Mattioli Anna Vittoria
Laboratorio di Ricerca Avanzata, Cattedra di Cardiologia, Istituto Nazionale di Ricerche Cardiovascolari, Università degli Studi di Modena e Reggio Emilia, Modena.
G Ital Cardiol (Rome). 2008 Apr;9(4):251-61.
Cell therapy is an adjunctive treatment to improve left ventricular function after myocardial injury. Multiple cell types have been tested experimentally in animal models of myocardial disease, with functional improvement as the primary endpoint. Regarding safety, the major concern has been that cell transplantation could generate an arrhythmogenic substrate as reported in clinical studies using myoblasts. The mechanism of these transplantation-related arrhythmias remains elusive but the cellular heterogeneity, resulting from differences in electrical membrane properties between recipient/donor cells, could provide a substrate for reentry circuits. The knowledge achieved from experimental studies on the substrate of arrhythmias in cell therapy gives useful information that could be translated into the development of a biological pacemaker or a non-pharmacological approach to atrial fibrillation. Limitations of current pharmacological and catheter ablation options to achieve rate control in patients with atrial fibrillation have motivated new strategies of cell therapy for non-pharmacological rate control without producing high-degree atrioventricular block. Although several issues remain to be addressed, some aspects of cell therapy are likely to be translated into clinical practice.
细胞疗法是心肌损伤后改善左心室功能的辅助治疗方法。多种细胞类型已在心肌疾病动物模型中进行了实验测试，主要终点是功能改善。关于安全性，主要担忧在于如使用成肌细胞的临床研究中所报道的那样，细胞移植可能产生致心律失常基质。这些与移植相关的心律失常的机制仍不清楚，但受体/供体细胞之间电膜特性差异导致的细胞异质性可能为折返环路提供基质。细胞疗法中心律失常基质的实验研究所得知识提供了有用信息，可转化为生物起搏器或房颤非药物治疗方法的开发。目前用于房颤患者心率控制的药物和导管消融方法存在局限性，这促使人们探索新的细胞疗法策略，以实现非药物心率控制且不产生高度房室传导阻滞。尽管仍有几个问题有待解决，但细胞疗法的某些方面很可能会转化为临床实践。
