人神经干细胞移植治疗重度新生儿缺氧缺血性脑病一例

Treatment of an infant with severe neonatal hypoxic-ischemic encephalopathy sequelae with transplantation of human neural stem cells into cerebral ventricle

目的探讨人神经干细胞移植方法治疗重度新生儿缺氧缺血性脑病(HIE)的可行性。方法一例出生75天的重度HIE后遗症患儿,智力运动发育严重滞后,肌张力异常,磁共振图像显示脑实质多发软化灶和萎缩。取孕11周人胚胎前脑细胞,经体外培养扩增为人神经干细胞(neuralstemcells,NSCS),并经患儿脑室穿刺注入。结果移植28天后患儿不仅肌张力显著改善,智力运动发育迅速追赶、接近正常同龄水平。PET显示顶颞叶放射性增加,细胞代谢明显增强,提示植入的细胞存活。结论本例人胚胎来源NSCS移植治疗重度新生儿HIE后遗症,近期临床疗效显著,远期疗效有待进一步观察。

Objective Severe newborn hypoxic-ischemic encephalopathy （HIE） has a very high rate of disability and no effective treatment is available. The present study aimed to preliminarily evaluate the effects of human neural stem cell transplantation in treatment of severe neonatal HIE. Methods The patient was a 75-day old male infant with sequelae of severe HIE who had highly delayed development of intelligence and movement and myotonia. MRI showed multiple cerebromalacia and encephalatrophy. Cells obtained from the forebrain of an ll-week old fetus were cultured and amplified for 15 days. And then the human fetal neural stem cells were injected into cerebral ventricle of this infant. Results Twenty eight days after transplantation, remarkable improvement occurred not only in his myotonia but also in his intelligence and movement, which became similar to those of the normal infants of the same age. Positron emission tomography （PET） showed significantly increased radioactivity at temporal and occipital lobes which suggested that the cellular metabolism had increased greatly. Conclusion The short-term effect of NSCs transplantation on the infant with severe HIE sequelae was significant. PET suggested that the implanted NSCs survived. Many more studies are needed to evaluate long-term effects of NSC transplantation in treatment of HIE.