Okamoto Ryuichi, Mizutani Tomohiro, Shimizu Hiromichi
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Digestion. 2023;104(1):24-29. doi: 10.1159/000527423. Epub 2022 Nov 9.
Inflammatory bowel disease (IBD) is characterized by idiopathic and chronic inflammation arising elsewhere within the gastrointestinal tract. Consequently, the mucosal tissue is destroyed during the active phase of the disease, and therefore, spontaneous repair of damaged tissue is required to restore the function and long-term homeostasis of the intestinal mucosa. Also, in patients with refractory Crohn's disease, loss of massive intestinal function can lead to short bowel syndrome or may lead to fatal intestinal failure.
The concept of mucosal healing shares the idea that both regulation of mucosal inflammation and repair of the damaged mucosa are critical to achieve the ideal clinical outcome in patients with IBD. However, current treatments lack the option of those targeted to mucosal repair, and therefore, patients must achieve mucosal healing depending on their intrinsic system. To counteract inflammation-induced mucosal damage, various biologics or cell-based treatments are currently being developed. In the early developmental phase, various growth factors have been tested for their ability to promote mucosal repair. However, most of these factors did not show clinical benefit, except the recombinant glucagon-like peptide-2 (GLP-2). On the contrary, cell-based treatments are rapidly emerging, using both somatic stem cells and pluripotent stem cells.
In this review, we focus on the current state of factor-based or cell-based regenerative medicine in the treatment of IBD. Additionally, we would like to introduce current examples of tissue engineering technologies and provide future prospects for the application of regenerative medicine in IBD.
炎症性肠病（IBD）的特征是胃肠道其他部位出现特发性慢性炎症。因此，在疾病的活动期黏膜组织会遭到破坏，所以需要受损组织的自发修复来恢复肠黏膜的功能和长期稳态。此外，在难治性克罗恩病患者中，大量肠功能丧失可导致短肠综合征或可能导致致命的肠衰竭。
黏膜愈合的概念认为，调节黏膜炎症和修复受损黏膜对于IBD患者实现理想的临床结局都至关重要。然而，目前的治疗方法缺乏针对黏膜修复的选择，因此，患者必须依靠自身系统实现黏膜愈合。为了对抗炎症引起的黏膜损伤，目前正在研发各种生物制剂或基于细胞的治疗方法。在早期开发阶段，已对多种生长因子促进黏膜修复的能力进行了测试。然而，除重组胰高血糖素样肽-2（GLP-2）外，这些因子大多未显示出临床益处。相反，基于细胞的治疗方法正在迅速兴起，使用的是体细胞干细胞和多能干细胞。
在本综述中，我们重点关注基于因子或基于细胞的再生医学在IBD治疗中的现状。此外，我们想介绍当前组织工程技术的实例，并提供再生医学在IBD中应用的未来前景。
