人肝干细胞改善暴发性肝功能衰竭模型引起的肝损伤(摘译)

Herrera MB,Fonsato V,Bruno S,et al.Human liver stem cells improve liver injury in a model of fulminant liver failure[J].Hepatology,2013,57(1):311-319.暴发性肝功能衰竭是一种严重威胁生命的疾病。目前治疗该疾病唯一确切有效的方法是肝脏移植,但肝脏移植受到诸多因素的限制,如供体器官的     

脂肪间充质干细胞移植治疗肝功能衰竭

BACKGROUND:Studies have found that both bone marrow mesenchymal stem cells and umbilical cord mesenchymal stem cells have therapeutic effects on liver failure, but little is reported on adipose-derived mesenchymal stem cell transplantation for treatment of liver failure. OBJECTIVE:To discuss the therapeutic effect of adipose-derived mesenchymal stem cell transplantation on rat liver failure. METHODS:Forty-five Sprague-Dawley rats were equally randomized into transplantation, model and control group. Except the control group, animal models of liver failure were made by intraperitoneal injection of D-galactosaminein in the transplantation and model groups. One week after modeling, rats in the transplantation group were given 1 mL of adipose-derived mesenchymal stem cells via the tail vein. RESULTS AND CONCLUSION:Adipose-derived mesenchymal stem cell transplantation successfully upregulated alanine aminotransferase and aspartate aminotransferase levels, and moreover, neatly arranged liver cells, reduced inflammatory cells and intact hepatic lobule were shown on B ultrasound after cell transplantation. All these findings indicate that adipose-derived mesenchymal stem cell transplantation has therapeutic effects on rat liver failure by improving rat’s liver function and pathological changes.     

APA微囊猪肝细胞移植治疗大鼠急性肝功能衰竭的实验研究

目的探讨APA微囊猪肝细胞移植治疗大鼠急性肝功能衰竭的有效性。方法用胶原酶灌注分离猪肝细胞,用海藻酸钠-聚赖氨酸-海藻酸钠(alginate-polylysine-alginate,APA)包埋肝细胞,测定肝细胞产量和存活率。用氨基半乳糖诱导建立大鼠急性肝功能衰竭(fulminatehepaticfailure,FHF)模型(n=68),实验动物分为微囊肝细胞植入组、游离肝细胞植入组、空囊组、对照组4组。分别将微囊肝细胞、游离肝细胞、空微囊、生理盐水植入或注入FHF大鼠腹腔,观察治疗效果。结果分离肝细胞产量为1.74×1010～2.90×1010个,微囊肝细胞存活率>80%。APA微囊肝细胞组与游离肝细胞、空囊和对照组相比,能提高FHF大鼠存活率,延长存活时间,改善肝功能。结论APA微囊猪肝细胞腹腔移植治疗FHF大鼠有较好疗效。ExperimentalStudyonHepaticFailureRatInstitute,Tianjin300170AbstractObjectiveThepaticfailurerat.Methpolylysine-alginate(APA(FHF)ratsweresetup     

诱导多功能干细胞源性肝细胞治疗肝功能衰竭的研究进展

肝细胞移植治疗多种原因造成的肝功能衰竭,在临床上已取得较好的疗效.诱导多功能干细胞（iPS）及其定向分化技术的进步,为获得大量、安全及具有生物学功能活性的肝细胞移植所需的种子细胞提供了一种新的方法.对iPS定向分化成肝细胞并应用于肝细胞移植治疗肝功能衰竭的研究进展进行综述.     

同种异体骨髓间充质干细胞移植治疗急性肝功能衰竭

背景：对于急性肝功能衰竭的临床治疗,目前尚缺乏特效手段。骨髓间充质干细胞在特定环境下可分化为具有部分肝功能的类肝样细胞,从而参与肝功能的修复和重构,为急性肝功能衰竭的治疗提供了新的手段。 目的：评价同种异体骨髓间充质干细胞移植治疗大鼠急性肝功能衰竭的疗效,为其临床应用提供理论依据。 方法：采用全骨髓培养法培养并纯化其骨髓间充质干细胞。30只健康SD大鼠随机均分为3组：正常对照组：不予任何处理;肝衰竭组和移植组：用腹腔注射四氯化碳石蜡油溶液的方法复制鼠急性肝功能衰竭模型后24 h分别经其尾静脉注射生理盐水和等量骨髓间充质干细胞。在移植后第1,2,3,7天抽血检测其肝功能,并取肝脏行病理学检查。 结果与结论：急性肝功能衰竭鼠经骨髓间充质干细胞移植治疗后生存率为70%,与肝衰竭组大鼠存活率20%相比差异有显著性意义(P < 0.05);肝功能指标中谷丙转氨酶和谷草转氨酶相比,移植组明显低于肝衰竭组,差异有显著性意义(P < 0.05)。肝脏组织病理学结果显示移植组肝细胞变性及坏死程度以及炎症浸润程度轻于肝衰竭组。因此,经尾静脉移植骨髓间充质干细胞能提高急性肝功能衰竭大鼠的生存率、改善肝功能及减轻肝脏坏死程度,对大鼠急性肝功能衰竭有一定的治疗作用。     

