25例恶性胶质瘤中肿瘤干细胞的分离与检测

目的 从不同病理级别胶质瘤组织标本中分离、培养并鉴定胶质瘤干细胞.方法 取25例(23例原发胶质瘤,2例复发胶质瘤)新鲜人脑胶质细胞瘤标本,分离脑肿瘤细胞,接种于含生长因子的无血清达尔伯克(氏)必需基本培养基/F-12(DMEM/F-12)培养基中培养至细胞形成干细胞球,免疫荧光法检测脑肿瘤干细胞CD133、Nestin的表达情况,干细胞球诱导分化后检测细胞表面分化标记物β微管蛋白Ⅲ(β-TubulinⅢ)、神经胶质酸性蛋白(GFAP)表达情况.结果 被检测的23例原发胶质瘤标本中,随着胶质瘤级别的增高,形成神经球的时间缩短,数量增多.2例复发胶质瘤组织分离得到的细胞形成的神经球较原发胶质瘤快而多.免疫荧光方法检测神经球CD133、巢蛋白(Nestin)表达阳性.神经球细胞经诱导分化后β-TubulinⅢ、GFAP表达阳性.结论 胶质瘤组织中存在肿瘤干细胞,不同级别胶质瘤中BTSC数量及增殖能力不同.     

人脑胶质瘤干细胞分化为血管内皮细胞的实验研究

目的 探讨体内外原代培养的人脑胶质瘤干细胞(GSCs)与胶质瘤新生血管内皮细胞的关系.方法 新鲜高级别(WHOⅢ级、Ⅳ级)的人脑胶质瘤标本经原代培养获取GSCs,免疫组化法检测其肿瘤干细胞及干细胞标记物Nestin的表达;鉴定后的GSCs经低氧诱导,免疫荧光法检测其诱导分化后内皮细胞标记物CD31、CD144和胶质瘤细胞标记物GFAP的表达,RT-PCR和Western-blot法检测其CD31的表达;建立胶质瘤干细胞皮下荷瘤裸鼠模型,免疫组化技术检测模型中人来源的CD31的表达.结果 (1)悬浮生长的胶质瘤干细胞球样细胞经免疫组化鉴定Nestin表达阳性;(2)低氧诱导后的GSCs能够表达CD31、CD144,有些细胞能够同时表达CD144和GFAP;(3)RT-PCR检测发现GSCs在诱导前后都有CD31 mRNA的表达,而Western-blot检测到只有诱导后的GSCs有CD31蛋白的表达;(4)胶质瘤干细胞荷瘤裸鼠模型的肿瘤组织中部分微血管抗人CD31抗体染色阳性.结论 胶质瘤干细胞不仅在体外低氧条件下可分化为内皮细胞,在体内微环境条件下同样可分化为血管内皮细胞,并参与胶质瘤新生组织的血液供应.     

免疫磁珠法分离、培养人脑胶质瘤干细胞

目的建立免疫磁珠法分离，并培养人脑胶质瘤干细胞的方法。方法将术中取得的脑胶质瘤标本，通过剪切、消化和吹打成单细胞悬液，筛网过滤，免疫磁珠分选试剂盒分选出CD133^＋细胞，用神经干细胞无血清培养法培养出具有单细胞克隆能力的细胞球，取第3代进行诱导分化，分化前后用免疫细胞荧光化学方法鉴定肿瘤干细胞及分化后细胞。结果免疫磁珠分选出的CD133^＋细胞，可悬浮生长并形成神经干细胞样细胞球，有较强的增殖能力，干细胞标志物巢蛋白（nestin）阳性，分化后细胞表达神经元小管相关蛋白β-3（β-tubulin3）和星形胶质细胞胶质纤维酸性蛋白质（GFAP）特异性抗原，而巢蛋白、CD133^＋阴性，并具有肿瘤的核型。结论免疫磁珠分选法可避免原代培养中众多细胞混杂生长的发生，能够从大量肿瘤细胞中分离出只占极少比例的肿瘤干细胞，细胞结合磁珠后在体外可以长期培养和传代，进一步证实了肿瘤干细胞的存在，并为胶质瘤干细胞的研究奠定基础。     

