Uvavanyo loKhuseleko kunye nokusebenza kakuhle kwe-Neurotrophic factor therapy kwi-Ischemic Stroke

I-Cerebral stroke, ekwaziwa ngokuba "yi-stroke" okanye "ingozi ye-cerebrovascular" (CVA), sisifo se-cerebrovascular esibonakala ngokugqabhuka ngequbuliso kwemithambo yegazi ebuchotsheni okanye ukuthintela ukuhamba kwegazi ebuchotsheni, okukhokelela kumonakalo kwizicubu zengqondo. Ibandakanya zombini i-ischemic kunye ne-hemorrhagic strokes. I-Stroke ngunobangela wesibini okhokelayo wokusweleka kwihlabathi jikelele, ngokusweleka okuphezulu kunye namazinga okukhubazeka kubantu abadala.

I-Ischemic Stroke (IS) ibhekisa kwi-ischemic necrosis yendawo okanye ukuthamba kwezicubu zobuchopho ezibangelwa kukuphazamiseka kokujikeleza kwe-cerebrovascular, ischemia, kunye ne-hypoxia. Ngenxa yokwanda kwezehlo, ukuxhaphaka, ukusweleka, kunye nezinga lokukhubazeka, iye yaba yenye yezona zizathu ziphambili zomthwalo wezifo kwihlabathi. Ngokwezibalo, malunga ne-15 yezigidi zabantu kwihlabathi jikelele baphathwa sisifo se-ischemic unyaka ngamnye, kunye nezigidi ezi-5 zokufa kunye ne-5 yezigidi zabantu abakhubazekileyo ixesha elide.

Indlela yoNyango lweStem Cell ye-Ischemic Stroke

I-Mesenchymal Stem Cells (MSCs) luhlobo lweeseli ze-stem ezininzi ezinokuthi zibekwe zodwa kwii-tissue ezahlukeneyo, kubandakanywa umongo, i-adipose tissue, kunye ne-umbilical cord blood. Ngenxa yeempawu zabo ze-pluripotent, ziyakwazi ukwahlula kwii-osteoblasts, i-chondrocytes, i-adipocytes, kunye ne-neurons. Okwangoku, ukutshintshwa kwe-MSC kuye kwavela njengendlela entsha yonyango yezifo ze-ischemic, kuquka i-stroke, isifo se-coronary artery, kunye nesifo se-peripheral artery. Uphononongo oluninzi lubonise ukuba isiphumo esihle kakhulu se-neuroprotective se-MSCs yeyona nto iphambili ekunyangeni ischemic stroke.

Iingxelo zangoku zophando zibonisa ukuba i-MSC ikakhulu ikhuthaza ukulungiswa komonakalo wezicubu ze-neural, ukubuyiselwa komsebenzi we-neural, ukunciphisa ubungakanani be-cerebral infarction, kunye nokukhuthazwa kwe-neurogenesis kunye ne-angiogenesis ngemiphumo ye-paracrine, i-immunomodulatory effects, kunye ne-anti-apoptotic effects, ngaloo ndlela idlala indima yonyango. kwi-ischemic stroke.

Impembelelo yeParacrine

Izinto ze-paracrine ze-MSC, eziquka i-exosomes kunye nee-extracellular vesicles, zezona zinegalelo kwiziphumo zazo zonyango. Kwindawo yokulimala kwe-cerebral stroke, i-MSCs inokubangela ukubonakaliswa kwezinto ezahlukeneyo zokukhula, kuquka i-brain-derived neurotrophic factor (BDNF), i-vascular endothelial growth factor (VEGF), i-stromal cell-derived factor 1 (SDF-1), i-fibroblast esisiseko. ukukhula kwezinto (bFGF), i-glial cell-derived neurotrophic factor, kunye ne-hepatocyte factor factor, phakathi kwabanye. Ezi zinto zinceda ukunciphisa indawo ye-cerebral infarction kunye nokubuyisela umsebenzi we-neural, ngaloo ndlela kuphuculwe ukulimala kwe-cerebral stroke.

Impembelelo ye-immunomodulatory

Uphando lufumene ukuba i-MSCs nayo inomsebenzi wokulawula kabini kwiimpendulo ze-immune ephakathi emva kokubetha: Ngakolunye uhlangothi, zinokwandisa kakhulu inani leeseli ze-B, iiseli ze-NK, kunye neeseli ze-T kwizicubu zengqondo, zisebenzisa i-immune-promotion effect. Ngakolunye uhlangothi, amanqanaba aphezulu ezinto ezivuthayo zinokuvula umsebenzi we-immunosuppressive we-MSCs, ngaloo ndlela zisebenzisa i-double inhibitory effect kwi-lymphocyte proliferation kunye ne-inflammation factor factor, eyenza i-phenotype echasayo.

Ukulawulwa kwe-apoptosis yeseli

I-cell apoptosis yindlela ebalulekileyo yokulimala kwe-neuronal kwi-stroke ye-ischemic, kwaye i-MSCs inokuthintela i-neuronal apoptosis, isebenzise i-neuroprotective effect. Unyango lwe-MSC lunokunciphisa i-ischemic stroke-induced astrocyte necrosis, kwaye ngaphezu koko, i-hypoxia-preconditioned MSCs ibonisa iziphumo ezingcono zonyango ekunciphiseni i-cell necrosis ebangelwa kukopha ebuchotsheni.

