干细胞与肺移植

Stem cells and lung transplantation

背景:肺移植是治疗多种终末期肺病的惟一有效方法,但围手术期风险大,干细胞在肺移植肺损伤修复的基础研究及临床工作中有较好的应用前景。目的:总结干细胞的生物学特性及其与免疫系统的相互作用,介绍干细胞在肺移植实验和临床研究中的应用现状。方法:以"lung,pulmonary,transplantation,stem cell"为检索词,检索Pubmed数据库、Springlink数据库、ScienceDirect数据库,检索年限为1990-01/2011-03,限定语种为英文;以"移植、肺、干细胞"为检索词,检索CNKI数据库、万方数据库、维普数据库,检索年限为1990-01/2011-03,限定语种为中文。共检索156篇文献,根据纳入排除标准,对其中50篇文献进行分析。结果与结论:干细胞通过替代损伤的肺组织、旁分泌作用减少细胞凋亡参与组织修复,减轻炎症反应及肺组织纤维化。以间充质干细胞为例,由于免疫原性较弱,在诱导器官移植的免疫耐受中有较好的应用,一方面通过调节多种因子减轻免疫排斥反应,另一方面通过抑制T细胞、B细胞、NK细胞、树突状细胞、中性粒细胞的活性来减少免疫应答。基于干细胞独特的生物学特性,其在诱导免疫嵌合减少肺移植慢性排斥反应有一定作用,也为干细胞介导的细胞和基因治疗提供可能。

BACKGROUND： Lung transplantation is the only therapeutic option for patients with various end-stage lung diseases; however, it has high risk for death during the perioperative period. Stem cells have a good application prospect in the basic and clinical research of lung repair after lung transplantation. OBJECTIVE： To summarize the biological characteristics of stem cells and the interaction of immune system, and to introduce the application status of stem cells in lung transplantation experiment and clinical research. METHODS： We searched the PubMed database, Springlink database, and Science Direct database from January 1990 to March 2011 with the key words of ＂lung, pulmonary, transplantation, stem cell＂ in English. An online search of CNKI database, Wanfang database, Chongqing VIP database from January 1990 to March 2011 was also conducted with the key words of ＂lung, pulmonary, transplantation, stem cell＂ in Chinese. A total of 156 literatures were screened out, and 50 documents were included in the review based on the inclusion and exclusion criteria. RESULTS AND CONCLUSION： Stem cells played an important role in tissue repair by replacing the damaged lung tissue. It could reduce cell apoptosis, inflammatory reaction and pulmonary fibrosis through paracrine effect. Mesenchymal stem cells could induce immune tolerance of organ transplantation due to its low immunogenicity, which reflected in two aspects on one hand, mesenchymal stem cells could reduce the immunological rejection by regulating several cytokines, and on the other hand, it could reduce the immune response by inhibiting the activity of T-lymphocytes, B-lymphocytes, natural killer cells, dendritic cells, and neutrophilic granulocytes. Based on the unique biological characteristics, stem cells played an important role in the induction of immune gomphosis and reducing the chronic rejection after lung transplant, which facilitate cell and gene therapy mediated by stem cells.