人脐带源间充质干细胞静脉移植治疗大鼠肝纤维化

背景：近来国内外研究证明,来自其他组织的干细胞能够归巢到肝脏,并可能参与肝组织的再生,这为发展干细胞治疗肝脏疾病提供了新的希望。 目的：探究人脐带源间充质干细胞的分离、培养方法,观察脐带间充质干细胞移植对大鼠肝纤维化模型的修复作用,为脐带间充质干细胞的临床应用提供可靠的理论依据。 方法：自然贴壁法分离、纯化人脐带间充质干细胞并进行体外培养和扩增,用皮下多点注射CCl₄制备肝纤维化大鼠模型。将22只模型大鼠随机分为模型损伤组(n=11)和细胞移植组(n=11)。细胞移植组在模型制备成功后的第1,2,3周经尾静脉给予1×10⁶脐带间充质干细胞治疗,4周后将大鼠处死,收集各组大鼠血液检测肝功能;摘取肝脏行苏木精-伊红染色,观察病理变化;免疫组化法观察库普弗细胞的数量及分布;免疫组化法观察治疗组脐带间充质干细胞的定位情况。 结果与结论：脐带间充质干细胞经尾静脉移植入肝硬化大鼠后,大鼠的肝功能均明显改善,与对照组比较,差异有显著性意义(P < 0.05);肝组织苏木精-伊红染色提示,肝纤维化程度明显改善;免疫组化法观察库普弗细胞的数量提示,库普弗细胞数量明显减少;免疫组化方法利用抗BrdU抗体在治疗组大鼠肝脏观察到BrdU标记的脐带间充质干细胞。说明脐带间充质干细胞移植可以改善大鼠外周血液的血生化特性和肝的组织学结构。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程全文链接：     

骨髓间充质干细胞经尾静脉移植治疗肝纤维化

BACKGROUND: Liver fibrosis is the early stage of terminal liver diseases. Effective treatment for liver fibrosis can prevent the occurrence of terminal liver diseases. Bone marrow mesenchymal stem cell transplantation is a promising method to treat liver fibrosis. OBJECTIVE: To study the therapeutic effect of bone marrow mesenchymal stem cells on liver fibrosis in rats. METHODS: Eighteen Sprague-Dawely rats were randomized into three groups: control, model and cell transplantation groups. Animal models of carbon tetrachloride-induced liver fibrosis were made in the latter two groups. After modeling, 1 mL bone marrow mesenchymal stem cells (5×105) or the same volume of normal saline was injected via the tail vein into the rats in the cell transplantation and model groups, respectively. Rats in the control group were given no treatment. Degree of liver fibrosis, liver function, histological changes of the liver were detected and observed in the three groups at 4 weeks after treatment. RESULTS AND CONCLUSION: In the control group, the liver tissues had normal structure with no fibrosis; in the model group, proliferation of fibrous tissues in the portal area of the liver, inflammatory cell infiltration, vacuolar degeneration and irregular arrangement of liver cells, and tissue structure damage were observed; in the transplantation group, liver tissue damage was severer than the control group but milder than the model group. Levels of serum hyaluronidase, type IV collagen and procollagen III were significantly lower in the cell transplantation group than the model group (P < 0.05). These findings indicate that bone marrow mesenchymal stem cell transplantation can alleviate liver fibrosis and improve liver function in rats with carbon tetrachloride-induced liver fibrosis.  中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程      

野生蕈类致中毒性脑病及暴发性肝功能衰竭1例

食用覃类味道鲜美且富于营养。毒覃由于其外观与无毒者不易区别,常因误食引起中毒。野生蕈类中毒致中毒性脑病及暴发性肝功能衰竭,文献报道较少。我院收治1例野生蕈类致中毒性脑病及暴发性肝功能衰竭,经护肝、抗感染、营养支持、抑制炎症反应、脱水降颅压等治疗获得了较好的效果。现报告如下。     

