Key Laboratory of Neonatal Diseases of Health Commission of the People's Republic of China, Shanghai, China.
Department of Neonatology, National Children's Medical Center/Children's Hospital of Fudan University, Shanghai, China.
J Neurosci Res. 2021 Mar;99(3):778-792. doi: 10.1002/jnr.24751. Epub 2020 Nov 18.
Preterm birth is a global public health problem. A large number of preterm infants survive with preterm white matter injury (PWMI), which leads to neurological deficits, and has multifaceted etiology, clinical course, monitoring, and outcomes. The principal upstream insults leading to PWMI initiation are hypoxia-ischemia and infection and/or inflammation and the key target cells are late oligodendrocyte precursor cells. Current PWMI treatments are mainly supportive, and thus have little effect in terms of protecting the immature brain or repairing injury to improve long-term outcomes. Umbilical cord blood (UCB) cells comprise abundant immunomodulatory and stem cells, which have the potential to reduce brain injury, mainly due to anti-inflammatory and immunomodulatory mechanisms, and also through their release of neurotrophic or growth factors to promote endogenous neurogenesis. In this review, we briefly summarize PWMI pathogenesis and pathophysiology, and the specific properties of different cell types in UCB. We further explore the potential mechanism by which UCB can be used to treat PWMI, and discuss the advantages of and potential issues related to UCB cell therapy. Finally, we suggest potential future studies of UCB cell therapy in preterm infants.
早产是一个全球性的公共卫生问题。大量早产儿患有早产儿脑白质损伤（PWMI），这导致了神经功能缺陷，其病因、临床过程、监测和结局具有多面性。导致 PWMI 发生的主要上游损伤因素是缺氧缺血和感染以及/或炎症，关键靶细胞是晚期少突胶质前体细胞。目前 PWMI 的治疗主要是支持性的，因此在保护未成熟大脑或修复损伤以改善长期结局方面效果甚微。脐带血（UCB）细胞含有丰富的免疫调节和干细胞，具有减轻脑损伤的潜力，主要通过抗炎和免疫调节机制，以及通过释放神经营养或生长因子来促进内源性神经发生。在这篇综述中，我们简要总结了 PWMI 的发病机制和病理生理学，以及 UCB 中不同细胞类型的特定特性。我们进一步探讨了 UCB 治疗 PWMI 的潜在机制，并讨论了 UCB 细胞治疗的优势和相关问题。最后，我们建议对早产儿的 UCB 细胞治疗进行潜在的未来研究。
