干细胞移植治疗心力衰竭的研究进展(2)

长因子和促血管生长因子来发挥作用。4、抑制损伤处心肌细胞凋亡。各种动物试验及初期临床研究都取得了可喜的成绩。

骨髓干细胞用于治疗心血管疾病的研究正日益深入, 但由于骨髓干细胞分化为心肌细胞的具体机制仍然不是十分清楚, 关于骨髓干细胞的横向分化在医学领域还存在很多争议, 甚至有人对成体干细胞的分化潜能提出了质疑, 有研究人员将骨髓干细胞和胚胎干细胞体外培养时发生自发融合, 而且自发融合的骨髓干细胞染色体为4n或6n, 并表达骨髓干细胞和

胚胎干细胞双重表型, 而在将神经干细胞和胚胎干细胞体外一起培养时也发现了此种现象, 他们认为这是对组织干细胞可塑性的合理解释, 这种观点还有待进一步研究。, 只有搞清楚这些具体机制才能彻底消除质疑, 并可以人为调控干细胞定向分化为需要的细胞, 提高其分化效率又避免过度增长, 使干细胞移植治疗更安全有效地应用于临床。

心肌再生医学做到真正安全有效地应用到临床, 目前也存在很多需要解决的问题: (1)选择适合移植的干细胞种类; (2)干细胞的提取、扩增、纯化、分化等技术问题,即高数量高纯度的干细胞来源问题; (3)干细胞移植方式和最佳时机的选择，细胞的分化是一个非常复杂的过程。首先, 被诱导的细胞应含有靶细胞相应蛋白的沉默基因, 而且这些基因应该能在适当的环境条件下和/ 或某些转录因子的参与下被激活并合成相应蛋白；其次,只有当这些合成的蛋白整合到相应亚单位或经过翻译后水平的修饰后, 被诱导的细胞才能获得相应靶细胞的功能; ( 4)接受干细胞移植的病人适应症及疗效评价体系的建立。另外，干细胞移植后在人体内分化为心肌细胞目前还没有明确的证据，其分化调控机制有待进一步阐明，远期疗效及相关并发症有待大量的临床试验进一步观察。尽管还有很多问题需要解决, 但相信经过努力, 骨髓干细胞用于治疗心血管疾病必将成为继传统药物、介入、手术等治疗的一种全新手段, 为广大患者带来福音。

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