肝干细胞的研究进展

肝干细胞又称肝卵圆细胞，在一定病生理条件下可向肝细胞和胆管上皮细胞、胰腺外分泌上皮等有限的几种组织细胞分化，具有多向分化增殖潜力，体外培养肝干细胞将为生物型人工肝提供一种新的细胞来源，肝干细胞移植不但可以替代坏死的肝组织，还可以刺激受体组织再生以达自身修复，治疗急性或亚急性肝坏死；同时为基因治疗提供新的可能。本将就肝干细胞分类、表面标志、来源、诱导分离方法及人类肝干细胞的研究综述如下。     

间质干细胞移植在大鼠缺血性脑卒中的实验研究

目的:探索间质干细胞移植在脑梗塞大鼠的脑内分化及促进神经功能的修复作用。方法:从健康人的肋骨骨髓中分离、纯化而获得的间质干细胞,经体外培养、扩增、鉴定的同时制造大脑中动脉皮层梗塞的实验动物模型;并且,在梗塞后10 d移植所鉴定的间质干细胞经免疫组化验证间质干细胞的脑内成活、及神经性分化后,在第2周和第6周进行神经功能评分。结果:间质干细胞在梗塞灶周边向神经元和神经胶质细胞的方向分化;移植的神经功能评分,修复作用与对照组有显著差异。结论:人间质干细胞为脑梗塞治疗提供了新的思路。     

Early up-regulation of chemokine expression in fulminant hepatic failure

CC-chemokines recruit and activate macrophages and T lymphocytes, the major components of inflammatory infiltrates in fulminant hepatic failure (FHF). To analyse the role of CC-chemokines in the pathogenesis of FHF, this study examined serum levels and intrahepatic expression of MCP-1, MIP-1alpha, MIP-1beta, and RANTES in the livers and sera of patients with FHF and controls by ELISA, immunohistochemistry, and competitive RT-PCR. Serum levels and intrahepatic expression of all chemokines studied in FHF exceeded the levels in chronic liver diseases and normal controls. Distinct patterns of expression of each chemokine were noted on Kupffer cells, sinusoidal endothelial cells, hepatocytes, lymphocytes, and bile ducts. Intrahepatic chemokine expression correlated closely with the extent of infiltration by macrophages and T lymphocytes (r = 0.65-0.95, p < 0.001). The functional relationship between intrahepatic chemokine release and infiltration was confirmed in chemotaxis assays by inhibiting chemotaxis induced by homogenates of liver tissue obtained from FHF patients with neutralizing MCP-1, MIP-1alpha, MIP-1beta, and RANTES antibodies. The time course of CC-chemokine release was studied in the concanavalin A and the galactosamine/LPS mouse models of FHF. In both models, intrahepatic chemokine up-regulation occurred as an early event prior to hepatic infiltration and liver damage. The data indicate that an abundant intrahepatic release of CC-chemokines is an early and pivotal step in the pathogenesis of FHF.     

肝干细胞的研究进展

肝干细胞又称肝卵圆细胞 ,在一定病生理条件下可向肝细胞和胆管上皮细胞、胰腺外分泌上皮等有限的几种组织细胞分化 ,具有多向分化增殖潜力 ,体外培养肝干细胞将为生物型人工肝提供一种新的细胞来源 ,肝干细胞移植不但可以替代坏死的肝组织 ,还可以刺激受体组织再生以达自身修复 ,治疗急性或亚急性肝坏死 ;同时为基因治疗提供新的可能。本文将就肝干细胞分类、表面标志、来源、诱导分离方法及人类肝干细胞的研究综述如下     

