Ishigami Shuta, Sano Toshikazu, Krishnapura Sunaya, Ito Tatsuo, Sano Shunji
Department of Pediatric Cardiothoracic Surgery, University of California, San Francisco, San Francisco, CA, USA.
Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, CA, USA.
Eur J Cardiothorac Surg. 2020 Nov 1;58(5):881-887. doi: 10.1093/ejcts/ezaa155.
Significant achievements in paediatric cardiology, surgical treatment and intensive care of congenital heart disease have drastically changed clinical outcomes for paediatric patients. Nevertheless, late-onset heart failure in children after staged surgeries still remains a serious concern in the medical community. Heart transplantation is an option for treatment; however, the shortage of available organs is a persistent problem in many developed countries. In order to resolve these issues, advanced technologies, such as innovative mechanical circulatory support devices and regenerative therapies, are strongly desired. Accumulated evidence regarding cell-based cardiac regenerative therapies has suggested their safety and efficacy in treating adult heart failure. Given that young children seem to have a higher regenerative capacity than adults, stem cell-based therapies appear a promising treatment option for paediatric heart failure as well. Based on the findings from past trials and studies, we present the potential of various different types of stem cells, ranging from bone marrow mononuclear cells to cardiosphere-derived stem cells for use in paediatric cell-based therapies. Here, we assess both the current challenges associated with cell-based therapies and novel strategies that may be implemented in the future to advance stem cell therapy in the paediatric population.
小儿心脏病学、先天性心脏病的外科治疗和重症监护方面的重大成就极大地改变了儿科患者的临床结局。然而,分期手术后儿童迟发性心力衰竭仍是医学界严重关切的问题。心脏移植是一种治疗选择;然而,在许多发达国家,可用器官短缺是一个长期存在的问题。为了解决这些问题,人们强烈期望采用先进技术,如创新的机械循环支持装置和再生疗法。关于基于细胞的心脏再生疗法的大量证据表明了其在治疗成人心力衰竭方面的安全性和有效性。鉴于幼儿似乎比成人具有更高的再生能力,基于干细胞的疗法似乎也是治疗小儿心力衰竭的一种有前景的选择。基于过去试验和研究的结果,我们展示了从骨髓单个核细胞到心球衍生干细胞等各种不同类型干细胞用于小儿细胞疗法的潜力。在此,我们评估了基于细胞疗法当前面临的挑战以及未来可能实施的新策略以推进儿科人群的干细胞治疗。