Roh Jae-Kyu, Jung Keun-Hwa, Chu Kon
Stroke & Neural Stem Cell Laboratory, Stem Cell Research Center, Clinical Research Institute, Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Curr Stem Cell Res Ther. 2008 Sep;3(3):185-96. doi: 10.2174/157488808785740352.
A growing number of studies have demonstrated stem cell-based therapy provides a feasible, realistic approach to the restoration of lost brain function after stroke. Moreover, adult stem cells may provide more appropriate clinical strategies. Leading candidate sources include bone marrow, peripheral blood, adipose tissue, skeletal muscle, and olfactory mucosa, which act as central repositories for multipotent stem cells that can repopulate neural tissues. The medical society is currently enthusiastic concerning the clinical applications of autologous adult stem cells in stroke, based on promising results obtained during experimental studies and initial clinical trials. However, before embracing clinical applications, several essential precautions must be properly addressed. For example, the regenerative potentials of adult stem cells decline with age, and stem cells isolated from aged patients may retain dysfunctional characteristics. Are the natures and amounts of available autologous cells appropriate for therapeutic application in stroke? Do transplanted cells remain functional in the diseased brain, and if so what are the optimal injection routes, cell doses, and timings? Thus, we believe that success in future clinical trials will depend on careful investigation at the experimental level, to allow us to understand not only the practicalities of stem cell use, but also the underlying biological principles involved. Here, we review the advantages and disadvantages of the different adult stem cell sources and discuss the challenges that must be negotiated to achieve transplantation success.
越来越多的研究表明，基于干细胞的疗法为中风后恢复丧失的脑功能提供了一种可行、现实的方法。此外，成体干细胞可能提供更合适的临床策略。主要的候选来源包括骨髓、外周血、脂肪组织、骨骼肌和嗅黏膜，它们是多能干细胞的主要储存库，这些干细胞可以重新填充神经组织。基于实验研究和初步临床试验中获得的有前景的结果，医学界目前对自体成体干细胞在中风中的临床应用充满热情。然而，在接受临床应用之前，必须妥善处理几个基本的预防措施。例如，成体干细胞的再生潜力会随着年龄的增长而下降，从老年患者中分离出的干细胞可能会保留功能失调的特征。可用的自体细胞的性质和数量是否适合中风的治疗应用？移植的细胞在患病大脑中是否仍保持功能，如果是，最佳的注射途径、细胞剂量和时间是什么？因此，我们认为未来临床试验的成功将取决于在实验层面的仔细研究，以便我们不仅了解干细胞使用的实际情况，还了解其中涉及的潜在生物学原理。在这里，我们回顾了不同成体干细胞来源的优缺点，并讨论了为实现移植成功必须应对的挑战。
