骨髓间充质干细胞移植在肝脏疾病中的应用

肝脏疾病是一组严重威胁人类健康的疾病,病程进展至晚期可导致肝硬化、肝衰竭,甚至肝细胞癌,全球发病率及病死率均较高。目前治疗手段以原位肝移植较为有效,但由于其治疗费用高昂、肝源供体短缺、远期存活率低等一系列问题限制了其在临床的广泛应用。近年来随着干细胞技术的日趋成熟,间充质干细胞与临床疾病的相关研究越来越多,此文就目前骨髓间充质干细胞移植治疗肝脏疾病的机理及临床应用作一综述。     

骨髓间充质干细胞移植治疗脑出血

脑出血起病急骤、病情凶险、病死率很高,目前缺乏真正有效的治疗措施和药物.骨髓间充质干细胞在特定微环境诱导下具有向多种细胞分化的潜能,而且已在不同微环境条件下将其成功诱导分化为成骨细胞、成软骨细胞、心肌细胞、神经元、神经胶质细胞等,为脑出血的治疗带来了新的希望.     

骨髓间充质干细胞移植对大鼠重症急性胰腺炎的治疗作用观察

目的探讨骨髓间充质干细胞（MSCs）移植对重症胰腺炎（SAP）的治疗作用及相关机制。方法将雄性SD大鼠120只随机分为假手术组、模型组及移植组各40只。模型组和移植组采用5%牛磺胆酸钠逆行胰胆管注射方法制作SAP模型,假手术组开腹后翻动肠壁即关腹。造模成功后移植组经门静脉植入MSCs;模型组及假手术组采用同样方法给予等量生理盐水。于24、48、72 h每组分别处死10只大鼠,对胰腺和肾脏损伤进行大体形态和光镜下观察,测定血清淀粉酶（AMY）、BUN、Cr、TNF-α和IL-6水平。结果模型组胰腺和肾脏组织损伤明显,各时间点血清AMY、BUN、Cr、TNF-α和IL-6水平均高于假手术组,P均〈0.05。移植组胰腺和肾脏组织损伤有所减轻;各时间点血清中AMY、BUN、Cr、TNF-α和IL-6水平均低于模型组及假手术组,P均〈0.05。结论经门静脉移植MSCs治疗SAP效果确切,可降低多器官功能障碍的发生率。     

骨髓间充质干细胞移植治疗阿尔茨海默病研究进展

阿尔茨海默病(AD)是一种与年龄相关的不可逆的神经退行性疾病[1],是老年人中引起痴呆最常见的一种疾病,具有高发病率、高患病率和高致残率特点.临床上以记忆力减退、认知功能障碍为特征,病情呈进行性加重,导致病人无法正常思考和判断,必须由他人照料生活.     

自体骨髓间充质干细胞移植对急性心肌梗死后心功能的影响

目的观察骨髓间充质干细胞（MSCs）经冠脉移植对急性心肌梗死后心功能的影响。方法24只日本大耳白兔,随机分为MSCs移植组（n=12）和培养液对照组（n=12）。从兔股骨抽取骨髓,体外培养MSCs。通过结扎左冠前降支建立急性心肌梗死模型。冠脉结扎后7d,细胞移植组和对照组直接经冠脉注入MSCs和培养液。于心肌梗死前、细胞移植前、细胞移植后1、2和4周对兔进行超声心动图检查。移植后4周处死动物,进行BrdU和第Ⅷ因子相关抗原免疫组化检测。结果移植后2周,MSCs移植组在射血分数（LVEF）和左室收缩末直径（LVESD）方面与移植前和对照组相比有显著改善（P<0.05）;移植4周后,LVEF、LVESD和左室舒张末直径（LVEDD）在MSCs移植组与移植前及对照组相比均有显著改善（P<0.05）。免疫组化检测发现,MSCs移植组BrdU染色阳性,血管计数较对照组明显增多（P<0.01）。结论经冠脉移植的MSCs可在梗死区心肌内存活并逐渐分化成心肌样细胞,促进毛细血管生成,显著改善心功能。     

骨髓间充质干细胞移植治疗心肌梗死的新技术

骨髓间充质干细胞移植是治疗心肌梗死的新途径之一,其技术和方法不断发展。诸如建立更好的大型活体实验动物模型；改进对植入细胞的标记追踪技术；进一步研究细胞植入的适宜方式和时间等。骨髓间充质干细胞移植和基因疗法相结合可能得到叠加的治疗效果。     

骨髓间充质干细胞移植治疗心肌梗死的新技术

骨髓间充质干细胞移植是治疗心肌梗死的新途径之一,其技术和方法不断发展.诸如建立更好的大型活体实验动物模型;改进对植入细胞的标记追踪技术;进一步研究细胞植入的适宜方式和时间等.骨髓间充质干细胞移植和基因疗法相结合可能得到叠加的治疗效果.     