微囊小肝细胞样前体细胞移植治疗大鼠急性肝衰竭

目的探索大鼠海藻酸钠-聚赖氨酸-海藻酸钠(APA)微囊小肝细胞样前体细胞(SHPC)移植治疗急性肝衰竭(AHF)大鼠模型的可行性和有效性。方法选择体质量150~180 g健康雄性Wistar大鼠10只。采用Retrosine(30 mg/kg)腹腔内注射联合2/3肝切除诱导雄性Wistar大鼠SHPC增殖模型,改进Seglen胶原酶灌注联合Percoll密度梯度离心分离SHPC,倒置显微镜、电子显微镜下观察,并进行免疫组织化学染色;静电液滴法APA微囊包埋。选择体质量180~220 g健康雌性Wistar大鼠20只,随机分为A组(微囊化SHPC腹腔内移植)、B组(空囊对照组);采用D-氨基半乳糖腹腔注射制备大鼠AHF模型;观察模型一般状况及生存时间,术后不同时间点检测血清丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)及血氨水平,检测肝脏病理改变。结果Retrosine腹腔内注射联合2/3肝切除成功建立SHPC增殖模型,分离获得细胞符合大鼠SHPC;APA微囊呈光滑规则球形,直径为(300±40)μm,强度、韧性良好,囊内细胞形态完整,存活率为(90.0±1.3)%。微囊SHPC移植后,A组较B组中位生存时间延长(119.00 h vs 70.33 h),差异有统计学意义(P<0.05);随时间延长,A组大鼠血清ALT、AST、TBiL及血氨水平明显下降,均低于移植前水平,各时间点A组明显低于B组,差异有统计学意义(P<0.05);肝组织病理显示A组肝细胞损伤较B组明显改善;存活48 h大鼠腹腔内微囊保持完整光滑球形,囊内SHPC形态完整,1周微囊有散在破损皱缩,囊内细胞有增多聚集趋势,细胞存活率85%以上。结论APA微囊化大鼠SHPC腹腔内移植能改善大鼠AHF模型生存时间、生物化学指标(ALT、TBiL等)及病理损伤。     

The role of hepatic venous congestion and endotoxaemia in the production of fulminant hepatic failure secondary to congestive heart failure

The present study was undertaken to clarify the role of congestion of the liver and endotoxemia in the production of fulminant hepatic failure secondary to congestive heart failure. Induction of congestion of the liver, i.e. an elevation of hepatic venous pressure, in rats was accomplished by partial obstruction of the inferior vena cava. A close relationship was demonstrated between venous pressure and serum levels of transaminases as a measure of hepatic dysfunction. Hepatic dysfunction was mild in rats with venous hypertension alone, and only centrilobular congestion was seen on microscopy. In contrast, severe abnormalities of hepatic function were induced by venous hypertension and endotoxaemia. Histologically, the liver revealed bridging centrilobular necrosis as seen in patients with congestive heart failure who develop fulminant hepatic failure. These data suggest that coexistence of endotoxaemia and congestion of the liver may induce fulminant hepatic failure, and that the latter alone is associated only with slight hepatic dysfunction and liver damage.     

Hepatic morphology and histochemistry of Wilson''s disease presenting as fulminant hepatic failure: a study of 11 cases

Eleven cases of Wilson's disease presenting as fulminant hepatic failure were analysed retrospectively to determine the specificity or otherwise of the histological findings. All cases were cirrhotic, eight with a micronodular pattern. There was marked parenchymal collapse with ductular proliferation and mild inflammation. Other features included cholestasis, hepatocyte necrosis, microvesicular fat and nuclear vacuolation. Orcein staining demonstrated copper-associated protein in the periphery of cirrhotic nodules in all cases and also variably within nodules in eight cases. Copper was demonstrable by the rhodanine method in similar locations but the staining reaction was qualitatively weaker in all cases. Characteristically, there was staining of both parenchymal and mononuclear phagocytic cells. This triad of cirrhosis, strong copper-associated protein deposition and copper positivity was not present in a control group of 20 cases of fulminant hepatic failure of other aetiology and with a similar clinical presentation. It is concluded that in the clinical context of fulminant hepatitis the presence of cirrhosis should raise the suspicion of Wilson's disease and that, with routinely processed and stained tissue, including autopsy tissue, the diagnosis can be made histologically.     

人胎儿肝干细胞分离鉴定及体内移植

目的分离鉴定人胎儿肝干细胞,并观察其对急性肝损伤严重联合免疫缺陷(SCID)小鼠进行异种移植的治疗效果。方法以改进Seglen胶原酶(Ⅳ型)原位灌注结合Percoll密度梯度离心法分离纯化要求终止中期妊娠而流产的男性胎儿肝干细胞,经光镜、电镜下观察细胞特点,进行肝干细胞细胞标志SABC免疫组化染色。经肝脏直接注射移植人胎儿肝干细胞(106细胞)以治疗D-氨基半乳糖(800mg/kg)诱发的急性肝损伤雌性SCID小鼠,于移植前及移植后24、48、72h、1周取血测定ALT、TBiL,于移植后1、2、4周取受体肝脏组织,PCR方法检测受体肝组织性别决定因子。结果人胎儿肝干细胞平均细胞产量(2.10±0.50)×107,细胞活性率为(92.30±1.23)%;光镜下呈游离状态、大小不等的单个细胞,约为正常肝细胞1/5～1/3大小;电镜下细胞表面可见少量短而小的微绒毛状突起,卵圆形细胞核,核/浆比例较大等特点;甲胎蛋白、细胞角蛋白8、19及α-1-抗胰蛋白酶免疫组化染色呈阳性,白蛋白及白细胞共同抗原染色呈阴性表现,培养3周可形成克隆样结构。人胎儿肝干细胞移植组急性肝损伤SCID小鼠移植24h后血清ALT、TBiL水平降低,各时间点均低于对照组(P<0.05),且肝脏病理损伤逐渐减轻;存活2周小鼠肝脏组织中PCR测定性别决定因子呈阳性表达,随时间延长表达增强。结论该方法能成功分离高产量、高活性人胎儿肝干细胞,在急性肝损伤SCID小鼠体内移植存活,并改善其肝功能、肝脏病理指标。     

