《柳叶刀》发布干细胞治疗大突破

　　

生物通报道：来自英国布里斯托尔大学，西班牙巴塞罗那大学，马德里Instituto de Salud Carlos III等处的研究人员成功给一名气管受损的女子移植用自身干细胞培养的气管，这样就完全不会出现排斥现象，这是目前全球首例结构干细胞培植完整器官移植的病例。这一研究成果公布在世界上最悠久及最受重视的同行评审性质的医学期刊《柳叶刀》（The Lancet）上。

文章的通讯作者是巴塞罗那大学附属医院的Paolo Macchiarini博士，其学术背景包括Pisa大学医学院，法国巴黎大学等。细胞培养是在英国布里斯托尔大学完成，布里斯托尔大学Martin A Birchall表示，干细胞培植器官移植技术大约只需要二十年的时间就可以发展成为常规手术。科学家会首先发展管状器官移植技术，随后会发展心、肝、肺等器官的培植技术。这次手术的成功实施是干细胞技术的重大突破，具有重要的里程碑意义，有可能因此改变外科手术的未来。

据科技日报报道，传统的器官移植技术，由于器官来自他人，受者会发生不同程度的免疫排斥反应，患者因此需服用大量抑制免疫反应的药物。到目前为止，为了防止过度免疫反应，肢体器官移植还是禁区。由于卡斯特罗所移植的气管源自其个人的干细胞，经过数次血液检测后，至今尚未发现其体内有免疫排斥的信号。

这位身患肺结核的病人名为克劳迪娅·卡斯特罗，疾病破坏了她的一个气管，一度使她呼吸困难。来自于英国、意大利、西班牙的研究人员在今年6月12日给她进行了气管移植手术。科学家们首先从一位因脑溢血死亡的51岁女患者身上切除了部分气管，然后反复不断地清除气管上残存的细胞，直至该气管仅留下胶原质结构。随后再从卡斯特罗身上提取骨髓干细胞，送往英国布里斯托大学的一个实验小组，培养了600多万个作为气管壁的软骨细胞。这些软骨细胞再被送往意大利，令软骨细胞生长在气管的胶原质结构上，并利用机器塑造所需的形状，最后，该团队在卡斯特罗被损坏的左侧主支气管上（该处的气管与肺部相连）嫁接了“定制”出来的一块5厘米气管。

（生物通：万纹）

原文摘要：

Clinical transplantation of a tissue-engineered airway

Summary
Background
The loss of a normal airway is devastating. Attempts to replace large airways have met with serious problems. Prerequisites for a tissue-engineered replacement are a suitable matrix, cells, ideal mechanical properties, and the absence of antigenicity. We aimed to bioengineer tubular tracheal matrices, using a tissue-engineering protocol, and to assess the application of this technology in a patient with end-stage airway disease.
Methods
We removed cells and MHC antigens from a human donor trachea, which was then readily colonised by epithelial cells and mesenchymal stem-cell-derived chondrocytes that had been cultured from cells taken from the recipient (a 30-year old woman with end-stage bronchomalacia). This graft was then used to replace the recipient's left main bronchus.
Findings
The graft immediately provided the recipient with a functional airway, improved her quality of life, and had a normal appearance and mechanical properties at 4 months. The patient had no anti-donor antibodies and was not on immunosuppressive drugs.
Interpretation
The results show that we can produce a cellular, tissue-engineered airway with mechanical properties that allow normal functioning, and which is free from the risks of rejection. The findings suggest that autologous cells combined with appropriate biomaterials might provide successful treatment for patients with serious clinical disorders.
Funding
Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Fondo de Investigación Sanitaria, Spain; Charles Courtenay-Cowlin Fund, University of Bristol; UK Arthritis Research Campaign; and the James Tudor Foundation.