Трансплантация ММСК жировой ткани как способ борьбы с

Íîâîñòè êëåòî÷íûõ òåõíîëîãèé
ËÈÒÅÐÀÒÓÐÀ:
1. Ëóöêàÿ È.Ê. Çàáîëåâàíèÿ ñëèçèñòîé îáîëî÷êè ïîëîñòè ðòà. Ì.: Ìåä.
ëèò.; 2006: 239-41.
2. Ïîæàðèöêàÿ Ì.Ì., Áî÷àðîâà Î.À., ×åêàëèíà Ò.Ë., Âîðîíèí Â.Ô., Êíÿæåâ
Â.À. Ñîâðåìåííûå àñïåêòû ïàòîãåíåçà è ëå÷åíèÿ ëåéêîïëàêèè ñëèçèñòîé
îáîëî÷êè ïîëîñòè ðòà. ÃÎÓ ÂÓÍÌÖ 2006: 31-3.
3. Falanga V, Saap L.J, Ozonoff A. Wound bed score and its correlation
with healing of chronic wounds. Dermatol. Ther. 2006; 19(6): 383-90.
4. Felipe M., Andrade P., Grisi M. et al. Comparison of two surgical
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procedures for use of the acellular dermal matrix graft in the treatment of gingival
recessions: a randomized controlled clinical study. J. Periodontol. 2007; 78(7):
1209-17.
5. Hotta T., Yokoo S., Terashi H., Komori T. Clinical and histopathological
analysis of healing process of intraoral reconstruction with ex vivo produced oral
mucosa equivalent. Kobe J. Med. Sci. 2007; 53(1-2): 1-14.
6. Pham C., Greenwood J., Cleland H., Woodruff P., Maddern G.
Bioengineered skin substitutes for the management of burns: A systematic review.
Burns. 2007; 33(8): 946-57.
Ïîäãîòîâèë À.Â. Âîëêîâ
Ïî ìàòåðèàëàì: Hotta T., Yokoo S., Terashi H., Komori T. Clinical and Histopathological Analysis of Healing Process of Intraoral
Reconstruction with ex vivo Produced Oral Mucosa Equivalent. Kobe J. Med. Sci. 2007; 53: 1-14
Òðàíñïëàíòàöèÿ ÌÌÑÊ æèðîâîé òêàíè êàê ñïîñîá áîðüáû
ñ ðåàêöèåé «òðàíñïëàíòàò ïðîòèâ õîçÿèíà» ó äåòåé
Îñíîâíîé ïðîáëåìîé ñîâðåìåííîé òðàíñïëàíòîëîãèè íàðÿäó ñî ñëîæíîñòüþ ïîäáîðà äîíîðà ÿâëÿåòñÿ ðàçâèòèå ðåàêöèè «òðàíñïëàíòàò ïðîòèâ õîçÿèíà» (ÐÒÏÕ) ïîñëå óñïåøíîé
òðàíñïëàíòàöèè. Äàííîå îñëîæíåíèå ìîæåò ïðèâåñòè ê òÿæåëûì îñëîæíåíèÿì è ñìåðòè ðåöèïèåíòà. Íà ñîâðåìåííîì
ýòàïå áîðüáû ñ ýòèì ñèíäðîìîì äîñòàòî÷íî ýôôåêòèâíî
èñïîëüçóþò öèòîñòàòèêè, ãëþêîêîðòèêîèäû, à òàê æå àíòèëåéêîöèòàðíóþ ñûâîðîòêó [1, 2]. Îäíàêî íå ó âñåõ ïàöèåíòîâ óäàåòñÿ äåðæàòü ðàçâèòèå äàííîãî îñëîæíåíèÿ ïîä êîíòðîëåì.
