Division of Cardiovascular Surgery and Toronto General Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada M5G 1L7.
Trends Cardiovasc Med. 2010 Nov;20(8):263-8. doi: 10.1016/j.tcm.2011.12.002.
Autologous mesenchymal stem cells (MSCs) have been proven safe in phase I and II clinical trials in patients who have suffered a myocardial infarction. However, their potential for proliferation and differentiation decreases with age, which limits their efficacy in elderly patients. Allogeneic MSCs offer several key advantages over autologous MSCs, including a high regenerative potential and availability for clinical use without the delay required for expansion. It was believed that allogeneic MSCs were immune privileged and thus able to escape the recipient's immune system. In several preclinical studies, allogeneic MSCs were successful in regenerating the myocardium, and the transplanted MSCs improved heart function early after implantation. However, the long-term ability of allogeneic MSCs to preserve heart function is limited because of a transition from an immune privileged to an immunogenic phenotype after the cells differentiate. The initial phase I/II clinical study using allogeneic MSCs in patients with acute myocardial infarction was safe, and no side effects were observed. However, the long-term safety and efficacy of allogeneic MSCs remain to be established. In this review, we discuss the challenges of using allogeneic MSCs for cardiac repair and present strategies to prevent the immune rejection of allogeneic MSCs to increase their potential for use in cardiac patients.
自体间充质干细胞（MSCs）在经历心肌梗死的患者的 I 期和 II 期临床试验中已被证明是安全的。然而，它们的增殖和分化潜力会随着年龄的增长而降低，这限制了它们在老年患者中的疗效。同种异体 MSCs 相对于自体 MSCs 具有几个关键优势，包括高再生潜力和可用于临床使用，而无需进行扩张所需的延迟。人们认为同种异体 MSCs 具有免疫特权，因此能够逃避受者的免疫系统。在几项临床前研究中，同种异体 MSCs 成功地再生了心肌，并且移植的 MSCs 在植入后早期改善了心脏功能。然而，由于细胞分化后从免疫特权状态向免疫原性表型的转变，同种异体 MSCs 长期保持心脏功能的能力是有限的。在一项使用急性心肌梗死患者的同种异体 MSCs 的 I/II 期临床初步研究中是安全的，没有观察到副作用。然而，同种异体 MSCs 的长期安全性和疗效仍有待确定。在这篇综述中，我们讨论了使用同种异体 MSCs 进行心脏修复的挑战，并提出了预防同种异体 MSCs 免疫排斥的策略，以增加它们在心脏患者中的应用潜力。
