Tlhahlobo ea Tšireletseho le Katleho ea Neurotrophic factor therapy ho Ischemic Stroke

Cerebral stroke, eo hape e tsejoang e le "stroke" kapa "cerebrovascular accident" (CVA), ke lefu le matla la cerebrovascular le khetholloang ke ho phatloha ka tšohanyetso ha methapo ea mali bokong kapa ho sitisa phallo ea mali bokong, ho bakang tšenyo ea lisele tsa boko. E kenyelletsa liropo tsa ischemic le hemorrhagic. Stroke ke sesosa sa bobeli se bakang lefu lefatšeng ka bophara, se nang le palo e phahameng ea batho ba shoang le ea bokooa ho batho ba baholo.

Ischemic Stroke (IS) e bua ka "ischemic necrosis" ea sebakeng sa heno kapa ho nolofala ha lisele tsa boko tse bakoang ke mathata a phallo ea methapo ea mali, ischemia le hypoxia. Ka lebaka la ho ata ha eona ho phahameng, ho ata, ho shoa le sekhahla sa bokooa, e fetohile e 'ngoe ea lisosa tse kholo tsa moroalo oa mafu lefatšeng ka bophara. Ho ea ka lipalo-palo, hoo e ka bang batho ba limilione tse 15 lefatšeng ka bophara ba tšoaroa ke lefu la ischemic selemo le selemo, 'me batho ba limilione tse 5 ba shoa le batho ba limilione tse 5 ba nang le bokooa ba nako e telele.

Mokhoa oa Therapy ea Stem Cell bakeng sa Ischemic Stroke

Mesenchymal Stem Cells (MSCs) ke mofuta oa lisele tsa stem tse nang le matla a mangata tse ka arohanngoang le lisele tse fapaneng, ho kenyeletsa moko oa masapo, lisele tsa adipose le mali a mokhubu. Ka lebaka la thepa ea bona ea pluripotent, ba ka khetholla li-osteoblasts, chondrocyte, adipocytes, esita le li-neuron. Hajoale, phetisetso ea MSC e hlahile e le mokhoa o mocha oa kalafo bakeng sa mafu a ischemic, ho kenyelletsa le stroke, lefu la methapo ea pelo, le lefu la methapo ea methapo. Liphuputso tse ngata li bonts'itse hore phello e ntle ea methapo ea methapo ea MSC ke ntlha ea bohlokoa ho alafong ischemic stroke.

Litlaleho tsa morao-rao tsa lipatlisiso li bonts'a hore MSC e khothaletsa haholo tokiso ea tšenyo ea methapo ea kutlo, ho khutlisa ts'ebetso ea methapo, phokotso ea boholo ba boko, le ho khothaletsa neurogenesis le angiogenesis ka litlamorao tsa paracrine, litlamorao tsa immunomodulatory, le litlamorao tsa anti-apoptotic, ka hona li bapala karolo ea kalafo. ka lefu la ischemic.

Phello ea Paracrine

Lintho tsa MSC tsa paracrine, ho kenyeletsoa li-exosomes le li-extracellular vesicles, ke tsona tse tlatsetsang litlamorao tsa bona tsa kalafo. Sebakeng sa kotsi ea lefu la boko, li-MSC li ka etsa hore ho be le maikutlo a lintlha tse sa tšoaneng tsa kholo, ho akarelletsa le boko-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), stromal cell-derived factor 1 (SDF-1), fibroblast ea motheo. growth factor (bFGF), glial cell-derived neurotrophic factor, le hepatocyte growth factor, har'a tse ling. Lintlha tsena li thusa ho fokotsa sebaka sa cerebral infarction le ho tsosolosa ts'ebetso ea methapo, kahoo ho ntlafatsa likotsi tsa boko.

Phello ea immunomodulatory

Lipatlisiso li fumane hore li-MSC li boetse li na le ts'ebetso e 'meli ea ho laola likarabo tsa' mele oa ho itšireletsa mafung ka mor'a ho otloa ke lefu: Ka lehlakoreng le leng, li ka eketsa haholo palo ea lisele tsa B, lisele tsa NK, le lisele tsa T liseleng tsa boko, tse fanang ka phello ea ho itšireletsa mafung. Ka lehlakoreng le leng, maemo a phahameng a ho ruruha a ka kenya tšebetsong tšebetso ea immunosuppressive ea li-MSC, ka hona a fana ka phello e habeli ea ho thibela ho ata ha lymphocyte le tlhahiso ea lintlha tsa ho ruruha, ho baka phenotype e khahlanong le ho ruruha.

Taolo ea apoptosis ea lisele

Cell apoptosis ke mokhoa oa bohlokoa oa ho lemala ha neuronal ho ischemic stroke, 'me li-MSC li ka thibela neuronal apoptosis, tsa fana ka phello ea neuroprotective. Kalafo ea MSC e ka boela ea fokotsa necrosis e bakoang ke ischemic stroke-induced astrocyte necrosis, 'me ho feta moo, li-MSC tse nang le hypoxia-preconditioned li bonts'a litlamorao tse betere tsa kalafo ho fokotsa necrosis ea sele e bakoang ke ho tsoa mali bokong.

