Department of Cardiothoracic Surgery, Cardiac and Vascular Sciences, St. George's Hospital, University of London, London, United Kingdom.
Ann Thorac Surg. 2010 Dec;90(6):1944-51. doi: 10.1016/j.athoracsur.2010.08.033.
Vascular trauma induced by surgical revascularization stimulates mobilization of hematopoietic and nonhematopoietic progenitor cells. However, it is not clear whether mobilized progenitors are functionally active and participate in peripheral homing. We have found no clinical studies available regarding the reaction of bone marrow to surgical revascularization.
This was an observational prospective study of 76 patients undergoing elective coronary artery bypass graft surgery. Bone marrow aspirates and blood samples were collected at baseline, at the end of surgery, and 24 hours postoperatively (blood samples only). The CD34+, CD34+CD133+, and CD34+CXCR4+ progenitor cell counts, CXCR4+ mononuclear cell counts, and CXCR4 expression on CD34+ cells were measured by flow cytometry. Progenitor cell functions were studied in vitro by clonogenic and migration assays.
In response to coronary revascularization there was mobilization of CD34+ progenitors, having increased migratory and clonogenic function. The CD34+CXCR4+ subsets and CXCR4 expression on CD34+ cells in peripheral blood increased significantly 24 hours postoperatively. The CXCR4 expression on mobilized progenitors at the end of surgery was independently related to baseline CXCR4 expression on bone marrow resident CD34+ cells and duration of cardiopulmonary bypass in a multivariate model. At the end of surgery there was a significant fall in the expression of CXCR4 on CD34+ bone marrow cells, suggesting egress into peripheral circulation of the most active CXCR4-expressing progenitors.
Coronary artery bypass graft surgery is associated with bone marrow release of functionally active progenitor cells. Further studies are needed to verify whether mobilized progenitors participate in regeneration of injured tissues.
手术血运重建引起的血管损伤会刺激造血和非造血祖细胞的动员。然而，目前尚不清楚动员的祖细胞是否具有功能活性并参与外周归巢。我们尚未发现有关骨髓对手术血运重建反应的临床研究。
这是一项 76 例行择期冠状动脉旁路移植术患者的观察性前瞻性研究。在基线、手术结束时和术后 24 小时（仅采集血液样本）采集骨髓抽吸物和血液样本。通过流式细胞术测量 CD34+、CD34+CD133+和 CD34+CXCR4+祖细胞计数、CXCR4+单核细胞计数和 CD34+细胞上的 CXCR4 表达。通过克隆形成和迁移测定体外研究祖细胞功能。
对冠状动脉血运重建的反应导致 CD34+祖细胞动员，具有增加的迁移和克隆形成功能。外周血中的 CD34+CXCR4+亚群和 CD34+细胞上的 CXCR4 表达在术后 24 小时显著增加。手术结束时动员的祖细胞上的 CXCR4 表达与多变量模型中的基线骨髓常驻 CD34+细胞上的 CXCR4 表达和体外循环持续时间独立相关。手术结束时，CD34+骨髓细胞上的 CXCR4 表达显著下降，提示最活跃的 CXCR4 表达祖细胞进入外周循环。
冠状动脉旁路移植术与骨髓释放功能活跃的祖细胞有关。需要进一步研究以验证动员的祖细胞是否参与受损组织的再生。
