Penn Marc S, Francis Gary S, Ellis Stephen G, Young James B, McCarthy Patrick M, Topol Eric J
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Prog Cardiovasc Dis. 2002 Jul-Aug;45(1):21-32. doi: 10.1053/pcad.2002.123466.
Autologous cell transplantation for the treatment of damaged myocardium after myocardial infarction is becoming an increasingly promising strategy. This form of treatment can be divided into 2 treatment strategies: The first uses differentiated cell types to replace the scarred tissue with living cells, while the second strategy uses stem cells in an attempt to regenerate myocardium. Over the past decade, multiple cell types have been used in animal studies, and clinical trials to determine the safety of injecting and engrafting skeletal myoblasts into damaged myocardium are presently being conducted. Animals studies focused on using stem cells to regenerate damaged myocardium have shown a naturally occurring reparative process that consists of up-regulation of progenitor cell release from the bone marrow after myocardial infarction, homing of these cells to the injured tissue, and differentiation of these progenitor cells into vascular cells and cardiac myocytes within the infarcted tissue. Unfortunately, this process occurs with great infrequency. Strategies to regenerate myocardium with stem cells either extract stem cells from the bone marrow and inject these cells into the damaged area or they attempt to increase the efficiency of the natural reparative process by increasing the mobilization of bone marrow-derived stem cells after myocardial infarction. This review summarizes the field of cell transplantation over the past decade, discusses areas of controversy, and proposes an outline of advancements that need to be made in both the clinical and scientific arenas for autologous cell transplantation to fully reach its clinical potential.
自体细胞移植治疗心肌梗死后受损心肌正成为一种越来越有前景的策略。这种治疗形式可分为两种治疗策略:第一种使用分化的细胞类型,用活细胞替代瘢痕组织,而第二种策略使用干细胞试图使心肌再生。在过去十年中,多种细胞类型已用于动物研究,目前正在进行将骨骼肌成肌细胞注射并植入受损心肌的安全性临床试验。专注于使用干细胞使受损心肌再生的动物研究显示出一种自然发生的修复过程,该过程包括心肌梗死后骨髓中祖细胞释放的上调、这些细胞归巢至受损组织以及这些祖细胞在梗死组织内分化为血管细胞和心肌细胞。不幸的是,这个过程很少发生。用干细胞使心肌再生的策略要么从骨髓中提取干细胞并将这些细胞注入受损区域,要么试图通过增加心肌梗死后骨髓源性干细胞的动员来提高自然修复过程的效率。本综述总结了过去十年细胞移植领域,讨论了争议领域,并提出了临床和科学领域为使自体细胞移植充分发挥其临床潜力而需要取得的进展概述。