Ukuhlolwa Kokuphepha kanye nokusebenza kahle kwe-Neurotrophic factor therapy ku-Ischemic Stroke

I-Cerebral stroke, eyaziwa nangokuthi "i-stroke" noma "ingozi ye-cerebrovascular" (CVA), yisifo esibucayi se-cerebrovascular esibonakala ngokuphuka kungazelelwe kwemithambo yegazi ebuchosheni noma ukuvimbela ukugeleza kwegazi ebuchosheni, okuholela ekulimaleni kwezicubu zobuchopho. Kuhlanganisa kokubili imivimbo ye-ischemic kanye ne-hemorrhagic. I-Stroke iyimbangela yesibili yokufa emhlabeni jikelele, enezinga eliphezulu lokufa nokukhubazeka kubantu abadala.

I-Ischemic Stroke (IS) ibhekisela ku-ischemic necrosis yasendaweni noma ukuthambisa kwezicubu zobuchopho okubangelwa ukuphazamiseka kokujikeleza kwe-cerebrovascular, ischemia, ne-hypoxia. Ngenxa yezigameko zayo eziphakeme, ukwanda, ukufa, nezinga lokukhubazeka, isibe ngesinye sezimbangela ezinkulu zomthwalo wezifo emhlabeni. Ngokwezibalo, cishe abantu abayizigidi eziyi-15 emhlabeni wonke bahlushwa yi-ischemic stroke unyaka ngamunye, nokufa kwabantu abayizigidi ezi-5 kanye nabantu abayizigidi ezi-5 abakhubazekile isikhathi eside.

I-Mechanism of Stem Cell Therapy ye-Ischemic Stroke

I-Mesenchymal Stem Cells (MSCs) wuhlobo lwamaseli e-stem anamandla amaningi angahlukaniswa nezicubu ezihlukahlukene, okuhlanganisa umnkantsha, izicubu ze-adipose, negazi lenkaba. Ngenxa yezakhiwo zabo ze-pluripotent, bangakwazi ukuhlukanisa ama-osteoblasts, ama-chondrocyte, ama-adipocytes, ngisho nama-neurons. Njengamanje, ukufakelwa kwe-MSC kuye kwavela njengendlela entsha yokwelapha izifo ze-ischemic, okuhlanganisa isifo sohlangothi, isifo se-coronary artery, nesifo se-peripheral artery. Ucwaningo oluningi lubonise ukuthi umphumela omuhle kakhulu we-neuroprotective we-MSC uyisici esibalulekile ekwelapheni ukushaywa yi-ischemic.

Imibiko yamanje yocwaningo ibonisa ukuthi i-MSC ikhuthaza ikakhulukazi ukulungiswa kokulimala kwezicubu ze-neural, ukubuyiselwa komsebenzi we-neural, ukunciphisa usayizi we-cerebral infarction, kanye nokukhuthazwa kwe-neurogenesis ne-angiogenesis ngokusebenzisa imiphumela ye-paracrine, imiphumela ye-immunomodulatory, nemiphumela ye-anti-apoptotic, ngaleyo ndlela idlala indima yokwelapha. ku-ischemic stroke.

Umphumela weParacrine

Ama-paracrine factor we-MSC, okuhlanganisa ama-exosomes nama-extracellular vesicles, anegalelo elikhulu emiphumeleni yawo yokwelapha. Endaweni yokulimala kwe-cerebral stroke, ama-MSC angakwazi ukugqugquzela ukuvezwa kwezinto ezihlukahlukene zokukhula, okuhlanganisa i-neurotrophic factor (BDNF) etholakala ebuchosheni, i-vascular endothelial growth factor (VEGF), i-stromal cell-derived factor 1 (SDF-1), i-fibroblast eyisisekelo. ukukhula factor (bFGF), i-glial cell-derived neurotrophic factor, kanye ne-hepatocyte growth factor, phakathi kokunye. Lezi zici zisiza ukunciphisa indawo ye-cerebral infarction kanye nokubuyisela ukusebenza kwe-neural, ngaleyo ndlela kuthuthukiswe ukulimala kwe-cerebral stroke.

Umphumela we-immunomodulatory

Ucwaningo luthole ukuthi ama-MSC aphinde abe nomsebenzi okabili wokulawula ekuphenduleni kwamasosha omzimba amaphakathi ngemva kokushaywa unhlangothi: Ngakolunye uhlangothi, angakwazi ukwandisa kakhulu inani lamaseli e-B, amaseli e-NK, nama-T cell kuzicubu zobuchopho, asebenzise umphumela wokukhuthaza umzimba. Ngakolunye uhlangothi, amazinga aphezulu ezinto ezivuvukalayo angenza kusebenze umsebenzi wokuzivikela komzimba wama-MSC, ngaleyo ndlela enze umphumela ovimbelayo okabili ekwandeni kwe-lymphocyte nokukhiqizwa kwezinto ezivuvukalayo, okudala i-phenotype elwa nokuvuvukala.

Ukulawulwa kwe-cell apoptosis

I-cell apoptosis iyindlela ebalulekile yokulimala kwe-neuronal ku-ischemic stroke, futhi ama-MSC angavimbela i-apoptosis ye-neuronal, enze umphumela we-neuroprotective. Ukwelashwa kwe-MSC nakho kungadambisa i-ischemic stroke-induced astrocyte necrosis, futhi ngaphezu kwalokho, ama-MSC ane-hypoxia-preconditioned abonisa imiphumela engcono yokwelapha ekwehliseni i-cell necrosis ebangelwa ukopha kobuchopho.

