嗅鞘细胞移植治疗脊髓损伤：理论研究的进展

Olfactory ensheathing cells transplantation for spinal cord injury:Advanced theoretical study

学术背景:一般认为中枢神经系统损伤后,由于内在的再生能力差和外在环境抑制,损伤轴突不能再生。近年来研究证实脊髓损伤后采用一些改变其局部环境的方法,能促使损伤神经修复、再生及恢复脊髓部分神经功能。目的:移植的嗅鞘细胞通过加速轴突穿过受损脊髓的区域,从而恢复部分神经功能,有必要对嗅鞘细胞移植治疗脊髓损伤的基础和临床研究现状进行深入认识。检索策略:由该论文的研究人员应用计算机检索Pubmed数据库1994-01/2007-07的相关文献,检索词"spinal cord injury,Olfactory Ensheathing Cells,Neumtrophic Factors",并限定文章语言种类为English。同时计算机检索中国期刊全文数据库2000-01/2007-07的相关文献,检索词"嗅鞘细胞,脊髓损伤",并限定文章语言种类为中文。共检索到76篇文献,对资料进行初审,纳入标准:①文章所述内容应与嗅鞘细胞移植治疗脊髓损伤密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准:①重复性研究。②Meta分析。文献评价:文献的来源主要是通过对嗅鞘细胞移植治疗脊髓损伤方面内容进行汇总分析。所选用的34篇文献中,4篇为综述,其余均为临床或基础实验研究。资料综合:①大量的基础和临床研究显示:脊髓损伤后采用一些改变其局部环境的方法,能促使损伤神经修复、再生和恢复脊髓部分冲经功能。在这些方法中,嗅鞘细胞被认为是治疗脊髓损伤最有前景的方法之一。②嗅鞘细胞具有许旺细胞和星形胶质细胞相似的特征,在其膜上表达出很多与细胞黏合和轴突生长相关的分子,还能分泌大量不同种类的神经营养和支持因子;实验证实嗅鞘细胞移植入各种脊髓损伤的模型表现出促进脊髓轴突再生的能力。③临床研究证实,嗅鞘细胞移植对脊髓损伤患者的脊髓神经功能恢复具有帮助作用,且安全性有保障。结论:采用嗅鞘细胞移植治疗脊髓损伤已被公认为非常有效且前景广阔的治疗方法之一。目前采用嗅鞘细胞移植治疗的晚期脊髓损伤患者为数尚少,还需要进一步观察研究其最终恢复程度和临床安全性;此外仍需探讨如何提高脊髓神经功能恢复的程度。

BACKGROUND： Generally speaking, the injured axons can not regenerate following lesion of central nervous system because of bad internal regeneration capacity and inhibition of extemal environment. Recent studies show that functions of injured nerves and spinal cord can be improved by changing local surroundings after spinal cord injury. OBJECTIVE： Parts of nerve functions can be improved by promoting axonal regeneration through the district of injured spinal cord. It is necessary to recognize the basic and clinical researches of Olfactory Ensheathing Cells （OECs） transplantation on curing spinal cord injury. RETRIEVE STRATEGY： The relevant articles published between January 1994 and July 2007 were searched in Pubmed database with the key words of ＂spinal cord injury, Olfactory Ensheathing Cells, Neurotrophic Factors＂ in English. Simultaneously, the relevant Chinese articles between January 2000 and July 2007 were searched in China Joumal Full-text Database with the key words of ＂olfactory ensheathing cells, spinal cord injury＂. Totally 76 literatures were collected and they were selected primarily. Inclusive criteria： ①The contents of the articles should be closely correlated with OECs transplantation on curing spinal cord injury. ②Those published in recent years or in authority journals were preferred for the same field. Exclusive criteria：①the duplicated study.②Meta analysis. LITERATURE EVALUATION： The literatures were obtained by collecting and analyzing the contents of OECs transplantation on curing spinal cord injury. There were four reviews in 34 literatures while the others were clinical or basic empirical studies. DATA SYNTHESIS： ①A lot of basic and clinical studies show that, injured nerves and function of spinal cord can be improved by some methods that can change local surroundings after spinal cord injury. In these methods, OECs transplantation is considered as one of the most promising therapies for spinal cord injury. ②OECs share similar properties with both Schwann calls and astrocyte. Their membrane can not only express lots of factors related to cell combination and axonal growth but also excrete variety classes of neurotrophic factors and supporting factors. Experiments prove that OECs transplantation in different models of spinal cord injury shows capability of promoting axonal regeneration. ③Clinical studies prove that OECs transplantation is positively useful and safe for functional recovery of spinal cord and nerves in patients of spinal cord injury. CONCLUSION： OECs transplantation on curing spinal cord injury is generally accepted as one of the newest, most useful and promising therapies. Nevertheless the OECs transplantation for spinal cord injury is just beginning to be developed in patients at later stage, there are still many problems need to be studied, such as the final recovery level, clinical safety and the methods to elevate the functional recovery of spinal nerves.