骨髓间充质干细胞对大鼠急性肝损伤修复的影响

目的: 观察骨髓间充质干细胞(BMSCs)移植通过抑制RhoA-ROCK信号转导通路对大鼠急性肝损伤修复过程的影响.方法: 贴壁筛选法培养、纯化♂ S D大鼠BMSCs.将健康♀SD大鼠随机分为3组: 正常对照组(N组,n = 10)、CCl4组(C组,n = 10)及CCl4+BMSCs组(T组,n = 10).N组不予任何处理;T组和C组腹腔注射0.1 mL/100 g 600 mL/LCCl4花生油溶液制造急性肝损伤模型后24 h,分别经鼠尾静脉移植的间充质干细胞和等量PBS.各组于不同时间点留取标本,采用HE染色和血清肝功能酶学指标观察受损肝脏恢复过程;RT-PCR方法检测RhoA mRNA的表达;Western blot检测RhoA蛋白的表达.结果: 与C组相比,T组移植BMSCs后能显著改善CCl4急性损伤大鼠肝功能(1 d,ALT: 89.70±3.09 U/L vs 147.59±6.83 U/L,AST: 263.67±17.05 U/L vs 472.68±19.04 U/L,P＜0.01或0.05;7 d,ALT: 42.38±14.31 U/L vs 92.75±6.70U/L,AST 173.85±16.80 U/L vs 260.41±25.35U/L,均P＜0.05),并迅速修复肝脏结构.N组大鼠肝脏RhoA mRNA和蛋白表达量极低,C组经CCl4损伤后RhoA mRNA和蛋白表达量迅速增加(1.39±0.046 vs 0.57±0.010,1.23±0.020vs 0.35±0.036,均P＜0.01),此后表达量缓慢降低.T组经BMSCs移植后,与C组比较,RhoAmRNA和蛋白表达水平迅速下降.结论: Rho-ROCK信号转导通路参与CCl4导致的急性肝损伤发生、发展和修复全过程.BMSCs可能通过抑制RhoA-ROCK信号转导通路加速受损肝脏修复.     

骨髓间充质干细胞移植治疗心肌梗死的研究进展

骨髓间充质干细胞是一种多能干细胞,在体外培养时,可以通过诱导使其分化为心肌细胞等。目前进行的动物实验和临床Ⅰ期实验表明骨髓间充质干细胞具有促进血管增生以及改善心肌梗死后心脏功能的作用,为心肌梗死的治疗提供了广阔前景。     

骨髓间充质干细胞治疗急性肝衰竭的研究进展

骨髓间充质干细胞(bone marrow mesenchymal stem cells,BMSCs)是干细胞中一类具有自我增殖和分化潜能的细胞.在适宜的微环境下,BMSCs可分化为骨细胞、软骨细胞、脂肪细胞、神经细胞、肝细胞等多种细胞,基于此种特性使之成为原位肝移植或生物人工肝支持系统的新型种子细胞.本文就BMSCs的...     

Effect evaluation of interleukin-1 receptor antagonist nanoparticles for mesenchymal stem cell transplantation

