Kuongororwa kweKuchengetedza uye Kubudirira kweNeurotrophic factor therapy muIschemic Stroke

Cerebral stroke, inozivikanwawo se "stroke" kana "cerebrovascular accident" (CVA), chirwere checerebrovascular chirwere chinoonekwa nekukasira kuputika kwetsinga dzeropa muuropi kana kuvharika kwekuyerera kweropa kuuropi, zvichikonzera kukuvara kwehuropi. Inosanganisira zvose ischemic uye hemorrhagic sitiroko. Stroke ndiyo yechipiri iri kukonzera rufu pasi rose, nekufa kwakanyanya uye hurema muvakuru.

Ischemic Stroke (IS) inoreva nzvimbo ischemic necrosis kana kupfava kwetishu yehuropi kunokonzerwa nekusagadzikana kwecerebrovascular circulation, ischemia, uye hypoxia. Nekuda kwekuwanda kwayo, kuwanda, kufa, nekuremara, chave chimwe chezvikonzero zvikuru zvekuremerwa kwezvirwere pasi rose. Maererano nenhamba, vanhu vangangosvika mamirioni gumi neshanu pasi rese vanotambura nesitiroko yeischemic gore rega rega, nekufa kwemamiriyoni mashanu uye 5 miriyoni vanhu vane hurema hwenguva refu.

Iyo Mechanism yeStem Cell Therapy yeIschemic Stroke

Mesenchymal Stem Cells (MSCs) imhando yemasero ane simba akawanda anogona kuparadzaniswa kubva kune akasiyana matishu, anosanganisira bone marrow, adipose tissue, uye umbilical cord ropa. Nekuda kwezvimiro zvavo zvepluripotent, vanogona kusiyanisa kuita osteoblasts, chondrocytes, adipocytes, uye kunyange neurons. Parizvino, kuisirwa kweMSC kwakabuda senzira yekurapa yezvirwere zveischemic, kusanganisira sitiroko, chirwere checoronary artery, uye peripheral artery chirwere. Zvidzidzo zvakawanda zvakaratidza kuti yakanakisa neuroprotective mhedzisiro yeMSCs chinhu chakakosha mukurapa ischemic sitiroko.

Mishumo yezvino yekutsvagisa inoratidza kuti MSC inonyanya kukurudzira kugadziridzwa kwekukuvara kwetishu, kudzoreredzwa kweneural basa, kuderedzwa kwecerebral infarction size, uye kusimudzirwa kweuneurogenesis uye angiogenesis kuburikidza neparacrine mhedzisiro, immunomodulatory mhedzisiro, uye anti-apoptotic mhedzisiro, nekudaro kutamba basa rekurapa. mune ischemic sitiroko.

Paracrine effect

MSC's paracrine factor, kusanganisira exosomes uye extracellular vesicles, ndiwo anonyanya kubatsira mukurapa kwavo maitiro. Munharaunda yekukuvara kwecerebral stroke, MSCs inogona kukonzera kutaura kwezvinhu zvakasiyana-siyana zvekukura, kusanganisira brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), stromal cell-derived factor 1 (SDF-1), basic fibroblast. kukura chinhu (bFGF), glial cell-derived neurotrophic factor, uye hepatocyte kukura factor, pakati pevamwe. Izvi zvinhu zvinobatsira kuderedza nzvimbo yecerebral infarction uye kudzorera neural function, nokudaro kuvandudza kukuvara kwecerebral stroke.

Iyo immunomodulatory effect

Tsvagiridzo yakawana kuti MSCs zvakare ine mbiri yekudzora basa pane yepakati immune system mushure mekurova: Kune rumwe rutivi, ivo vanogona zvakanyanya kuwedzera huwandu hweB masero, NK masero, uye T masero muhuropi tishu, ichishandisa immune-inokurudzira maitiro. Kune rimwe divi, mazinga epamusoro ezvimba zvinogona kuita kuti immunosuppressive basa reMSCs, nekudaro ichiita mbiri inhibitory mhedzisiro pakupararira kwelymphocyte uye kugadzirwa kwechinhu chinozvimba, zvichiita kuti anti-inflammatory phenotype.

Kudzora kwesero apoptosis

Cell apoptosis inzira yakakosha yekukuvadza neuronal mune ischemic sitiroko, uye MSCs inogona kuvharira neuronal apoptosis, ichiita neuroprotective mhedzisiro. Kurapa kweMSC kunogona zvakare kuderedza ischemic sitiroko-induced astrocyte necrosis, uyezve, hypoxia-preconditioned MSCs inoratidza zvirinani kurapa mhedzisiro mukuderedza sero necrosis inokonzerwa necerebral hemorrhage.

