基于“心-肾-髓-以通为养”理论探讨中医药促进骨髓间充质干细胞治疗心肌梗死的作用机制

Mechanism of Traditional Chinese Medicine in Promoting Bone Marrow Mesenchymal Stem Cells to Treat Myocardial Infarction Based on Theory of “Nourishing Heart-Kidney-Marrow by Circulation”

心血管疾病是全球死亡率最高的疾病,其中心肌梗死(Myocardial infarction,MI)更是占心血管疾病死亡率的46%,对人类的健康造成了严重威胁。干细胞移植能促进受损心肌细胞修复和再生,在MI的治疗中发挥重要作用。其中,骨髓间充质干细胞(Bone marrow mesenchymal stem cells,BMSCs)凭借其低免疫原性、高增殖能力以及强免疫调节的优势成为干细胞疗法的主要细胞来源,但其仍存在移植后存活、迁移和分化能力低下等一系列问题。中医学认为MI属“胸痹”范畴,对其治疗已有几千年的历史。中医药在BMSCs治疗MI中的作用引起了学者的广泛关注。文中将基于中医理论总结目前BMSCs移植过程的各阶段中医药起到的关键作用。同时,总结干细胞移植的不同阶段不同治则的方药调控干细胞治疗MI的作用机制,探讨中医理论与BMSCs增殖、迁移、归巢、分化、存活的关系,并通过现代纳米给药系统,高通量筛选中药有效成分,增强中药疗效。结合中医基础理论提出“心-肾-髓-以通为养”理论以及BMSCs的“肾精属性”,推动中西医结合治疗结合的理论创新。

Cardiovascular disease is the leading cause of death globally,among which the death rate caused by myocardial infarction(MI)accounts for 46% of mortality in cardiovascular disease,posing a serious threat to human health.Stem cell transplantation can promote the repair and regeneration of damaged cardiomyocytes and plays an important role in the treatment of MI.Among them,bone marrow mesenchymal stem cells(BMSCs)have become the main cell source of stem cell therapy due to their low immunogenicity,high proliferative capacity,and strong immunomodulatory advantages.However,they still have a series of problems such as low post-transplantation survival,migration,and differentiation capabilities.Traditional Chinese medicine(TCM)considers MI as belonging to the category of “chest obstruction”,with a history of treatment spanning thousands of years.The role of TCM in the treatment of MI with BMSCs has attracted widespread attention among scholars.This paper summarized the key roles of TCM at various stages in the BMSC transplantation process based on TCM theory.At the same time,the paper summarized the mechanism of different prescriptions at different stages of stem cell transplantation in the treatment of MI and discussed the relationship between TCM theory and BMSC proliferation,migration,homing,differentiation,and survival.In addition,the paper also discussed improving the efficacy of TCM through high-throughput screening of effective ingredients of TCM by modern nano-drug delivery systems.Combining the basic theory of TCM,the paper proposed the “nourishing heart-kidney-marrow by circulation” theory and the “kidney essence attribute” of BMSCs,promoting the theoretical innovation in the combination of TCM and Western medicine.