Ka loiloi o ka palekana a me ka pono o ka Neurotrophic factor therapy ma Ischemic Stroke

ʻO ka maʻi maʻi cerebral, i ʻike ʻia ʻo "stroke" a i ʻole "cerebrovascular accident" (CVA), he maʻi cerebrovascular acute i hōʻike ʻia e ka haki koke ʻana o nā kīʻaha koko i loko o ka lolo a i ʻole ke keʻakeʻa ʻana i ke kahe o ke koko i ka lolo, e hopena ai i ka pōʻino o ka ʻiʻo o ka lolo. Loaʻa iā ia nā maʻi ischemic a me ka hemorrhagic stroke. ʻO ka maʻi maʻi ka lua o ke kumu nui o ka make ma ka honua holoʻokoʻa, me ka nui o ka make a me ke kino kīnā i nā pākeke.

ʻO ka Ischemic Stroke (IS) e pili ana i ka necrosis ischemic kūloko a i ʻole ka palupalu o ka ʻiʻo o ka lolo i hoʻokumu ʻia e nā maʻi cerebrovascular circulation, ischemia, a me hypoxia. Ma muli o ke kiʻekiʻe o ka maʻi, ka laha, ka make, a me ka helu kīnā, ua lilo ia i kumu nui o ke kaumaha o ka maʻi honua. Wahi a nā helu helu, ma kahi o 15 miliona mau kānaka ma ka honua holoʻokoʻa e loaʻa ana i ka maʻi ischemic stroke i kēlā me kēia makahiki, me 5 miliona mau make a me 5 miliona mau kānaka e loaʻa ana i nā kīnā lōʻihi.

Ka Mechanism of Stem Cell Therapy for Ischemic Stroke

ʻO Mesenchymal Stem Cells (MSCs) kekahi ʻano o nā pūnaewele multipotent i hiki ke hoʻokaʻawale ʻia mai nā ʻiʻo like ʻole, e like me ka ʻiʻo iwi, ka ʻiʻo adipose, a me ke koko umbilical cord. Ma muli o kā lākou mau waiwai pluripotent, hiki iā lākou ke hoʻokaʻawale i nā osteoblasts, chondrocytes, adipocytes, a me nā neurons. I kēia manawa, ua puka mai ka hoʻololi ʻana o MSC ma ke ʻano he ala lapaʻau hou no nā maʻi ischemic, e like me ka hahau ʻana, ka maʻi ʻaʻaʻa coronary, a me ka maʻi aʻa peripheral. Ua hōʻike ʻia nā haʻawina he nui ʻo ka hopena neuroprotective maikaʻi loa o MSC he kumu nui i ka mālama ʻana i ka maʻi ischemic.

Hōʻike nā hōʻike noiʻi o kēia manawa ʻo MSC ka mea e hoʻoikaika nui ai i ka hoʻoponopono ʻana i ka pōʻino o ka neural tissue, ka hoʻihoʻi ʻana i ka hana neural, ka hōʻemi ʻana i ka nui o ka infarction cerebral, a me ka hoʻolaha ʻana i ka neurogenesis a me ka angiogenesis ma o nā hopena paracrine, nā hopena immunomodulatory, a me nā hopena anti-apoptotic, no laila ke pāʻani nei i kahi hana therapeutic. i ka ischemic stroke.

Ka hopena paracrine

ʻO nā kumu paracrine o MSC, me nā exosome a me nā vesicle extracellular, nā mea nui i ko lākou hopena therapeutic. Ma kahi o ka hōʻeha ʻana i ka cerebral stroke, hiki i nā MSC ke hoʻoulu i ka hōʻike ʻana o nā mea ulu like ʻole, me ka brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), stromal cell-derived factor 1 (SDF-1), fibroblast kumu. mea ulu (bFGF), glial cell-derived neurotrophic factor, and hepatocyte growth factor, a me kekahi. Kōkua kēia mau mea i ka hōʻemi ʻana i ka wahi o ka cerebral infarction a hoʻihoʻi i ka hana neural, a laila e hoʻomaikaʻi ai i nā ʻeha cerebral stroke.

ʻO ka hopena immunomodulatory

Ua ʻike ʻia ka noiʻi he hana hoʻoponopono ʻelua ka MSC ma nā pane ʻana o ke kikowaena ma hope o ka hahau ʻana: Ma kekahi ʻaoʻao, hiki iā lākou ke hoʻonui nui i ka helu o nā pūnaewele B, nā pūnaewele NK, a me nā pūnae T i loko o ka ʻiʻo lolo, e hoʻoikaika ana i ka hopena immune-promoting. Ma kekahiʻaoʻao, hiki i nā kiʻekiʻe kiʻekiʻe o nā mea inflammatory ke hoʻoikaika i ka hana immunosuppressive o MSCs, a laila e hoʻohana ana i ka hopena pāpālua i ka hoʻonuiʻana i ka lymphocyte a me ka hana inflammatory factor, e hoʻoulu ai i kahi phenotype anti-inflammatory.

Hoʻoponopono i ka apoptosis cell

ʻO ka cell apoptosis kahi hana koʻikoʻi o ka hōʻeha neuronal i ka ischemic stroke, a hiki i nā MSC ke kāohi i ka apoptosis neuronal, e hana ana i kahi hopena neuroprotective. Hiki i ka MSC therapy ke ho'ēmi i ka ischemic stroke-induced astrocyte necrosis, a eia kekahi, hōʻike nā MSC hypoxia-preconditioned i nā hopena therapeutic maikaʻi loa i ka hōʻemi ʻana i ka necrosis cell i hoʻoulu ʻia e ka cerebral hemorrhage.

