McGovern Medical School at The University of Texas Health Science Center, Houston, Texas.
Pediatr Res. 2018 Jan;83(1-2):325-332. doi: 10.1038/pr.2017.253. Epub 2017 Nov 1.
Neurological injury is the primary lethal mechanism of injury in children, and the primary etiology of long-term disability after trauma. Laboratories and clinical/translational teams have sought to develop stem/progenitor cell therapies to improve recovery in a clinical setting in which there is no significant reparative option. While none of these treatments are currently standard therapeutics, phase IIb clinical trials are underway in both adults and children in severe traumatic brain injury (TBI) and phase I/IIa trials in spinal cord injury. This review will characterize the cell therapy strategies: cell replacement and tissue integration vs. immunomodulation/enhanced endogenous tissue repair. TBI is somewhat different from other central nervous system injuries (spinal cord injury and stroke), in that TBI is a diffuse injury, whereas spinal cord injury and stroke are anatomically discrete. Importantly, this drives cell therapy approaches, as TBI is less apt to be treatable with a local cell replacement intervention. More localized injuries may be more amenable to local approaches and cell replacement to bridge focal gaps. This review focuses on a few reports in the field that highlight areas of progress, but is not intended to be a comprehensive survey of the state of regenerative medicine for neurological injuries.
神经损伤是儿童损伤的主要致死机制，也是创伤后长期残疾的主要病因。实验室和临床/转化团队一直在寻求开发干细胞/祖细胞疗法，以改善临床环境中没有明显修复选择的情况下的恢复。虽然这些治疗方法目前都不是标准疗法，但在严重创伤性脑损伤（TBI）中，成人和儿童的 IIb 期临床试验正在进行中，在脊髓损伤中进行 I/IIa 期临床试验。这篇综述将描述细胞治疗策略：细胞替代和组织整合与免疫调节/增强内源性组织修复。TBI 与其他中枢神经系统损伤（脊髓损伤和中风）有些不同，因为 TBI 是弥漫性损伤，而脊髓损伤和中风是解剖上离散的。重要的是，这推动了细胞治疗方法的发展，因为 TBI 不太可能通过局部细胞替代干预来治疗。更局部的损伤可能更容易接受局部方法和细胞替代来桥接局灶性间隙。本综述重点介绍了该领域的一些报告，这些报告强调了进展的领域，但并不是对神经损伤再生医学现状的全面调查。
