Chinnadurai Raghavan, Ng Spencer, Velu Vijayakumar, Galipeau Jacques
Raghavan Chinnadurai, Spencer Ng, Vijayakumar Velu, Jacques Galipeau, Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA 30322, United States.
World J Gastroenterol. 2015 Apr 28;21(16):4779-87. doi: 10.3748/wjg.v21.i16.4779.
Utilization of mesenchymal stromal cells (MSCs) for the treatment of Crohn's disease and ulcerative colitis is of translational interest. Safety of MSC therapy has been well demonstrated in early phase clinical trials but efficacy in randomized clinical trials needs to be demonstrated. Understanding MSC mechanisms of action to reduce gut injury and inflammation is necessary to improve current ongoing and future clinical trials. However, two major hurdles impede the direct translation of data derived from animal experiments to the clinical situation: (1) limitations of the currently available animal models of colitis that reflect human inflammatory bowel diseases (IBD). The etiology and progression of human IBD are multifactorial and hence a challenge to mimic in animal models; and (2) Species specific differences in the functionality of MSCs derived from mice versus humans. MSCs derived from mice and humans are not identical in their mechanisms of action in suppressing inflammation. Thus, preclinical animal studies with murine derived MSCs cannot be considered as an exact replica of human MSC based clinical trials. In the present review, we discuss the therapeutic properties of MSCs in preclinical and clinical studies of IBD. We also discuss the challenges and approaches of using appropriate animal models of colitis, not only to study putative MSC therapeutic efficacy and their mechanisms of action, but also the suitability of translating findings derived from such studies to the clinic.
利用间充质基质细胞(MSCs)治疗克罗恩病和溃疡性结肠炎具有转化医学意义。间充质干细胞疗法的安全性已在早期临床试验中得到充分证明,但随机临床试验中的疗效仍需证明。了解间充质干细胞减少肠道损伤和炎症的作用机制对于改进当前正在进行的以及未来的临床试验是必要的。然而,有两个主要障碍阻碍了将动物实验数据直接转化为临床应用:(1)目前可用的反映人类炎症性肠病(IBD)的结肠炎动物模型存在局限性。人类IBD的病因和进展是多因素的,因此在动物模型中模拟具有挑战性;(2)小鼠来源的间充质干细胞与人类来源的间充质干细胞在功能上存在物种特异性差异。小鼠和人类来源的间充质干细胞在抑制炎症的作用机制上并不相同。因此,用小鼠来源的间充质干细胞进行的临床前动物研究不能被视为基于人类间充质干细胞的临床试验的精确复制品。在本综述中,我们讨论了间充质干细胞在IBD临床前和临床研究中的治疗特性。我们还讨论了使用合适的结肠炎动物模型的挑战和方法,不仅用于研究假定的间充质干细胞治疗效果及其作用机制,还用于探讨将此类研究结果转化到临床的适用性。