Nishino H, Borlongan C V
Department of Physiology, Nagoya City University Medical School, Nagoya 467-8601, Japan.
Prog Brain Res. 2000;127:461-76. doi: 10.1016/s0079-6123(00)27022-2.
Stroke remains a major brain disorder that often renders patients severely impaired and permanently disabled. There is no available treatment for reversing these deficits. Hippocampal, striatal and cortical grafting studies demonstrate that fetal cells/tissues, immortalized cells, and engineered cell lines can survive grafting into the ischemic adult brain, correct neurotransmitter release, establish both afferent and efferent connections with the host brain, and restore functional and cognitive deficits in specific models of stroke. The success of neural transplantation depends on several factors: the stroke model (location, extent, and degree of infarction), the donor cell viability and survival at pre- and post-transplantation, and the surgical technique, among others. Further exploitation of knowledge of neural transplantation therapy already available from our experience in treating Parkinson's disease needs to be critically considered for stroke therapy. While the consensus is to create a functional neuronal circuitry in the damaged host brain, there is growing evidence that trophic action of the grafts and host, as well as exogenous application of trophic factors may facilitate functional recovery in stroke. Current treatment modules, specifically that of rehabilitative medicine, should also be explored with neural transplantation therapy. However, validation of neural transplantation and any other treatment for stroke should be critically assessed in laboratory experiments and limited clinical trials. No direct treatment is recognized as safe and effective for reversing the stroke-induced brain damage and functional/cognitive deficits. The first clinical trial of neural transplantation in stroke patients is a mile-stone in stroke therapy, but subsequent large-scale trials should be approached with caution.
中风仍然是一种主要的脑部疾病，常常使患者严重受损并永久致残。目前尚无能够逆转这些缺陷的治疗方法。海马体、纹状体和皮质移植研究表明，胎儿细胞/组织、永生化细胞和工程细胞系能够在移植到缺血性成年大脑后存活，纠正神经递质释放，与宿主大脑建立传入和传出连接，并在特定的中风模型中恢复功能和认知缺陷。神经移植的成功取决于几个因素：中风模型（梗死的位置、范围和程度）、供体细胞在移植前后的活力和存活率以及手术技术等。对于中风治疗，需要审慎考虑进一步利用我们在治疗帕金森病方面已有的神经移植治疗知识。虽然共识是在受损的宿主大脑中创建功能性神经元回路，但越来越多的证据表明，移植体和宿主的营养作用以及外源性应用营养因子可能有助于中风后的功能恢复。当前的治疗模式，特别是康复医学的治疗模式，也应该与神经移植治疗相结合进行探索。然而，神经移植以及任何其他中风治疗方法的有效性都应该在实验室实验和有限的临床试验中进行严格评估。目前尚无被认可的安全有效的直接治疗方法来逆转中风引起的脑损伤以及功能/认知缺陷。中风患者神经移植的首次临床试验是中风治疗的一个里程碑，但后续的大规模试验应谨慎进行。