AIM: To study the efficacy of marrow mesenchymal stem cells (MSCs) transplantation combined with interleukin-1 receptor antagonist (IL-1Ra) for acute liver failure (ALF). METHODS: Chinese experimental miniature swine were randomly divided into four groups (n = 7), and all animals were given D-galactosamine (D-gal) to induce ALF. Group A animals were then injected with 40 mL saline via the portal vein 24 h after D-gal induction;Group B animals were injected with 2 mg/kg IL-1Ra via the ear vein 18 h, 2 d and 4 d after D-gal induction; Group C received approximately 1 × 108 green fluorescence protein (GFP)-labeled MSCs (GFP-MSCs) suspended in 40 mL normal saline via the portal vein 24 h after D-gal induction; Group D animals were injected with 2 mg/kg IL-1Ra via the ear vein 18 h after D-gal induction, MSCs transplantation was then carried out at 24 h after D-gal induction, and finally 2 mg/kg IL-1Ra was injected via the ear vein 1 d and 3 d after surgery as before. Liver function, serum inflammatory parameters and pathological changes were measured and the fate of MSCs was determined.RESULTS: The optimal efficiency of transfection (97%) was achieved at an multiplicity of infection of 80, as observed by fluorescence microscopy and flow cytometry (FCM). Over 90% of GFP-MSCs were identified as CD44+ CD90+ CD45-MSCs by FCM, which indicated that most GFP-MSCs retained MSCs characteristics. Biochemical assays, the levels of serum inflammatory parameters and histological results in Group D all showed a significant improvement in liver injury compared with the other groups (P < 0.05). The number of GFP-MSCs in Group D was also greater than that in Group B, and the long-term cell proliferation rate was also better in Group D than in the other groups.CONCLUSION: MSCs transplantation is useful in ALF, IL-1Ra plays an important role in alleviating the inflammatory condition, and combination therapy with MSCs transplantation and IL-1Ra is a promising treatment for ALF.     

Targeted migration of mesenchymal stem cells modified with CXCR4 to acute failing liver improves liver regeneration

AIM: To improve the colonization rate of transplanted mesenchymal stem cells (MSCs) in the liver and effect of MSC transplantation for acute liver failure (ALF).METHODS: MSC was modified with the chemokine CXC receptor 4 (CXCR4) gene (CXCR4-MSC) or not (Null-MSC) through lentiviral transduction. The characteristics of CXCR4-MSCs and Null-MSCs were determined by real-time quantitative polymerase chain reaction, Western blotting and flow cytometry. CXCR4-MSCs and Null-MSCs were infused intravenously 24 h after administration of CCl₄ in nude mice. The distribution of the MSCs, survival rates, liver function, hepatocyte regeneration and growth factors of the recipient mice were analyzed.RESULTS: In vitro, CXCR4-MSCs showed better migration capability toward stromal cell-derived factor-1α and a protective effect against thioacetamide in hepatocytes. In vivo imaging showed that CXCR4-MSCs migrated to the liver in larger numbers than Null-MSCs 1 and 5 d after ALF. Higher colonization led to a longer lifetime and better liver function. Either CXCR4-MSCs or Null-MSCs exhibited a paracrine effect through secreting hepatocyte growth factor and vascular endothelial growth factor. Immunohistochemical analysis of Ki-67 showed increased cell proliferation in the damaged liver of CXCR4-MSC-treated animals.CONCLUSION: Genetically modified MSCs expressing CXCR4 showed greater colonization and conferred better functional recovery in damaged liver.     

诱导分化的骨髓间充质干细胞不同途径移植治疗慢性肝损伤的研究

目的 探讨诱导分化的骨髓间充质干细胞(MSC)不同途径移植治疗慢性肝损伤的可行性.方法 密度梯度离心法联合贴壁培养分离、扩增骨髓MSC,体外诱导向肝系细胞分化,反转录-聚合酶链反应(RT-PCR)、免疫细胞化学法检测肝系细胞标志,电镜观察超微结构的变化.清洁级Wistar大鼠120只,其中114只建立慢性肝损伤模型(实验组),另6只作为正常对照组.实验组8周内自然死亡12只,将剩余96只根据三种移植途径及体质量分层随机均分为门静脉移植实验组、门静脉移植对照组、脾脏移植实验组、脾脏移植对照组、尾静脉移植实验组和尾静脉移植对照组,各移植实验组移植4',6-二脒基-2'-苯基吲哚(DAPI)标记诱导分化14 d的MSC,观察移植后细胞的迁徙、定位,血清肝功能指标,肝脏组织病理学及移植效果.结果 诱导后第7、14天均检测到甲胎蛋白(AFP)mRNA表达,第14、21天检测到白蛋白(ALB)mRNA、兔抗鼠细胞角蛋白18(CK18)和肝细胞抗原表达.诱导后MSC胞体增大,胞质中含有较多线粒体、粗面内质网、高尔基体、溶酶体和糖原颗粒等.各移植实验组大鼠均发现DAPI标记细胞且丙氨酸转氨酶等肝功能指标及肝脏病变程度均较其移植对照组改善,以脾内移植途径更为显著[(98.13±8.22)U/L比(145.85±15.88)U/L,P＜0.05].结论 诱导分化的骨髓MSC通过三种移植途径均对慢性肝损伤具有修复作用,且脾内移植优于门静脉及尾静脉移植.     

