracrine mediator in facilitating postischemic myocardial recovery and likely plays a role in mediating the observed age threshold during stem cell therapy.     

Myocardial regeneration potential of adipose tissue-derived stem cells

Various tissue resident stem cells are receiving attention from basic scientists and clinicians as they hold promise for myocardial regeneration. For practical reasons, adipose tissue-derived stem cells (ASCs) are attractive cells for clinical application in repairing damaged myocardium based on the following advantages: abundant adipose tissue in most patients and easy accessibility with minimally invasive lipoaspiration procedure. Several recent studies have demonstrated that both cultured and freshly isolated ASCs could improve cardiac function in animal model of myocardial infarction. The mechanisms underlying the beneficial effect of ASCs on myocardial regeneration are not fully understood. Growing evidence indicates that transplantation of ASCs improve cardiac function via the differentiation into cardiomyocytes and vascular cells, and through paracrine pathways. Paracrine factors secreted by injected ASCs enhance angiogenesis, reduce cell apoptosis rates, and promote neuron sprouts in damaged myocardium. In addition, Injection of ASCs increases electrical stability of the injured heart. Furthermore, there are no reported cases of arrhythmia or tumorigenesis in any studies regarding myocardial regeneration with ASCs. This review summarizes the characteristics of both cultured and freshly isolated stem cells obtained from adipose tissue, their myocardial regeneration potential, and the underlying mechanisms for beneficial effect on cardiac function, and safety issues.     

How do resident stem cells repair the damaged myocardium?

It has been a decade since the monumental discovery of resident stem cells in the mammalian heart, and the following studies witnessed the continuous turnover of cardiomyocytes and vascular cells, maintaining the homeostasis of the organ. Recently, the autologous administration of c-kit-positive cardiac stem cells in patients with ischemic heart failure has led to an incredible outcome; the left ventricular ejection fraction of the celltreated group improved from 30% at the baseline to 38% after one year and to 42% after two years of cell injection. The potential underlying mechanisms, before and after cell infusion, are explored and discussed in this article. Some of them are related to the intrinsic property of the resident stem cells, such as direct differentiation, paracrine action, and immunomodulatory function, whereas others involve environmental factors, leading to cellular reverse remodeling and to the natural selection of "juvenile" cells. It has now been demonstrated that cardiac stem cells for therapeutic purposes can be prepared from tiny biopsied specimens of the failing heart as well as from frozen tissues, which may remarkably expand the repertoire of the strategy against various cardiovascular disorders, including non-ischemic cardiomyopathy and congenital heart diseases. Further translational investigations are needed to explore these possibilities.     

Activation of Cardiac Stem Cells in Myocardial Infarction

The development of heart failure caused by acute myocardial infarction is accompanied by massive necrotic death of cardiomyocytes in lesion areas and subsequent pathological myocardial remodeling. Traditionally, the possibility of heart reparation has been considered to be severely limited or absent in the postnatal period. Endogenous cardiac stem cells with a regenerative potential have recently been described, but the mechanisms of activation of these cells remain poorly understood. The aim of our work was to obtain cardiac stem cells from the ischemic area of the myocardium and compare their functional properties with stem cells isolated from the healthy area of the myocardium. RT-PCR was used to quantify the gene expression in cardiac stem cells. In addition, differentiated cells were stained for specific markers using immunocytochemical method. Cardiac stem cells originating from the infarction area had a higher proliferative potential and a greater propensity to migrate in comparison to the cells originated from a healthy myocardial area. The expression level of several specific markers of cardiogenic, osteogenic and adipogenic differentiation upon induction of corresponding differentiation was higher in the cells from the infarction area than in cells from the healthy myocardium. We conclude that myocardial ischemia activates the internal regenerative potential of cardiac stem cells.