Kuongororwa kwekiriniki kwe stem cell therapy ye ischemic sitiroko.

Kutapurirana mesenchymal stem masero (MSCs) ekurapa ischemic sitiroko kwakaratidza mhedzisiro inovimbisa muzvidzidzo zvepreclinical. Vatsvakurudzi vakaita meta-analysis ye20 kliniki miedzo inosanganisira huwandu hwevarwere ve1127, kusanganisira 573 muboka rekuedza (vakarapwa neMSCs) uye 554 muboka rekutonga (kurapwa kwemazuva ose). Kuenzaniswa nekurapa kwakajairika, MSC transplantation yakaderedza zvakanyanya National Institutes of Health Stroke Scale (NIHSS) zvibodzwa pa1, 3, 6 mwedzi, uye 1 gore mushure mekurapwa. Yakavandudzawo zvakanyanya zviitiko zvemazuva ese ekurarama indekisi pamwedzi 1 uye 6, pamwe nekushanda kwemota uye mashandiro ekuzvimiririra zvibodzwa pa1, 3, uye 6 mwedzi.

Zviratidzo zvikuru zvekuongorora zvinosanganisira: (1) National Institutes of Health Stroke Scale (NIHSS) chikamu; (2) Barthel Index (BI); (3) Fugl-Meyer Assessment (FMA) chikamu; (4) Functional Independence Measure (FIM) chikamu; uye (5) Modified Rankin Scale (mRS) zvibodzwa.

Kuenzaniswa nekurapa kwakajairika, mesenchymal stem cell (MSC) kurapwa kwesitiroko kunoderedza zvakanyanya NIH Stroke Scale (NIHSS) mamakisi pamwedzi mitatu.

Kuenzaniswa nekurapa kwakajairika, pakanga pasina mutsauko wakakosha muchikamu cheBarthel Index (BI) pamwedzi ye3 ine mesenchymal stem cell (MSC) kurapwa kwesitiroko.

Kuenzaniswa nekurapa kwakajairika, mesenchymal stem cell (MSC) kurapwa kwesitiroko kwakavandudza zvakanyanya chikamu cheFunctional Movement Assessment (FMA) pamwedzi ye3.

Kuenzaniswa nekurapa kwakajairwa, mesenchymal stem cell (MSC) kurapwa kwesitiroko kwakavandudza zvakanyanya Functional Independence Measure (FIM) mamakisi pamwedzi ye3.

Kana ichienzaniswa neyakajairwa kurapwa, mesenchymal stem cell (MSC) kurapwa kwesitiroko yakaratidza kusakosha mutsauko muModified Rankin Scale (mRS) mumwedzi ye3.

Zvakatorwa pamwechete, boka guru rezvidzidzo zvepreclinical rinoratidza kugona uye kushanda kwe mesenchymal stem cell (MSC) transplantation therapy mukurapa ischemic sitiroko, iyo pamwero yakati inovandudza kushomeka kwetsinga, basa remota, uye zviitiko zvehupenyu hwezuva nezuva kune varwere vane ischemic. sitiroko.

Ramangwana Nezvinotarisirwa

Mumakore achangopfuura, kubva pakusiyanisa kwakapusa uye shanduko cognition yekutsvagisa stem cell kusvika pakudzika nekuenderera mberi kwemaitiro akasiyana ekutsvaga kweMSC, kusimukira kwemunda we stem cell research kwave kukura uye nekuvandudza. Parizvino, kwete chete kuyedza kwemhuka kwakasimbisa kurapa kwesero maseru, asiwo kugona kweMSC kurapwa kweischemic sitiroko yakatsanangurwa. Mumakiriniki akawanda miedzo, MSC kurapa ischemic sitiroko iri kufambira mberi zvishoma nezvishoma.

Kubva nguva pfupi yadarika, pakave nemiedzo yekiriniki ye101 yakanyoreswa muUS Clinical test database ye stem cell therapy yesitiroko, ine zvidzidzo makumi maviri neshanu zvine chekuita neMSC kurapwa ischemic sitiroko. Miedzo yemakiriniki yakaratidza kuti maMSC ane kuvandudzwa kwakakosha mukushanda kwetsinga kune varwere vane ischemic sitiroko, zvichisimbisa kushanda kwavo uye kuchengetedzwa kwenguva refu.

Mune ramangwana, kuchange kuine mamwe mabhindauko ezvekurapa anosanganisira maMSC ayo achashandurirwa mumakiriniki ekushandisa, achibatsira muindasitiri yezvehutano nekuchengetedza hutano nekugara zvakanaka kwevanhu pasi rese.