Therapeutic potential of mesenchymal stem cells in the treatment of acute liver failure

Acute liver failure (ALF) is a severe and life-threatening condition in which rapid deterioration of liver function develops in a patient who has no preexisting liver disease. Mesenchymal stem cells (MSCs) are immunoregulatory stem cells which are able to modulate phenotype and function of all immune cells that play pathogenic role in the development and progression of ALF. MSCs in juxtacrine and paracrine manner attenuate antigen-presenting properties of dendritic cells and macrophages, reduce production of inflammatory cytokines in T lymphocytes, suppress hepatotoxicity of natural killer T (NKT) cells and promote generation and expansion of immunosuppressive T, B and NKT regulatory cells in acutely inflamed liver. Due to their nano-sized dimension and lipid envelope, intravenously injected MSC-derived exosomes (MSC-Exos) may by-pass all biological barriers to deliver MSC-sourced immunoregulatoy factors directly into the liver-infiltrated immune cells and injured hepatocytes. Results obtained by us and others revealed that intravenous administration of MSCs and MSC-Exos efficiently attenuated detrimental immune response and acute inflammation in the liver, suggesting that MSCs and MSC-Exos could be considered as potentially new remedies in the immunotherapy of ALF. In this review, we emphasize the current knowledge about molecular and cellular mechanisms which are responsible for MSC-based modulation of liver-infiltrated immune cells and we discuss different insights regarding the therapeutic potential of MSCs in liver regeneration.     

Intraportal mesenchymal stem cell transplantation prevents acute liver failure through promoting cell proliferation and inhibiting apoptosis

BACKGROUND: Transplantation of mesenchymal stem cells(MSCs) has been regarded as a potential treatment for acute liver failure(ALF), but the optimal route was unknown. The present study aimed to explore the most effective MSCs transplantation route in a swine ALF model.METHODS: The swine ALF model induced by intravenous injection of D-Gal was treated by the transplantation of swine MSCs through four routes including intraportal injection(In P group), hepatic intra-arterial injection(AH group), peripheral intravenous injection(PV group) and intrahepatic injection(IH group). The living conditions and survival time were recorded. Blood samples before and after MSCs transplantation were collected for the analysis of hepatic function. The histology of liver injury was interpreted and scored in terminal samples. Hepatic apoptosis was detected by TUNEL assay. Apoptosis and proliferation related protein expressions including cleaved caspase-3, survivin, AKT, phospho-AKT(Ser473), ERK and phospho-ERK(Tyr204) were analyzed by Western blotting.RESULTS: The average survival time of each group was 10.7 ±1.6 days(In P), 6.0±0.9 days(AH), 4.7±1.4 days(PV), 4.3±0.8 days(IH), respectively, when compared with the average survival time of 3.8±0.8 days in the D-Gal group. The survival rates between the In P group and D-Gal group revealed a statistically significant difference(P0.01). Pathological and biochemical analysis showed that liver damage was the worst in the D-Gal group, while less injury in the In P group. Histopathological scores revealed a significant decrease in the In P group(3.17±1.04, P0.01) and AH group(8.17±0.76, P0.05) as compared with that in the D-Gal group(11.50±1.32). The apoptosis rate in the In P group(25.0%±3.4%, P0.01) and AH group(40.5%±1.0%, P0.05) was lower than that in the D-Gal group(70.6%±8.5%). The expression of active caspase-3 was inhibited, while the expression of survivin, AKT, phosphoAKT(Ser473), ERK and phospho-ERK(Tyr204) was elevated in the In P group.CONCLUSIONS: Intraportal injection was superior to other pathways for MSC transplantation. Intraportal MSC transplantation could improve liver function, inhibit apoptosis and prolong the survival time of swine with ALF. The transplanted MSCs may participate in liver regeneration via promoting cell proliferation and suppressing apoptosis during the initial stage of ALF.     

