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Lancet：干细胞组织工程器官置换术儿童两年随访

2012-12-20 Lancet Lancet

干细胞柳叶刀器官置换器官衰竭
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　　　　 　　干细胞组织工程移植可能为器官衰竭患者带来新的希望。英国伦敦大奥蒙德街儿童医院的Martin J Elliott等在《柳叶刀》杂志报道了一例干细胞组织工程器官置换术治疗儿童两年随访。该患者为12岁儿童，出生时患先天性长段气管狭窄和肺动脉吊带，经金属内支架治疗失败。该移植手术采用同种异体去细胞器官支架，并植入粒细胞集落刺激因子刺激后获得的自体骨髓间充质干细胞。应用重组红细胞生成素刺激血

干细胞　　　　

　　干细胞组织工程移植可能为器官衰竭患者带来新的希望。英国伦敦大奥蒙德街儿童医院的Martin J Elliott等在《柳叶刀》杂志报道了一例干细胞组织工程器官置换术治疗儿童两年随访。该患者为12岁儿童，出生时患先天性长段气管狭窄和肺动脉吊带，经金属内支架治疗失败。该移植手术采用同种异体去细胞器官支架，并植入粒细胞集落刺激因子刺激后获得的自体骨髓间充质干细胞。应用重组红细胞生成素刺激血管再生，应用TGF-β刺激软骨生成。移植手术后1周血管再生；术后8周内有较强的局部中性粒细胞反应；直到术后1年有明显的上皮细胞重建；术后18个月移植物恢复生物学活力，无需继续住院治疗，此时胸部CT和通气灌注扫描正常，较移植时体重增加5kg，身高增长11cm；术后2年气管功能正常。

与干细胞相关的拓展阅读：


Background
Stem-cell-based, tissue engineered transplants might offer new therapeutic options for patients, including children, with failing organs. The reported replacement of an adult airway using stem cells on a biological scaffold with good results at 6 months supports this view. We describe the case of a child who received a stem-cell-based tracheal replacement and report findings after 2 years of follow-up.
Methods
A 12-year-old boy was born with long-segment congenital tracheal stenosis and pulmonary sling. His airway had been maintained by metal stents, but, after failure, a cadaveric donor tracheal scaffold was decellularised. After a short course of granulocyte colony stimulating factor, bone marrow mesenchymal stem cells were retrieved preoperatively and seeded onto the scaffold, with patches of autologous epithelium. Topical human recombinant erythropoietin was applied to encourage angiogenesis, and transforming growth factor β to support chondrogenesis. Intravenous human recombinant erythropoietin was continued postoperatively. Outcomes were survival, morbidity, endoscopic appearance, cytology and proteomics of brushings, and peripheral blood counts.
Findings
The graft revascularised within 1 week after surgery. A strong neutrophil response was noted locally for the first 8 weeks after surgery, which generated luminal DNA neutrophil extracellular traps. Cytological evidence of restoration of the epithelium was not evident until 1 year. The graft did not have biomechanical strength focally until 18 months, but the patient has not needed any medical intervention since then. 18 months after surgery, he had a normal chest CT scan and ventilation-perfusion scan and had grown 11 cm in height since the operation. At 2 years follow-up, he had a functional airway and had returned to school.
Interpretation
Follow-up of the first paediatric, stem-cell-based, tissue-engineered transplant shows potential for this technology but also highlights the need for further research.
Funding
Great Ormond Street Hospital NHS Trust, The Royal Free Hampstead NHS Trust, University College Hospital NHS Foundation Trust, and Region of Tuscany.

    

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    2013-02-06 yxch48

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    2012-12-22 zhu_jun9838

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    2012-12-22 ms117281293605716

    #置换术#

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