Keane Colm, Jerkic Mirjana, Laffey John G
From the Department of Anaesthesia, Galway University Hospitals and National University of Ireland, Galway, Ireland (C.K., J.G.L.); Department of Anesthesia, Keenan Research Centre for Biomedical Sciences, St. Michael's Hospital, Toronto, Ontario, Canada (M.J., J.G.L.); and Departments of Anesthesia, Physiology, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada (J.G.L.).
Anesthesiology. 2017 Dec;127(6):1017-1034. doi: 10.1097/ALN.0000000000001882.
Sepsis is a life-threatening syndrome resulting in shock and organ dysfunction stemming from a microbial infection. Sepsis has a mortality of 40% and is implicated in half of all in-hospital deaths. The host immune response to microbial infection is critical, with early-phase sepsis characterized by a hyperinflammatory immune response, whereas the later phase of sepsis is often complicated by suppression. Sepsis has no treatment, and management remains supportive.Stem cells constitute exciting potential therapeutic agents for sepsis. In this review, we examine the rationale for stem cells in sepsis, focusing on mesenchymal stem/stromal cells, which currently demonstrate the greatest therapeutic promise. We examine the preclinical evidence base and evaluate potential mechanisms of action of these cells that are important in the setting of sepsis. We discuss early-phase clinical trials and critically appraise translational barriers to the use of mesenchymal stem/stromal cells in patients with sepsis.
脓毒症是一种危及生命的综合征,可导致由微生物感染引起的休克和器官功能障碍。脓毒症的死亡率为40%,占所有住院死亡人数的一半。宿主对微生物感染的免疫反应至关重要,早期脓毒症的特征是免疫反应过度炎症,而脓毒症的后期往往伴有免疫抑制。脓毒症尚无治疗方法,治疗仍以支持治疗为主。干细胞是脓毒症令人兴奋的潜在治疗药物。在这篇综述中,我们探讨了干细胞用于脓毒症治疗的理论依据,重点关注间充质干/基质细胞,目前这些细胞显示出最大的治疗前景。我们研究了临床前证据基础,并评估了这些细胞在脓毒症情况下重要的潜在作用机制。我们讨论了早期临床试验,并严格评估了在脓毒症患者中使用间充质干/基质细胞的转化障碍。