基于细胞的围产期缺氧缺血性脑病治疗方法。

Cell-based treatment for perinatal hypoxic-ischemic encephalopathy.

作者信息

Park You Jeong, Borlongan Cesario V, Dezawa Mari

机构信息

Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.

Department of Stem Cell Biology and Histology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

出版信息

Brain Circ. 2021 Mar 30;7(1):13-17. doi: 10.4103/bc.bc_7_21. eCollection 2021 Jan-Mar.

Abstract

Hypoxic-ischemic encephalopathy (HIE) is a major cause of acute neonatal brain injury and can lead to disabling long-term neurological complications. Treatment for HIE is limited to supportive care and hypothermia within 6 h injury which is reserved for full-term infants. Preclinical studies suggest the potential for cell-based therapies as effective treatments for HIE. Some clinical trials using umbilical cord blood cells, placenta-derived stem cells, mesenchymal stem cells (MSCs), and others have yielded promising results though more studies are needed to optimize protocols and multi-center trials are needed to prove safety and efficacy. To date, the therapeutic effects of most cell-based therapies are hypothesized to stem from the bystander effect of donor cells. Transplantation of stem cells attenuate the aberrant inflammation cascade following HIE and provide a more ideal environment for endogenous neurogenesis and repair. Recently, a subset of MSCs, the multilineage-differentiating stress-enduring (Muse) cells have shown to treat HIE and other models of neurologic diseases by replacing dead or ischemic cells and have reached clinical trials. In this review, we examine the different cell sources used in clinical trials and evaluate the underlying mechanism behind their therapeutic effects. Three databases-PubMed, Web of Science, and ClinicalTrials.gov-were used to review preclinical and clinical experimental treatments for HIE.

摘要

缺氧缺血性脑病(HIE)是急性新生儿脑损伤的主要原因,可导致致残性的长期神经并发症。HIE的治疗仅限于支持性护理和在损伤后6小时内进行的低温治疗,该治疗仅适用于足月儿。临床前研究表明,基于细胞的疗法有可能成为治疗HIE的有效方法。一些使用脐带血细胞、胎盘来源的干细胞、间充质干细胞(MSCs)等的临床试验已取得了有前景的结果,不过仍需要更多研究来优化方案,并且需要进行多中心试验以证明其安全性和有效性。迄今为止,大多数基于细胞的疗法的治疗效果被认为源于供体细胞的旁分泌效应。干细胞移植可减轻HIE后的异常炎症级联反应,并为内源性神经发生和修复提供更理想的环境。最近,间充质干细胞的一个亚群,即多谱系分化应激耐受(Muse)细胞,已显示出可通过替代死亡或缺血细胞来治疗HIE和其他神经疾病模型,并且已进入临床试验阶段。在本综述中,我们研究了临床试验中使用的不同细胞来源,并评估了其治疗效果背后的潜在机制。我们使用了三个数据库——PubMed、科学网和临床试验.gov——来回顾HIE的临床前和临床实验性治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/176b/8057102/02fd57761a18/BC-7-13-g001.jpg

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