Dixit Parul, Katare Rajesh
Department of Physiology, HeartOtago, Otago School of Medical Sciences, University of Otago, Dunedin, 9010, New Zealand.
Stem Cell Res Ther. 2015 Mar 13;6(1):26. doi: 10.1186/s13287-015-0010-8.
The overall clinical cardiac regeneration experience suggests that stem cell therapy can be safely performed, but it also underlines the need for reproducible results for their effective use in a real-world scenario. One of the significant challenges is the identification and selection of the best suited stem cell type for regeneration therapy. Bone marrow mononuclear cells, bone marrow-derived mesenchymal stem cells, resident or endogenous cardiac stem cells, endothelial progenitor cells and induced pluripotent stem cells are some of the stem cell types which have been extensively tested for their ability to regenerate the lost myocardium. While most of these cell types are being evaluated in clinical trials for their safety and efficacy, results show significant heterogeneity in terms of efficacy. The enthusiasm surrounding regenerative medicine in the heart has been dampened by the reports of poor survival, proliferation, engraftment, and differentiation of the transplanted cells. Therefore, the primary challenge is to create clearcut evidence on what actually drives the improvement of cardiac function after the administration of stem cells. In this review, we provide an overview of different types of stem cells currently being considered for cardiac regeneration and discuss why associated factors such as practicality and difficulty in cell collection should also be considered when selecting the stem cells for transplantation. Next, we discuss how the experimental variables (type of disease, marker-based selection and use of different isolation techniques) can influence the study outcome. Finally, we provide an outline of the molecular and genetic approaches to increase the functional ability of stem cells before and after transplantation.
整体临床心脏再生经验表明,干细胞治疗可以安全进行,但这也凸显了在现实场景中有效应用干细胞疗法需要可重复结果的必要性。其中一个重大挑战是识别和选择最适合用于再生治疗的干细胞类型。骨髓单个核细胞、骨髓间充质干细胞、驻留或内源性心脏干细胞、内皮祖细胞和诱导多能干细胞是一些已针对其再生受损心肌能力进行广泛测试的干细胞类型。虽然这些细胞类型大多正在临床试验中评估其安全性和有效性,但结果显示在疗效方面存在显著异质性。关于心脏再生医学的热情因移植细胞存活率低、增殖能力差、植入率低和分化能力弱的报道而受挫。因此,主要挑战是明确证明干细胞给药后究竟是什么推动了心脏功能的改善。在本综述中,我们概述了目前用于心脏再生的不同类型干细胞,并讨论在选择移植干细胞时为何还应考虑诸如实用性和细胞采集难度等相关因素。接下来,我们讨论实验变量(疾病类型、基于标志物的选择以及不同分离技术的使用)如何影响研究结果。最后,我们概述了在移植前后提高干细胞功能能力的分子和基因方法。
Stem Cell Res Ther. 2015-3-13
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