Kumar Manoj, Bhoi Sanjeev, Sharma Keshava
Department of Emergency Medicine, JPN Apex Trauma Centre, AIIMS, New Delhi, 110029, India.
J Clin Orthop Trauma. 2019 Mar-Apr;10(2):269-273. doi: 10.1016/j.jcot.2018.04.009. Epub 2018 Apr 22.
Hematopoietic failure (HF) has been observed in trauma hemorrhagic shock (T/HS) patients. Multiple factors are involved. Elevated serum levels of cytokines, catecholamine, granulocyte colony stimulating factor, peripheral blood hematopoietic progenitor cells (HPCs) and decreased expression of erythropoietin receptor are associated with HF among T/HS. HF leads to anaemia, susceptibility to infection, sepsis and multi-organ failure. There is a lack of molecular understanding of HF and its potential therapeutic strategies. Cell-based therapy has ability to modulate the production of inflammatory cytokines, vascular dysfunction, tissue damage and apoptosis. Human-induced pluripotent stem cells (iPSC) derived HPCs may have the ability to restore HF in T/HS. Autologous cell-based iPSC have great promises for various diseases such as Alzheimer's disease, Parkinson's disease, cardiovascular disease, diabetes, amyotrophic lateral sclerosis, and spinal cord injury without ethical concerns. Similarly, treatment with iPSC derived hematopoietic stem cells can used for the treatment of HF among T/HS and may also improve the outcome. Here, we review the potential of human iPSC derived HSC to reversed HF following T/HS.
在创伤性失血性休克(T/HS)患者中已观察到造血功能衰竭(HF)。这涉及多种因素。T/HS患者中,细胞因子、儿茶酚胺、粒细胞集落刺激因子血清水平升高、外周血造血祖细胞(HPC)以及促红细胞生成素受体表达降低均与HF有关。HF会导致贫血、易感染、败血症和多器官功能衰竭。目前对HF及其潜在治疗策略缺乏分子层面的了解。基于细胞的疗法有能力调节炎性细胞因子的产生、血管功能障碍、组织损伤和细胞凋亡。人诱导多能干细胞(iPSC)衍生的HPC可能有能力恢复T/HS患者的HF。自体iPSC基疗法在治疗阿尔茨海默病、帕金森病、心血管疾病、糖尿病、肌萎缩侧索硬化症和脊髓损伤等各种疾病方面前景广阔,且不存在伦理问题。同样,用iPSC衍生的造血干细胞进行治疗可用于治疗T/HS患者的HF,也可能改善治疗结果。在此,我们综述了人iPSC衍生的造血干细胞逆转T/HS后HF的潜力。