恶性胶质瘤细胞在不同培养液和不同时期中CD133阳性细胞比率的变化

目的:观察不同培养液及不同培养时期等因素对体外培养人脑胶质瘤细胞CD133阳性(CD133+)细胞比率的影响.方法:用干细胞培养液(含EGF、FGF-2、B27)培养6例原代胶质瘤细胞和3例对照细胞株,用流式细胞仪检测培养第0、3、7,28、60、90和120天时不同细胞的CD133+细胞比率;免疫组化观察胶质瘤干细胞的多向分化能力;用血清、无血清和干细胞3种培养液分别培养2例长期培养的胶质瘤SHG62、SH066细胞系以及对照的U87和U251细胞株,观察胶质瘤中CD133+细胞在不同培养液中的相互转换.结果:胶质瘤CD133+细胞比率随培养时间推移明显下降(P＜0.05),1周左右均降至＜1%的低水平,而细胞株则比较稳定;干细胞培养液培养的细胞中CD133+细胞比率明显高于血清和无血清培养液培养(P＜0.01);此外,胶质瘤细胞中的干细胞具有多向分化的能力,并且可以在干细胞和血清培养液中互相转换.结论:原代胶质瘤体外培养过程中CD133+细胞比率逐渐下降,而干细胞培养液能明显提高CD133+细胞比率,并且CD133+细胞可以在不同培养液中相互转换.说明生长环境对于细胞比率影响较大,提示可能存在尚未明了的影响干细胞生长分化的相关因子.     

CD133:脑胶质瘤干细胞标志物?

过去十五年,癌症研究中的重大进展之一为"肿瘤干细胞"模式的提出.该模式认为,恶性肿瘤的发生类似于正常组织发生,最初起源于与"正常干细胞"具有相类似的自我更新和多向分化潜能特性的"肿瘤干细胞"[1].细胞表面分子CD133在各类肿瘤干细胞的分选及鉴定中广泛应用[2].然而最近,CD133分子在脑胶质瘤、结直肠癌、肺癌等恶性肿瘤组织中作为肿瘤干细胞标志物的作用受到了质疑,例如,在脑胶质瘤中的研究表明,CD133阴性的肿瘤细胞在体外实验中也可具备自我更新及多向分化能力,在免疫缺陷鼠中亦可有效导致肿瘤发生;而且CD133阴性肿瘤细胞在免疫缺陷鼠中所诱发的肿瘤可包含CD133阳性肿瘤细胞[3].因此,CD133分子作为肿瘤于细胞,尤其是脑胶质瘤干细胞标志物的特异性成为当前研究的热点.     

人胶质瘤干细胞内在自我更新能力

目的 了解胶质瘤干细胞内在的自我更新和增殖能力。方法 观察原代胶质瘤细胞在单纯改良Eagle/F12培养液（DMEM/F12）中胶质瘤干细胞球的形成,并检测其CD133、胶质纤维酸性蛋白（GFAP）、微管相关蛋白（MAP2）、髓磷脂碱性蛋白（MBP）的表达。通过二代球体形成、细胞增殖测定、分化实验分析其自我更新、增殖、多能分化能力。通过裸鼠移植瘤实验观察所分离细胞球细胞与原代培养胶质瘤细胞成瘤能力的差异。结果 在单纯DMEM/F12培养液中形成的胶质瘤细胞球细胞表达神经干细胞标记CD133,不表达分化标志GFAP、MAP2,少数细胞表达MBP。分离出的胶质瘤细胞球细胞可在单纯DMEM/F12培养基中增殖,并能形成CD133阳性的二代细胞球,可分化为GFAP、MAP2、MBP阳性表达的肿瘤细胞。裸鼠成瘤实验显示其成瘤能力显著高于原代胶质瘤细胞。结论 胶质瘤干细胞能在无血清、无外源性细胞因子培养基中形成肿瘤干细胞球,胶质瘤干细胞的自我更新和增殖不依赖于外源性生长因子,它可能拥有自我更新的自身活化机制。     

