组织工程膀胱构建中生物支架材料及其性能评价

背景:利用肠道进行膀胱的修复和重建仍是进行膀胱替代的金标准.但是.由于肠道处在泌尿系的环境中,可能会引起代谢紊乱、感染、结石形成甚至恶变等一系列并发症.目的:总结评价组织工程膀胱构建中生物支架材料的性能,以寻找合理的膀胱替代物.方法:以"组织工程,膀胱,支架,间充质干细胞"为中文关键词,"tissue engineering,Bladder,Mesenchymal stem cells"为英文关键词,采用计算机检索1993-01/2009-10相关文章.纳入与有关种子细胞与组织工程膀胱相关及与膀胱生物支架材料相关的文章;排除重复研究或Meta分析类文章.以29篇文献为主,重点对一下5个问题进行了讨论:①如何稳定可靠迅速地获取充足的有活力的细胞源?②膀胱生物支架材料方面的选择?③修复重建膀胱的组织工程技术选择?④伦理学问题.⑤如何促进体外构建的膀胱组织植入体内后的快速血管化?结果与结论:采用自体间充质干细胞作为种子细胞应用于膀胱组织工程,不仅取材方便、具有低免疫原性,而且还可能分化为构建膀胱组织所必须的移行上皮细胞和平滑肌细胞以及血管内皮细胞、神经细胞从而改善再生组织的血供和神经功能,并能避免移植物纤维化挛缩,显示其独特的优越性,具有广阔的发展前景.但是,组织工程膀胱用于临床的有效性尚有待进一步评估,如组织工程膀胱与自体膀胱组织的愈合、结构和功能的重塑、血管化及神经支配的建立、伦理问题等重大难题都需要进一步研究.

Bio-scaffold materials and their functional evaluation in tissue-engineered urinary bladder construction

BACKGROUND: It is a gold standard to repair and construct bladder via intestinal tract. However, intestinal tract existing in urinary system may cause metabolic disorder, infection, lithogenesis, or even a series of severe complications.OBJECTIVE: To summarize the performance of tissue engineering during reconstruction of urinary bladder, and to search a reasonable replacement of urinary bladder.METHODS: A computer-based online search was conducted with the key words of "tissue engineering, bladder, mesenchymal stem cells" in both Chinese and English from January 1993 to October 2009. Inclusion criteria: Articles about correlation among seed cells, tissue-engineered bladder, and bio-scaffold materials were included. Exclusion criteria: Duplicated researches or Meta analysis was excluded. Among 29 articles, the following five points were mainly analyzed: how to stably and rapidly obtain sufficient and viable cell source; how to choose bio-scaffold materials of bladder; how to repair and reconstruct bladder tissue; how to solve the ethics problem; how to accumulate vascularization of the in vitro constructed bladder tissue after transplantation. RESULTS AND CONCLUSION: Autoallergic bone marrow mesenchymal stem cells (BMSCs) which were chosen for bladder tissue engineering characterized by convenient collection and low immunogenicity; additionally, BMSCs could differentiate into transitional epithelial cells, smooth muscle cells, vascular endothelial cells, and neurocytes so as to improve blood supply and neural function of regenerated tissue. Furthermore, BMSCs could help grafts avoid from fibration-contracture; therefore, BMSCs have a perspective application. However, the efficacy of tissue-engineered bladder needs to be further evaluated for clinical application. For example, the healing, structure, functional reconstruction, and vascularization of tissue-engineered bladder and autoallergic bladder tissue, innervated establishment, and ethical difficulty will be further studied in the future.