ʻO ka loiloi lapaʻau o ka lāʻau stem cell no ka ischemic stroke.

ʻO ka hoʻololi ʻana i nā pūnaewele mesenchymal stem (MSCs) no ka mālama ʻana i ka maʻi ischemic i hōʻike i nā hopena hoʻohiki i nā haʻawina preclinical. Ua hana nā mea noiʻi i kahi meta-analysis o 20 mau hoʻokolohua lapaʻau e pili ana i ka huina o 1127 mau maʻi, me 573 i loko o ka hui hoʻokolohua (mālama ʻia me MSC) a me 554 i ka pūʻulu hoʻomalu (hana maʻamau). Hoʻohālikelike ʻia me ka mālama maʻamau, ua hoʻemi nui ka MSC transplantation i nā helu National Institutes of Health Stroke Scale (NIHSS) ma 1, 3, 6 mahina, a me 1 makahiki ma hope o ka mālama ʻana. Ua hoʻomaikaʻi maikaʻi ʻia nā hana o ka helu ola i kēlā me kēia lā ma 1 a me 6 mahina, a me ka hana kaʻa a me nā helu kūʻokoʻa hana ma 1, 3, a me 6 mau mahina.

Aia nā hōʻailona loiloi nui: (1) National Institutes of Health Stroke Scale (NIHSS) score; (2) Barthel Index (BI); (3) helu Fugl-Meyer Assessment (FMA); (4) Ka helu ʻana i ke kūʻokoʻa hana (FIM); a me ka helu (5) Hoʻololi ʻia Rankin Scale (mRS).

Hoʻohālikelike ʻia me ka mālama maʻamau, ʻo ka lāʻau mesenchymal stem cell (MSC) no ka hahau ʻana e hoʻemi nui i ka helu NIH Stroke Scale (NIHSS) ma 3 mahina.

Ke hoʻohālikelike ʻia me ka mālama maʻamau, ʻaʻohe ʻokoʻa koʻikoʻi ma ka helu Barthel Index (BI) ma 3 mau mahina me ka mesenchymal stem cell (MSC) therapy no ka hahau.

Hoʻohālikelike ʻia me ka mālama maʻamau, ʻoi aku ka maikaʻi o ka lāʻau mesenchymal stem cell (MSC) no ka hahau ʻana i ka helu Functional Movement Assessment (FMA) ma 3 mahina.

Hoʻohālikelike ʻia me ka mālama maʻamau, ʻoi aku ka maikaʻi o ka lāʻau mesenchymal stem cell (MSC) no ka hahau ʻana i ka helu Functional Independence Measure (FIM) ma 3 mahina.

Hoʻohālikelike ʻia me ka mālama maʻamau, ʻaʻohe ʻokoʻa koʻikoʻi i ka helu Modified Rankin Scale (mRS) ma ka 3 mahina.

Hoʻohui pū ʻia, hōʻike ka nui o nā haʻawina preclinical i ka hiki a me ka maikaʻi o ka mesenchymal stem cell (MSC) transplantation therapy i ka mālama ʻana i ka maʻi ischemic, kahi e hoʻomaikaʻi ai i nā hemahema neurological, ka hana kaʻa, a me nā hana o ka noho ʻana i kēlā me kēia lā i nā maʻi me ka ischemic. hahau.

ʻO ka wā e hiki mai ana a me nā manaʻo

I nā makahiki i hala iho nei, mai ka ʻokoʻa maʻalahi a me ka hoʻololi ʻana o ka noiʻi stem cell a hiki i ka hoʻomau mau ʻana a me ka hoʻonui ʻana i nā ʻano hana like ʻole o ka noiʻi MSC, ua lilo ka hoʻomohala ʻana i ke kahua o ka noiʻi stem cell. I kēia manawa, ʻaʻole wale nā ​​​​hoʻokolohua holoholona i hōʻoia i ka hopena therapeutic o nā pūnaʻi stem, akā ua manaʻo ʻia ka hiki ke mālama ʻia o ka MSC no ka maʻi ischemic stroke. I loko o nā hoʻokolohua lapaʻau he nui, ke neʻe mau nei ka lāʻau MSC no ka maʻi ischemic stroke.

I kēia mau lā, ua loaʻa he 101 mau hoʻokolohua lapaʻau i hoʻopaʻa inoa ʻia ma ka waihona hoʻāʻo hoʻokolohua US no ka lāʻau stem cell no ka hahau ʻana, me 25 mau haʻawina e pili ana i ka mālama ʻana i ka MSC no ka maʻi ischemic stroke. Ua hōʻike ʻia nā hoʻokolohua lapaʻau he hoʻomaikaʻi nui ka MSC i ka hana neurological no nā poʻe maʻi ischemic stroke, e hōʻoia ana i ko lākou pono a me ka palekana lōʻihi.

I ka wā e hiki mai ana, ʻoi aku ka nui o nā mea lapaʻau e pili ana i nā MSC e unuhi ʻia i loko o nā noi lapaʻau, e hāʻawi ana i ka ʻoihana mālama olakino a me ka mālama ʻana i ke olakino a me ka maikaʻi o nā kānaka a puni ka honua.