Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan, ROC.
Cell Transplant. 2013;22(4):723-9. doi: 10.3727/096368912X655217. Epub 2012 Oct 12.
Mesenchymal stem cells (MSCs) have been shown to be effective in the management of graft-versus-host disease (GVHD) due to their immunomodulatory effects. In addition to prevention and treatment of GVHD, many studies have demonstrated that MSCs can promote hematopoietic engraftment, accelerate lymphocyte recovery, reduce the risk of graft failure, and repair tissue damage in patients receiving hematopoietic stem cell transplantation (HSCT). Bone marrow (BM) has been considered as the traditional source of MSCs, and most of the knowledge concerning MSCs comes from BM studies. However, BM-derived MSCs have several limitations for their clinical application. Fetal-type MSCs can be isolated easier and proliferate faster in vitro as well as possessing a lower immunogenicity. Therefore, fetal-type MSCs, such as umbilical cord-derived MSCs, represent an excellent alternative source of MSCs. MSCs play multiple important roles in HSCT. Nevertheless, several issues regarding their clinical application remain to be discussed, including the safety of use in humans, the available sources and the convenience of obtaining MSCs, the quality control of in vitro-cultured MSCs and the appropriate cell passages, the optimum cell dose, and the optimum number of infusions. Furthermore, it is important to evaluate whether the rates of cancer relapse and infections increase when using MSCs for GVHD. There are still many questions regarding the clinical application of MSCs to HSCT that need to be answered, and further studies are warranted.
间充质干细胞 (MSCs) 因其免疫调节作用，已被证明在移植物抗宿主病 (GVHD) 的治疗中有效。除了预防和治疗 GVHD 外，许多研究还表明，MSCs 可以促进造血植入，加速淋巴细胞恢复，降低造血干细胞移植 (HSCT) 患者移植物失败的风险，并修复组织损伤。骨髓 (BM) 一直被认为是 MSCs 的传统来源，并且大多数关于 MSCs 的知识都来自于 BM 的研究。然而，BM 来源的 MSCs 在临床应用中存在一些局限性。胎儿型 MSCs 在体外更容易分离和增殖，且免疫原性较低。因此，胎儿型 MSCs，如脐带来源的 MSCs，是 MSCs 的一种极好的替代来源。MSCs 在 HSCT 中发挥着多种重要作用。然而，关于其临床应用的几个问题仍有待讨论，包括在人体中的使用安全性、可用的来源和获取 MSCs 的便利性、体外培养的 MSCs 的质量控制和合适的细胞传代数、最佳细胞剂量以及最佳输注次数。此外，还需要评估在使用 MSCs 治疗 GVHD 时，癌症复发和感染的发生率是否会增加。关于 MSCs 在 HSCT 中的临床应用仍有许多问题需要解答，需要进一步研究。
