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[间充质干细胞作为纤维化/肝硬化治疗的前瞻性方法]

[Mesenchymal stem cells as perspective method of fibrosis/cirrhosis treatment].

作者信息

Lukashik S P, Aleĭnikova O V, Tsyrkunov V M, Isaĭkina Ia I, Romanova O N, Shimanskiĭ A T, Kravchuk R I

出版信息

Eksp Klin Gastroenterol. 2013(12):3-7.

Abstract

UNLABELLED

THE PURPOSE OF THE REVIEW: Discuss the background and available results of transplantation of bone marrow stem cells as a promising treatment of hepatic fibrosis. KEY PROVISIONS: Actuality of the problem of chronic hepatitis is present due to their progressive course with the formation of liver cirrhosis and a high level of mortality. Conservative treatment of patients with decompensated process requires a liver transplantation that is compounded by the high percentage of graft reinfection in infectious hepatology. It is necessary to study the use of bone marrow-derived stem cells transplantation, because MSCs have certain therapeutic potential, low immunogenicity and the capacity for directional migration. In experimental models MSCs mechanisms of action are shown to limit the progression of liver fibrosis and stimulation of regeneration processes. In clinical studies good tolerability and relative safety of administration of autologous MSCs have reported as well as the positive effects on liver synthetic function, a decrease in the severity of cirrhosis on class Child-Pugh and MELD, reduction in overall mortality are shown. The results of our own prospective pilot study using autologous MSCs from bone marrow in patients with HCV-associated liver cirrhosis are described.

CONCLUSION

MSCs can exert multiple synergistic effects on the hepatic stellate cells, reduce inflammation in the liver tissue remodeling processes and fibrogenesis. For objective evidence of the clinical benefits of the method, evaluation of long-term efficacy and safety of MSCs, as well as developing rational strategies, further clinical studies are required.

摘要

未标注

综述目的:探讨骨髓干细胞移植作为肝纤维化一种有前景的治疗方法的背景及现有结果。关键要点:慢性肝炎问题的现状是由于其进展性病程会形成肝硬化且死亡率高。对失代偿期患者的保守治疗需要肝移植,但在感染性肝病中移植物再感染的比例很高,这使情况变得复杂。有必要研究骨髓来源干细胞移植的应用,因为间充质干细胞具有一定的治疗潜力、低免疫原性和定向迁移能力。在实验模型中,已显示间充质干细胞的作用机制可限制肝纤维化进展并刺激再生过程。在临床研究中,已报道自体间充质干细胞给药具有良好的耐受性和相对安全性,以及对肝脏合成功能有积极影响、降低Child-Pugh和MELD分级的肝硬化严重程度、降低总体死亡率。描述了我们自己使用来自骨髓的自体间充质干细胞对丙型肝炎相关肝硬化患者进行的前瞻性初步研究结果。

结论

间充质干细胞可对肝星状细胞发挥多种协同作用,减少肝组织重塑过程中的炎症和纤维化形成。为了客观证明该方法的临床益处、评估间充质干细胞的长期疗效和安全性以及制定合理策略,还需要进一步的临床研究。

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