无血清培养基体外分离培养人胶质瘤干细胞与鉴定

背景：最近有研究者采用神经干细胞的无血清培养基从脑肿瘤组织中培养出肿瘤干细胞。 目的：探讨利用无血清培养基从原发胶质母细胞瘤组织中分离培养胶质瘤干细胞的可行性。 设计、时间及地点：细胞学体外观察,于2008-08在山东省青岛市脑科研究所完成。 材料：胶质瘤组织来自青岛大学医学院附属医院神经外科手术切除标本,DMEM/F12培养基、B27为GIBCO公司产品,碱性成纤维细胞生长因子、表皮生长因子为Peprotech公司产品。 方法：无菌条件下取肿瘤深部无坏死囊变、未电凝组织,剪切消化成单细胞悬液后,加入含碱性成纤维细胞生长因子、表皮生长因子、B27添加剂的无血清DMEM/F12培养基,体外分离培养获得胶质瘤干细胞。待培养孔中细胞团数量增多、培养液刚刚变色时,吸取含有细胞团的培养液进行传代。取第3代胶质瘤干细胞,加入巢蛋白和CD133抗体行免疫荧光检测;加入含体积分数为0.1胎牛血清的DMEM/F12培养基诱导5 d,行胶质纤维酸性蛋白免疫荧光染色观察分化情况。 主要观察指标：原代与传代培养的胶质瘤干细胞形态及生长情况,胶质瘤干细胞巢蛋白、CD133的表达及其分化。 结果：原代培养7~10 d可形成大小不一的细胞团,球形或近似球形,呈悬浮或半悬浮状态生长,细胞形态均一,折光性好;传代24 h后次代细胞团形成,细胞的大小、形态与原代无明显差别,连续传代5次后细胞团增殖活跃。第3代胶质瘤干细胞呈巢蛋白和CD133阳性表达,加入胎牛血清后细胞球贴壁分化,呈胶质纤维酸性蛋白阳性。 结论：人脑胶质瘤组织中存在胶质瘤干细胞,在体外无血清条件下可保持未分化的悬浮状态;加入血清后贴壁分化呈胶质瘤细胞样或神经元样,符合干细胞的自我繁殖和多向分化特征。     

恶性胶质瘤细胞株U251中肿瘤干细胞的分离、培养及鉴定

目的:从恶性胶质瘤细胞株U251中分离、培养并鉴定肿瘤干细胞。方法:将U251细胞置于含EGF、bFGF、LIF及B27的无血清培养基中培养,形成悬浮生长的细胞球后经免疫磁珠分离获取CD133阳性细胞,采用单细胞克隆法继续在上述培养液中培养。应用细胞免疫荧光染色对肿瘤干细胞及其分化细胞进行鉴定。结果:在恶性胶质瘤细胞株U251中成功分离出肿瘤干细胞,在上述无血清培养液中呈悬浮生长,具有很强的自我更新与繁殖能力,免疫荧光染色显示该细胞表达CD133,诱导分化后可分化成为神经元与星形胶质细胞。结论:体外培养的恶性胶质瘤细胞株U251中存在脑肿瘤干细胞,并能将其分离、培养及诱导分化。     

小檗碱对U251胶质瘤干细胞的诱导分化作用

目的研究小檗碱对胶质瘤干细胞(GSC)分化的影响。方法用CD133免疫磁珠法由U251胶质瘤细胞中分选培养GSC,并用流式细胞术进行验证;细胞毒性实验评价小檗碱对GSC生长的抑制作用,采用不同浓度小檗碱(0.001、0.01、0.1、1μmol/L)作用于GSC,测量其吸光度值(OD);用RT-PCR、免疫荧光法检测干细胞标记物CD133、Nestin及细胞分化标记物胶质纤维酸性蛋白(GFAP)、微管相关蛋白2(MAP2)的表达水平。结果免疫磁珠法分选后CD133+细胞比例超过98%,无血清培养条件下能形成干细胞球。细胞毒性实验显示:小檗碱对GSC生长的抑制作用随剂量和时间的增加而增强。RT-PCR检测显示:随时间延长,小檗碱可使干细胞标记物CD133、Nestin基因的mRNA表达水平逐步降低,而细胞分化标记物GFAP、MAP2基因的mRNA表达水平逐渐升高。免疫荧光法检测显示:小檗碱能抑制CD133、Nestin蛋白的表达,上调GFAP、MAP2蛋白的表达。结论小檗碱能有效抑制GSC生长,并诱导其分化。     

人恶性胶质瘤细胞株U251三种克隆的分化特性和胶质瘤干细胞的初步鉴定

目的 观测U251细胞的克隆在形态和分化上的差异,鉴定含胶质瘤于细胞的克隆.方法 克隆形成实验观察U251细胞克隆的形态并分类,免疫细胞化学染色观测不同克隆GFAP和nestin的表达差异.分离低分化克隆,检测其自我更新能力、多向分化潜能及CD133表达情况.结果 U251细胞可形成紧密型、中间型和松散型三种克隆类型.紧密型克隆分化程度最低,此克隆在无血清培养基内形成神经干细胞样细胞球,具有自我更新能力、多向分化潜能,并表达CD133.结论 U251细胞的克隆在形态和分化程度上存在差异,紧密型克隆可能富含胶质瘤干细胞.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.