间充质干细胞治疗移植物抗宿主病的研究进展

目前，激素类药物是治疗急性移植物抗宿主病（aGVHD）的标准首选药物。aGVHD的二线治疗药物有巴利昔单抗、甲氨蝶呤（MTX）、芦可替尼等。抗胸腺细胞球蛋白（ATG）、间充质干细胞（MSCs）、粪菌移植等在治疗移植物抗宿主病（GVHD）方面也有应用。近年来，不少基础以及临床研究将MSCs应用在异基因造血干细胞移植后GVHD的预防和治疗方面。MSCs可通过细胞间接触而释放免疫调节因子来实现免疫抑制功能。可溶性因子、氧浓度、toll样受体配体（TLR）、MSCs注射剂量、免疫抑制剂的采用和温度控制等因素影响了MSCs在GVHD中的治疗效果，但具体机制有待进一步研究。大多数研究显示MSCs治疗对急性和慢性GVHD均有益处，但由于缺乏大规模的随机对照试验，这一结果仍有待证实。对目前治疗GVHD的主要方法进行总结，着重于前沿技术MSCs的临床研究和作用机制，并且对进一步发展新的治疗策略提出相应观点。

Research Progress of Mesenchymal Stem Cells for Graft-versus-Host Disease

Currently, hormonal drugs are the first choice for the treatment of acute graft-versus-host disease (aGVHD). The second-line treatment drugs for aGVHD include basiliximab, methotrexate (MTX), ruxolitinib, etc. Antithymocyte globulin (ATG), mesenchymal stem cells (MSCs), and fecal bacterial transplantation are also used in the treatment of GVHD. In recent years, MSCs employed for the prevention and treatment of GVHD after allo-HSCT have generated a wealth of basic and clinical research. MSCs can achieve immunosuppressive function through cell-to-cell contact and release of immunomodulatory factors. Soluble factors, oxygen concentration, distinct ligands of Toll-like receptors (TLR), injection dose, immunosuppressant adoption and temperature control are engaged in the therapeutic effects of MSCs, yet their underlying mechanisms remain to be elucidated. Most studies have revealed that MSCs therapy could benefit acute and chronic GVHD, but that still remains to be confirmed due to lack of large-scale randomized controlled trial. This paper summarizes the main treatment methods for GVHD, with focus on the clinical research and mechanism of the cutting-edge technology of MSCs, and attempts to provide some insight for further development of new therapeutic strategies.