骨髓单个核细胞移植治疗缺血性心脏病的进展

骨髓单个核细胞包括间充质干细胞、造血干细胞和内皮祖细胞，这些细胞移植到缺血心肌后可分化为心肌细胞、血管内皮细胞和平滑肌细胞；并且可通过旁分泌和自分泌一些细胞因子促进血管新生，防止宿主细胞和移植细胞凋亡，并使内源性修复细胞归巢，修复受损的心肌。目前国内外已进行了大量应用于缺血性心脏病的试验，这些研究采用多种途径将骨髓单个核细胞植入到冠状动脉或心肌内，包括冠状动脉内注射、静脉输入、直接室壁注射、心外膜或心内膜下输入，并通过将细胞制成碎片而提高其滞留率，或应用一些细胞因子提高治疗效果。虽然目前这些临床试验结果尚存在争议，但这些方法在治疗缺血性心脏病方面仍有前景。现对骨髓单个核细胞移植治疗缺血性心脏病的机制、移植途径、骨髓单个核细胞的滞留、归巢、存活和展望等进行综述。

The Advance of Bone Marrow Mononuclear Cell Transplantation in Treating Ischemia Heart Disease

The bone marrow mononuclear cell （BMMNC） subset comprises mesenchymal stem ceils, hematopoietic stein cells, endothelial progenitor cells. These cells can differentiate into cardiomyocytes, vascular endothelial cells and sraooth muscle cells, and they can also release a wide array of cytokines that exert their effects on surrounding cells, including inducing neovascularization, preventing apoptosis of home cells and homing of endogenous systemic repairing cells. Many trials have been developed to evaluate the effect of bone marrow mononuclear cell transplantation in treating ischemia heart diseases in this country and others. Several routes have been used to deliver these cells to human myocardium or to the coronary circulation in these trials, such as intracoronary injection, intravenous infusion, direct injection into the ventricular wall, or transepicardial/transendocardial infusions, and the cells are constructed into fragmented cell sheets to improve cell retention, or some cytokines are used to enhance therapeutic effect. Although the results of the recent clinical trials in this area are rather conflicting, these therapeutic approaches seem to be promising for the treatment of ischemic heart disease. In this review, many aspects of bone marrow mononuclear cell transplantation in myocardial infarction are summarized such as the mechanism, delivery routes, retaining of cells, homing, survival and future development, etc.