嗅鞘细胞移植修复脊髓损伤的新思考

New thinking on olfactory ensheathing cell transplantation in the repair of spinal cord injury

目的:针对嗅鞘细胞移植在脊髓损伤修复中的作用进行综述,并对可能导致最佳细胞移植干预脊髓损伤效果的特定因素进行深入探讨。资料来源:应用计算机检索Medline 1994-01/2007-03期间关于嗅鞘细胞移植与脊髓损伤的文章,检索词“olfactory ensheathing cells,spinal cord injury”,并限定语言种类为English。同时计算机检索万方数据资源系统与中国期刊全文数据库1994-01/2007-03关于嗅鞘细胞移植与脊髓损伤的文章,限定文章语言种类为中文,检索词“嗅鞘细胞,脊髓损伤”。资料选择:对资料进行初审,选取包括实验组和对照组的文献,筛除非随机实验,对剩余的文献开始查找全文,进一步判断为随机对照实验。纳入标准:①随机对照实验,采用单盲,双盲或非盲法。②实验包含平行对照组。排除标准:重复性实验研究及综述类文章。资料提炼:共收集到45篇关于嗅鞘细胞干预脊髓损伤的随机实验文章,30篇符合纳入标准,排除的13篇为重复的同一研究和综述。资料综合:综述神经干细胞、胚胎干细胞移植以及基因修饰的嗅鞘细胞治疗脊髓损伤的方法,并对各方法给予评价。细胞联合移植治疗各有特色,但所有的实验结果主要以啮齿类动物-大鼠的脊髓损伤模型为基础而获得的,选择的模型包括脊髓完全横断模型、挫裂伤模型、脱髓鞘模型等,目前还不能获得完全模拟人的脊髓损伤的动物模型。如何选择适当的细胞类型联合应用,并使之实现从实验室走向应用研究是不同细胞移植策略中应重点考虑的问题。结论:尚无充分证据证明目前的嗅鞘细胞联合干预策略对人类脊髓损伤后的功能恢复有十分确切的作用,但单一、纯化的嗅鞘细胞移植可能不是干预脊髓损伤的最佳选择。

OBJECTIVE： To review the effect of olfactory ensheathing cell （OEC） transplantation on spinal cord injury and deeply explore special factors, which affected the intervention of cell transplantation on spinal cord injury. DATA SOURCES： Using the key terms of ＂olfactory ensheathing cells, spinal cord injury＂, we searched the Medline database for the articles about OEC transplantation and spinal cord injury published from January 1994 to March 2007 in English. Meanwhile, using the same key terms in Chinese, we searched the Chinese Journals Full-Text Database and Wanfang Database for articles of OEC transplantation and spinal cord injury during the same period. STUDY SELECTION： All articles were selected firstly, and these including experimental group and control group were collected. The non-randomized controlled trials were excluded and full-texts of the rest were looked up to get the further judgment. Inclusive criteria： （1）randomized controlled trials, single-blind, double-blind and non-blind methods, （2） experiments including parallel control group. Exclusive criteria： The articles of repetitive studies and summarizations were excluded. DATA .EXTRACTION： A total of 45 articles of randomized controlled trials were collected, which were relevant to the OEC transplantation strategies for spinal cord injury. 30 of them met the inclusive criteria, and the other 13 were excluded because of repetitive studies and summarizations. DATA SYNTHESIS： The methods of neural stem cells （NSCs）, embryonic stem calls （ESCs） and extracelluar matrixes with OEC transplantation strategies in treating spinal cord injury were reviewed and appraised. Each trial had special characteristic, but all results were obtained based on modele of spinal injury in rats. The collected model included transaction of spinal cord, contusion and demyelination, etc. Recently, no spinal cord injury animal models of completely human analogue were obtained. The important problems were how to choose appropriate cellular association and how to move from the laboratory to the clinical application in different cell transplantation. CONCLUSION： No evidence is obtained to prove that appropriate OEC composition can promote the functional restoration after spinal injury, but single and rarefied OEC transplantatfon strategies may not be the best choice to treat spinal cord injury.