Tlhahlobo ea kliniki ea stem cell therapy bakeng sa lefu la ischemic.

Ho fetisoa ha lisele tsa stem tsa mesenchymal (MSCs) bakeng sa phekolo ea lefu la ischemic stroke ho bontšitse liphello tse tšepisang lithutong tsa pele ho kliniki. Bafuputsi ba ile ba etsa tlhahlobo ea meta-analysis ea liteko tsa kliniki tse 20 tse kenyelletsang kakaretso ea bakuli ba 1127, ho kenyeletsoa 573 sehlopheng sa liteko (tse tšoaroang ka MSCs) le 554 sehlopheng sa taolo (phekolo e tloaelehileng). Ha ho bapisoa le phekolo e tloaelehileng, phetisetso ea MSC e fokolitse haholo lintlha tsa National Institutes of Health Stroke Scale (NIHSS) ho 1, 3, 6 likhoeli le selemo sa 1 ka mor'a phekolo. E boetse e ntlafalitse haholo mesebetsi ea index ea bophelo ba letsatsi le letsatsi ho 1 le likhoeli tsa 6, hammoho le ts'ebetso ea makoloi le lintlha tsa boipuso tse sebetsang ho 1, 3, le 6 likhoeli.

Lipontšo tse ka sehloohong tsa tlhahlobo li kenyelletsa: (1) lintlha tsa National Institutes of Health Stroke Scale (NIHSS); (2) Barthel Index (BI); (3) Lintlha tsa Tekolo ea Fugl-Meyer (FMA); (4) Lintlha tsa Tekanyo ea Boipuso ba Mosebetsi (FIM); le (5) lintlha tse fetotsoeng tsa Rankin Scale (mRS).

Ha ho bapisoa le phekolo e tloaelehileng, phekolo ea mesenchymal stem cell (MSC) bakeng sa stroke e fokotsa haholo palo ea NIH Stroke Scale (NIHSS) likhoeling tsa 3.

Ha ho bapisoa le phekolo e tloaelehileng, ho ne ho se na phapang e khōlō palo ea Barthel Index (BI) likhoeling tsa 3 ka phekolo ea mesenchymal stem cell (MSC) bakeng sa stroke.

Ha ho bapisoa le phekolo e tloaelehileng, phekolo ea mesenchymal stem cell (MSC) bakeng sa stroke e ntlafalitse haholo palo ea Functional Movement Assessment (FMA) likhoeling tsa 3.

Ha ho bapisoa le phekolo e tloaelehileng, phekolo ea mesenchymal stem cell (MSC) bakeng sa stroke e ntlafalitse haholo palo ea Functional Independence Measure (FIM) likhoeling tsa 3.

Ha ho bapisoa le phekolo e tloaelehileng, phekolo ea mesenchymal stem cell (MSC) bakeng sa stroke e bontšitse hore ha ho na phapang e khōlō ho palo ea Modified Rankin Scale (mRS) likhoeling tsa 3.

Ha li kopantsoe, sehlopha se seholo sa liphuputso tsa preclinical se bonts'a bokhoni le katleho ea phekolo ea ho fetisetsa mesenchymal stem cell (MSC) kalafo ea ischemic stroke, eo ka tekanyo e itseng e ntlafatsang bofokoli ba methapo ea kutlo, ts'ebetso ea motlakase le mesebetsi ea bophelo ba letsatsi le letsatsi ho bakuli ba nang le ischemic. setorouku.

Bokamoso le Ditebello

Lilemong tsa morao tjena, ho tloha phapanong e bonolo le temoho ea phetoho ea lipatlisiso tsa stem cell ho ea ho tebello e tsoelang pele le katoloso ea mekhoa e fapaneng ea lipatlisiso tsa MSC, nts'etsopele ea lefapha la lipatlisiso tsa lisele tsa stem e se e holile ebile e le boqapi. Hajoale, ha se feela liteko tsa liphoofolo tse netefalitseng litlamorao tsa kalafo ea lisele tsa stem, empa hape le monyetla oa kalafo ea MSC bakeng sa stroke ea ischemic e hlahisitsoe. Litekong tse ngata tsa bongaka, kalafo ea MSC bakeng sa stroke ea ischemic e ntse e tsoela pele butle.

Haufinyane tjena, ho bile le liteko tsa kliniki tse 101 tse ngolisitsoeng polokelong ea liteko tsa bongaka tsa US bakeng sa kalafo ea lisele tsa stem bakeng sa stroke, ka lithuto tse 25 tse amanang le kalafo ea MSC bakeng sa stroke sa ischemic. Liteko tsa bongaka li bonts'itse hore li-MSC li na le ntlafatso e kholo ts'ebetsong ea methapo ea kutlo bakeng sa bakuli ba ischemic stroke, ho netefatsa katleho ea bona le polokeho ea nako e telele.

Nakong e tlang, ho tla ba le lintlafatso tse ngata tsa bongaka tse kenyelletsang li-MSC tse tla fetoleloa lits'ebetsong tsa bongaka, tse tlatselletsang indastering ea tlhokomelo ea bophelo le ho sireletsa bophelo bo botle le boiketlo ba batho lefatšeng ka bophara.