Fulminant hepatic failure in the elderly: a clinicopathological study of autopsy cases aged over 65 years

The pathology of fulminant hepatic failure (FHF) in the elderly is little known because of its very low frequency. Thirteen autopsy cases, all above 65 years of age (mean ± SD, 72 ± 6 years), and 10 younger control cases, all below 40 years of age (30 ± 7 years), were analyzed. The elderly group comprised 10 cases with subacute FHF and three cases with acute FHF, while the younger group comprised seven cases with subacute FHF and three cases with acute FHF. The most predominant pathological type in the elderly group was submassive hepatic necrosis (10 cases), followed by acute hepatitis with bridging hepatic necrosis (AH-BHN; two cases) and massive hepatic necrosis (one case). In two cases of submassive hepatic necrosis, hepatic regeneration seemed to be insufficient for the suggested history. The underlying diseases and terminal complications were significantly more frequent in the elderly group than in the younger group. In conclusion, the immune response in the elderly group is found to be strong enough to cause massive or submassive hepatic necrosis. However, impaired hepatic regeneration is occasionally observed in the elderly cases and AH-BHN is often lethal because of frequent underlying diseases and severe complications.     

间充质干细胞的免疫调节特性及其在干细胞移植中的应用

间充质干细胞具有独特的免疫负调节特性,能在不同层次作用于T淋巴细胞、B淋巴细胞、自然杀伤细胞（NK细胞）和树突状细胞,通过直接接触、分泌细胞因子转化生长因子（TGF-β）或调节这些细胞的代谢而发挥免疫调节作用,可望在干细胞移植后免疫重建及移植物抗宿主病的治疗中发挥重要作用。     

Acute hepatic failure: limitations of medical treatment and indications for liver transplantation

Dedicated to Prof. Dr. G. Paumgartner on the occasion of his 60th birthday     

同基因与异基因胚胎肝干细胞移植治疗小鼠肝硬化

背景：胚胎肝干细胞移植免疫相关研究较少,同基因与异基因胚胎肝干细胞移植对小鼠肝硬化的治疗作用,目前尚不清楚。 目的：观察同种同基因与同种异基因胚胎肝干细胞移植对小鼠肝硬化的治疗作用,以及治疗过程中免疫排斥反应发生情况。 方法：采用Ⅳ型胶原酶消化法分离纯化BALB/c与C57BL/6胚胎肝干细胞。104只健康BALB/c小鼠随机分为4 组：正常对照组不予任何处理;肝硬化组、同种同基因移植组、同种异基因移植组腹腔注射四氯化碳石蜡油溶液复制肝硬化模型,16周后分别经其尾静脉注射生理盐水,等量同种同基因胚胎肝干细胞和同种异基因胚胎肝干细胞。在移植4周后比较各组受体小鼠存活情况、肝功能恢复情况、肝纤维化程度、免疫细胞(CD4⁺T、CD8⁺T、NK、NKT)数目及比值、肝脏病理学变化。 结果与结论：同种同基因移植组和同种异基因移植组生存率均为100%,与肝硬化组小鼠存活率67%相比差异有显著性意义(P < 0.05);各组肝功能和肝纤维化指标差异无显著性意义(P > 0.05)。各组免疫学指标比较差异无显著性意义(P > 0.05)。肝脏组织病理学显示肝组织修复：同种异基因移植组>同种同基因移植组>肝硬化组。因此,经尾静脉移植胚胎肝干细胞能提高肝硬化小鼠的生存率、减轻肝细胞坏死程度;同种同基因与同种异基因胚胎肝干细胞移植未发现免疫排斥,对小鼠肝硬化有一定的治疗作用。