干细胞移植治疗ami临床研究进展

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1、干细胞移植治疗AMI临床研究进展哈尔滨医科大学第一临床医学院李悦Despiteadvancesinreperfusionstrategiesandmedicaltreatment,MIandsubsequentHFremainmajorcausesofmorbidityandmortality.Theuseofcelltherapytopromotemyocardialrepairhasgainedprofoundscientificandpublicinterest.干细胞移植（stemcelltransp

2、lantation)亦称为细胞心肌成形术（cellularcardiomyoplasty,CCMP)胚胎干细胞伦理问题、来源有限、免疫排斥、发生肿瘤风险，研究受到很大限制。成体干细胞横向分化(transdifferentiation)临床角度，成体干细胞优于胚胎干细胞，自体干细胞优于同种干细胞。骨髓间质干细胞（mesenchymalstemcells，MSC）从骨髓中分离，可使用G-CSF动员或在体外扩增。内皮祖细胞（endothelialprogenitorcells，EPC）数量往往不足，特别是从外周血采

3、集时，需要分离、纯化并在体外培养扩增EPC。成骨骼肌细胞（skeletalmyoblasts，SM）为获得足够数量SM，需要大块肌肉组织。体外培养、扩增卫星细胞周期较长。可供移植干细胞Experimentalstudieshaveshownthatbonemarrowcells(BMCs)arecapableofinducingmyogenesisandangiogenesis;thisleadsinturntoameliorationofcardiacfunctioninmiceandpigs.Nature

4、.2001;410:701–705NatMed.2001;7:430–436ProcNatlAcadSciUSA.2001;98:10344–10349.JThoracCardiovascSurg.2002;123:1132–1135.ThefirststudyonintracoronarymBMCtherapyshortlyafterAMIinhumanswasreportedin2002.Circulation2002;15:1913–8.10patientsweretransplantedwithaut

5、ologousmononuclearBMCsviaaballooncatheterplacedintotheinfarct-relatedarteryduringballoondilatation。FrombenchtobedsideConclusions：Demonstrateforthefirsttimethatselectiveintracoronarytransplantationofautologous,mononuclearBMCsissafeandseemstobeeffectiveunderc

6、linicalconditions.However,theefficacyresultsvarybetweenstudies.Possibleexplanationsforthesedifferencesaresmallstudysamples,differentimagingtechniquesanddifferencesintimingoftreatment,celldose,placebotreatmentorcellprocessingprotocols.Concernshavebeenraiseda

7、boutacceleratedatherosclerosis,intramyocardialcalcificationsandriskforarrhythmias.Long-termdataonsafetyandefficacyofthistreatmentareneeded.2004～2005年，黄禹锡在《科学》杂志发表伪造的干细胞论文，夸张干细胞治疗绝症的可能性，并由此从农协和SK领取20亿韩元研究费、政府支援的研究费(《特定经济犯罪加重处罚法》的诈骗及工作上的贪污)。并且还涉嫌非法买卖卵子(违反《生命伦

8、理法》)，因而于2006年5月被拘留立案。REPAIR-AMItrial（randomized,double-blind,placebocontrolled,multicenter)NEnglJMed.2006;355:1210–1221204AMIpatientsreceiveintracoronaryinfusionofprogenitorcellsderivedfrombonemarrow(B