Uvavanyo lweklinikhi yonyango lwe-stem cell for stroke ischemic.

Ukutshintshwa kweeseli ze-mesenchymal stem (MSCs) kunyango lwe-ischemic stroke kubonise iziphumo ezithembisayo kwizifundo zangaphambili. Abaphandi baqhube i-meta-analysis ye-20 izilingo zeklinikhi ezibandakanya izigulane ze-1127 zizonke, kubandakanywa ne-573 kwiqela lokulinga (liphathwe nge-MSCs) kunye ne-554 kwiqela lolawulo (unyango oluqhelekileyo). Xa kuthelekiswa nonyango oluqhelekileyo, ukutshintshwa kwe-MSC kuncitshiswe kakhulu amanqaku eNational Institutes of Health Stroke Scale (NIHSS) kwi-1, 3, 6 iinyanga, kunye ne-1 emva kokunyanga. Kwakhona kwaphucula kakhulu imisebenzi ye-index yokuphila kwansuku zonke kwi-1 kunye neenyanga ze-6, kunye nokusebenza kweemoto kunye namanqaku okuzimela asebenzayo kwi-1, i-3, kunye ne-6 iinyanga.

Iimpawu eziphambili zovavanyo ziquka: (1) amanqaku eZiko leSizwe leMpilo yeStroke Scale (NIHSS); (2) I-Barthel Index (BI); (3) iFugl-Meyer Assessment (FMA) amanqaku; (4) Amanqaku oMlinganiselo wokuZimela (FIM); kunye (5) ne-Modified Rankin Scale (mRS) amanqaku.

Xa kuthelekiswa nonyango oluqhelekileyo, unyango lwe-mesenchymal stem cell (MSC) lwe-stroke lunciphisa kakhulu amanqaku e-NIH Stroke Scale (NIHSS) kwiinyanga ze-3.

Xa kuthelekiswa nonyango oluqhelekileyo, kwakungekho mmahluko obalulekileyo kwi-Barthel Index (BI) amanqaku kwiinyanga ze-3 kunye ne-mesenchymal stem cell (MSC) unyango lwe-stroke.

Xa kuthelekiswa nonyango oluqhelekileyo, unyango lwe-mesenchymal stem cell (MSC) lwe-stroke luphucule kakhulu i-Functional Movement Assessment (FMA) kwiinyanga ze-3.

Xa kuthelekiswa nonyango oluqhelekileyo, unyango lwe-mesenchymal stem cell (MSC) lwe-stroke luphucule kakhulu i-Functional Independence Measure (FIM) amanqaku kwiinyanga ze-3.

Xa kuthelekiswa nonyango oluqhelekileyo, unyango lwe-mesenchymal stem cell (MSC) lwe-stroke alubonisi mmahluko omkhulu kwi-Modified Rankin Scale (mRS) amanqaku kwiinyanga ze-3.

Kuthatyathwe kunye, iqela elikhulu lezifundo zangaphambi kweklinikhi libonisa ukuba nokwenzeka kunye nokusebenza kwe-mesenchymal stem cell (MSC) unyango lokufakelwa kunyango lwe-ischemic stroke, ethi kwinqanaba elithile liphucule ukusilela kwe-neurological, ukusebenza kwemoto, kunye nemisebenzi yokuphila kwemihla ngemihla kwizigulana ezine-ischemic. istroke.

Ikamva kunye namaThemba

Kwiminyaka yakutshanje, ukusuka kulwahlulo olulula kunye nokuqonda inguqu yophando lwe-stem cell ukuya ekuqhubekeni nzulu kunye nokwandiswa kweendlela ezahlukeneyo zophando lwe-MSC, uphuhliso lwecandelo lophando lwe-stem cell luye lwakhula kwaye lwenziwa izinto ezintsha. Okwangoku, akukho kuphela uvavanyo lwezilwanyana oluqinisekisile iziphumo zonyango lweeseli ze-stem, kodwa kunye nokuba nokwenzeka konyango lwe-MSC kwi-stroke ye-ischemic iye yacetywa. Kulingo oluninzi lwezonyango, unyango lwe-MSC lwe-ischemic stroke luqhubela phambili ngokuthe ngcembe.

Kutshanje, kukho izilingo zeklinikhi ze-101 ezibhaliswe kwi-database yovavanyo lweklinikhi yase-US ye-stem cell therapy ye-stroke, kunye nezifundo ze-25 ezinxulumene nonyango lwe-MSC ye-ischemic stroke. Ulingo lwezonyango luye lwabonisa ukuba ii-MSC ziphuculwe kakhulu kumsebenzi we-neurological wezigulane ze-ischemic stroke, eziqinisekisa ukusebenza kwazo kunye nokhuseleko lwexesha elide.

Kwixesha elizayo, kuya kubakho ukuphumelela kwezonyango okubandakanya ii-MSC eziya kuguqulelwa kwizicelo zeklinikhi, ezinegalelo kwishishini lezempilo kunye nokukhusela impilo kunye nokuphila kwabantu kwihlabathi jikelele.