Ukuhlolwa komtholampilo kwe-stem cell therapy ye-ischemic stroke.

Ukufakelwa kabusha kwe-mesenchymal stem cell (MSCs) ukuze ekwelaphe ukushaywa yi-ischemic kubonise imiphumela ethembisayo ezifundweni zangaphambi komtholampilo. Abacwaningi benze uhlaziyo lwemeta yokuhlolwa kwemitholampilo engama-20 okubandakanya ingqikithi yeziguli eziyi-1127, okuhlanganisa nezingu-573 eqenjini lokuhlola (ezilashwe ngama-MSC) kanye nezingu-554 eqenjini lokulawula (ukwelashwa okuvamile). Uma kuqhathaniswa nokwelashwa okuvamile, ukufakelwa kabusha kwe-MSC kwehlise kakhulu amaphuzu eNational Institutes of Health Stroke Scale (NIHSS) ku-1, 3, 6 izinyanga, kanye nonyaka ongu-1 ngemva kokwelashwa. Iphinde yathuthukisa kakhulu imisebenzi yenkomba yokuphila kwansuku zonke ezinyangeni ezi-1 neziyi-6, kanye nokusebenza kwezimoto kanye nezikolo zokuzimela ezisebenzayo ku-1, 3, kanye nezinyanga ezingu-6.

Izinkomba zokuhlola eziyinhloko zifaka: (1) amaphuzu eNational Institutes of Health Stroke Scale (NIHSS); (2) I-Barthel Index (BI); (3) Amaphuzu okuhlolwa kwe-Fugl-Meyer (FMA); (4) Isilinganiso se-Independence Measure (FIM) esisebenzayo; kanye (5) nesikolo se-Rankin Scale (mRS) esilungisiwe.

Uma kuqhathaniswa nokwelashwa okuvamile, ukwelashwa kwe-mesenchymal stem cell (MSC) kwe-stroke kunciphisa kakhulu isikolo se-NIH Stroke Scale (NIHSS) ezinyangeni ze-3.

Uma kuqhathaniswa nokwelashwa okuvamile, awukho umehluko ophawulekayo kumaphuzu we-Barthel Index (BI) ezinyangeni ze-3 nge-mesenchymal stem cell (MSC) yokwelapha isifo sohlangothi.

Uma kuqhathaniswa nokwelashwa okuvamile, ukwelashwa kwe-mesenchymal stem cell (MSC) kwe-stroke kwathuthukisa kakhulu amaphuzu we-Functional Movement Assessment (FMA) ezinyangeni ze-3.

Uma kuqhathaniswa nokwelashwa okuvamile, ukwelashwa kwe-mesenchymal stem cell (MSC) ye-stroke kwathuthukisa kakhulu amaphuzu we-Functional Independence Measure (FIM) ezinyangeni ze-3.

Uma kuqhathaniswa nokwelashwa okuvamile, ukwelashwa kwe-mesenchymal stem cell (MSC) kwe-stroke akuzange kubonise umehluko omkhulu kumaphuzu we-Modified Rankin Scale (mRS) ezinyangeni ze-3.

Sekuhlanganiswe ndawonye, ​​indikimba enkulu yezifundo zangaphambi komtholampilo ikhombisa ukuthi kungenzeka kanye nokusebenza kahle kwe-mesenchymal stem cell (MSC) yokufakelwa kabusha kwe-mesenchymal stem cell (MSC) ekwelapheni i-ischemic stroke, okuthi ngezinga elithile ithuthukise ukushoda kwezinzwa, ukusebenza kwemoto, kanye nemisebenzi yokuphila kwansuku zonke ezigulini ezine-ischemic. unhlangothi.

Ikusasa Namathemba

Eminyakeni yamuva nje, kusukela ekuhlukaniseni okulula nasekuguquleni ukuqonda kocwaningo lwe-stem cell kuya ekujuleni okuqhubekayo kanye nokwandiswa kwezinqubo ezihlukahlukene zocwaningo lwe-MSC, ukuthuthukiswa komkhakha wocwaningo lwama-stem cell sekukhulile futhi kwasungulwa. Njengamanje, akukona nje kuphela ukuhlola kwezilwane okuqinisekisile imiphumela yokwelapha yama-stem cells, kodwa futhi nokwenzeka kokwelashwa kwe-MSC ye-ischemic stroke kuhlongozwa. Ezivivinyweni eziningi zomtholampilo, ukwelashwa kwe-MSC kwe-ischemic stroke kuqhubekela phambili.

Kusukela muva nje, kube nezinhlolo zomtholampilo eziyi-101 ezibhaliswe kusizindalwazi socwaningo lwezokwelapha lwase-US lwe-stem cell therapy for stroke, nezifundo ezingu-25 ezihlobene nokwelashwa kwe-MSC ye-ischemic stroke. Izivivinyo zemitholampilo zibonise ukuthi ama-MSC anokuthuthukiswa okuphawulekayo emsebenzini wezinzwa ezigulini ze-ischemic stroke, okuqinisekisa ukusebenza kwazo nokuphepha kwesikhathi eside.

Ngokuzayo, kuzoba nokunye okuthuthukayo kwezokwelapha okubandakanya ama-MSC azohunyushwa abe yizicelo zomtholampilo, anikele embonini yokunakekelwa kwezempilo kanye nokuvikela impilo nempilo yabantu emhlabeni jikelele.