骨髓间充质干细胞移植治疗大鼠急性肝功能衰竭

目的探讨骨髓间充质干细胞（BMSCs）移植对急性肝功能衰竭的治疗作用。方法大鼠90%肝脏切除制备急性肝功能衰竭模型,实验组大鼠肝内移植2×106个BMSCs,对照组仅注射生理盐水。观察大鼠的生存情况,RT-PCR检测BMSCs在肝脏的植入,血清检测肝功能确认BMSCs移植对肝脏修复的作用。结果移植BM-SCs的实验组大鼠存活80%,对照组大鼠仅存活20%。RT-PCR显示,BMSCs移植后定植于大鼠肝脏内。肝功能检测显示,实验组大鼠的血清丙氨酸氨基转移酶水平、天冬氨酸氨基转移酶水平显著降低,血清白蛋白水平显著升高。结论 BMSCs移植可以显著提高急性功能衰竭大鼠的生存率,促进其肝功能的恢复,对急性肝功能衰竭的治疗具有积极作用。     

Combined mesenchymal stem cell transplantation and interleukin-1 receptor antagonism after partial hepatectomy

AIM: To study the therapeutic effects of mesenchymal stem cells(MSCs) and an interleukin-1 receptor antagonist(IL-1Ra) in acute liver failure. METHODS: Chinese experimental miniature swine(15 ± 3 kg, 5-8 mo) were obtained from the Laboratory Animal Centre of the Affiliated Drum Tower Hospital of Nanjing University Medical School. Acute liver failure was induced via 85% hepatectomy, and animals were treated by MSC transplantation combined with IL-1Ra injection. Blood samples were collected for hepatic function analysis, and the living conditions and survival time were recorded. Liver injury was histologically analyzed. Hepatic cell regeneration and apoptosis were studied by Ki67 immunohistochemistry and terminal deoxynucleotidyl transferase d UTP nick end labeling, respectively. The levels of protein kinase B and nuclear factor-κB expression were analyzed by Western blotting.RESULTS: MSCs were infected with a lentivirus for expression of green fluorescent protein(GFP) for subsequent identification; 97.3% of the MSCs were positive for GFP as assessed by flow cytometry.Additional flow cytometric analysis of cell surface marker expression demonstrated that 90% of GFP-expressing MSCs were also positive for CD29, CD44, and CD90, indicating that most of these cells expressed typical markers of MSCs, and the population of MSCs was almost pure. Transplantation of MSCs in combination with 2 mg/kg IL-1Ra therapy significantly improved survival time compared to the acute liver failure model group(35.3 ± 6.7 d vs 17.3 ± 5.5 d, P 0.05). Combined therapy also promoted improvement in serum inflammatory cytokines and biochemical conditions. The observed hepatic histopathologic score was significantly lower in the group with combined therapy than in the model group(3.50 ± 0.87 vs 8.17 ± 1.26, P 0.01). In addition, liver cell apoptosis in the combined therapy group was significantly inhibited(18.1 ± 2.1% vs 70.8 ± 3.7%, P 0.01), and hepatic cell regeneration increased. A significant increase in protein kinase B expression and decrease in nuclear factor-κB expression were observed(P 0.01), which supports their important roles in liver regeneration.CONCLUSION: MSCs and IL-1Ra had a synergistic effect in liver regeneration via regulation of inflammation and apoptotic signaling.     

间充质干细胞治疗急性肺损伤/急性呼吸窘迫综合征的研究进展

间充质干细胞已成为21世纪最有前途的组织工程材料之一,研究表明其在脓毒血症、急性肾衰竭、急性心肌梗死等疾病中有潜在的治疗作用,大量的临床前研究也证实其能减轻急性肺损伤的炎症反应,改善肺部渗出液体的清除,促进受损肺组织的修复,具有广阔的临床应用前景.本文就间充质干细胞临床移植治疗急性肺损伤的前景及存在问题予以综述.     

骨髓间充质干细胞移植治疗心肌梗死机制的研究进展

心肌梗死（myocardial infarction,MD是由于冠状动脉循环改变引起冠状血流和心肌需求之间不平衡而导致的心肌损害,是临床上一种严重的缺血性心脏病（ischemic heart isease,IHD）。梗死的心肌细胞逐渐被瘢痕组织取代,由于瘢痕组织缺乏弹性,难以满足心脏收舒功能的要求,