Cedars-Sinai Medical Center, Division of Cardiology, Los Angeles, California 90048, USA.
JACC Cardiovasc Interv. 2009 Jan;2(1):1-8. doi: 10.1016/j.jcin.2008.10.010.
Meta-analyses of intracoronary autologous bone marrow cell infusion in patients with acute myocardial infarction establish the procedure as safe. Nonetheless, the typical small increase in ejection fraction is of uncertain clinical significance, with little if any evidence of myocardial regeneration. In this paper, we describe 3 new paradigms of myocardial preservation and regeneration that provide reasonable hope that the goal of myocardial rejuvenation can be achieved. The first paradigm is that substantial preservation of myocardium is possible even during the period of coronary occlusion and immediate reperfusion, before interventions aimed at myocardial regeneration. The factors that induce myocardial preservation may also create an environment more receptive to subsequent myocardial regeneration. The second paradigm is that the local environment may regulate the behavior of cells in the ischemic/infarct region. For instance, adult cells may be induced to re-enter the cell cycle and proliferate with appropriate environmental modification. The final paradigm is that autologous cardiac stem cells or induced pluripotent stem cells can create new myocytes and myocardium. Taken together, these new ideas, each still to be proven, suggest that the goal of regenerating functioning new myocardium can still be achieved.
荟萃分析表明，经冠状动脉内自体骨髓细胞输注治疗急性心肌梗死是安全的。然而，射血分数的典型小幅度增加其临床意义不确定，几乎没有心肌再生的证据。本文描述了 3 种新的心肌保护和再生范例，它们为实现心肌年轻化的目标提供了合理的希望。第一个范例是，即使在冠状动脉闭塞和即刻再灌注期间，甚至在旨在促进心肌再生的干预措施之前，也有可能实现心肌的大量保存。诱导心肌保护的因素也可能为随后的心肌再生创造一个更易接受的环境。第二个范例是，局部环境可能调节缺血/梗死区域内细胞的行为。例如，适当的环境修饰可以诱导成年细胞重新进入细胞周期并增殖。最后一个范例是，自体心脏干细胞或诱导多能干细胞可以产生新的心肌细胞和心肌。总的来说，这些新的想法，每一个都有待证实，表明再生有功能的新心肌的目标仍然可以实现。
