实现人类心肌的再生:干细胞的风雨路

The hard road to regenerating the human heart

如何实现人类心肌的再生,科研工作者和临床医生已经为之努力了近一个世纪。1953年,实施了第一例室间隔缺损修复手术,1967年第一例心脏移植成功,2002年骨髓来源的细胞首次移植到心肌内,使心肌的修复取得重大进步。然而慢性心力衰竭仍是世界范围内的难题。为什么实现心肌的再生面临巨大的挑战?要实现心肌的再生还有多远?细胞移植技术近年已取得突飞猛进的进步,许多大型动物实验结果带来了曙光和挑战。将对心肌再生的历史和临床研究进行探讨,对干细胞的实施和目前正在进行的实验进行综述。

Regenerating the human heart is a challenge that has engaged researchers and clinicians around the globe for nearly a century. From the repair of the first septal defect in 1953, followed by the first successful heart transplant in 1967, and later to the first infusion of bone marrow-derived cells to the human myocardium in 2002, significant progress has been made in heart repair. However, chronic heart failure remains a leading pathological burden worldwide. Why has regenerating the human heart been such a challenge, and how close are we to achieve clinically relevant regeneration？ Exciting progress has been made to establish cell transplantation techniques in recent years, and new preclinical studies in large animal models have shed light on the promises and challenges that lie ahead. In this review, we will discuss the history of cell therapy approaches and provide an overview of clinical trials using cell transplantation for heart regeneration. Focusing on the delivery of human stem cell derived cardiomyocytes, current experimental strategies in the field will be discussed as well as their clinical translation potential.