 ïîñëåäíåå âðåìÿ ñòàëî èçâåñòíî îá èììóíîìîäóëèðóþùåì äåéñòâèè ìóëüòèïîòåíòíûõ ìåçåíõèìàëüíûõ ñòðîìàëüíûõ êëåòîê (ÌÌÑÊ) êîñòíîãî ìîçãà ïîñëå òðàíñïëàíòàöèè èõ
ïàöèåíòàì ñ àóòîèììóííûìè çàáîëåâàíèÿìè [3, 5]. ÌÌÑÊ
æèðîâîé òêàíè è ôèáðîáëàñòîïîäîáíûå êëåòêè èç äðóãèõ
èñòî÷íèêîâ îêàçûâàþò ñõîäíîå äåéñòâèå íà èììóííûé ñòàòóñ îðãàíèçìà [4]. Èììóíîêîððåêöèÿ ìóëüòèïîòåííûìè
ñòðîìàëüíûìè êëåòêàìè íåêîñòíîìîçãîâîãî ïðîèñõîæäåíèÿ
äëÿ êîíòðîëÿ íàä ÐÒÏÕ ïðåäñòàâëÿåòñÿ ïåðñïåêòèâíûì íàïðàâëåíèåì â ñîâðåìåííîé òðàíñïëàíòîëîãèè, ïîñêîëüêó ïðîâåäåííàÿ èììóíîàáëÿöèÿ íå ïîçâîëÿåò ïîëó÷èòü àóòîÌÌÑÊ
èç êîñòíîãî ìîçãà ïàöèåíòà, ò.ê. îí ïîðàæåí îíêîëîãè÷åñêèì
ïðîöåññîì.
 ïîñëåäíåì íîìåðå æóðíàëà Pediatr. Transplantation
áûëî îïóáëèêîâàíî êëèíè÷åñêîå íàáëþäåíèå òðàíñïëàíòàöèè àóòîãåííûõ ÌÌÑÊ æèðîâîé òêàíè ïîäðîñòêàì ñ ÿâëåíèÿìè ÐÒÏÕ â âèäå òÿæåëîãî ýíòåðîêîëèòà. Ìàëü÷èêó 15 ëåò
áûëà âûïîëíåíà àëëîãåííàÿ òðàíñïëàíòàöèÿ ïóïîâèííîé
êðîâè â ñâÿçè ñ õðîíè÷åñêèì ìèåëîëåéêîçîì â ðåçóëüòàòå
íàñëåäñòâåííîé ïàòîëîãèè – òðàíñëîêàöèè t(9;22)(q34;q11)
(ôèëàäåëüôèéñêàÿ õðîìîñîìà). Ìàðêåðîì õðîíè÷åñêîãî
ìèåëîëåéêîçà ÿâëÿåòñÿ ðåöèïðîêíàÿ òðàíñëîêàöèÿ
t(9;22)(q34;q11), êîòîðóþ îáíàðóæèâàþò ó 90-95% áîëüíûõ.
 ðåçóëüòàòå ýòîé òðàíñëîêàöèè ìåæäó äëèííûìè ïëå÷àìè
9-é è 22-é õðîìîñîì ïðîèñõîäèò óêîðî÷åíèå äëèííîãî ïëå÷à 22-é õðîìîñîìû. Èìåííî îíà îòâåòñòâåííà çà ðàçâèòèå
õðîíè÷åñêîãî ìèåëîëåéêîçà.
Ïîñëå ðåíòãåíîòåðàïèè è õèìèîòåðàïåâòè÷åñêîé èììóíîàáëÿöèè áûëà âûïîëíåíà àëëîãåííàÿ òðàíñïëàíòàöèÿ ïóïîâèííîé êðîâè. Îäíàêî ñïóñòÿ íåêîòîðîå âðåìÿ ó ïàöèåíòà
ðàçâèëàñü ÐÒÏÕ. Ñòàíäàðòíàÿ òåðàïèÿ íå áûëà óñïåøíîé.
Äëÿ êîððåêöèè èììóííîãî êîíôëèêòà áûëà âûïîëíåíà àóòîòðàíñïëàíòàöèÿ ÌÌÑÊ æèðîâîé òêàíè ïàöèåíòà. Íà ôîíå ïîëó÷àåìîé ñòàíäàðòíîé òåðàïèè ÿâëåíèÿ ÐÒÏÕ ñíèçèëèñü è
ìèíèìèçèðîâàëèñü, ÷òî áûëî ïîäòâåðæäåíî áèîïñèåé ñëèçèñòîé îáîëî÷êè òîëñòîé êèøêè.
Âòîðîå íàáëþäåíèå èììóíîêîððåãèðóþùåãî ñâîéñòâà
ÌÌÑÊ æèðîâîé òêàíè áûëî ó äåâî÷êè 12 ëåò ïîñëå òðàíñïëàíòàöèè àëëîãåííûõ ãåìîïîýòè÷åñêèõ êëåòîê ïåðèôåðè÷åñêîé
êðîâè. Èììóíîàáëÿöèÿ îñóùåñòâëÿëàñü õèìèîòåðàïåâòè÷åñêèìè ïðåïàðàòàìè. Òàêæå, íåñìîòðÿ íà èììóíîñóïðåññèâíóþ òåðàïèþ, íå óäàëîñü èçáåæàòü ÐÒÏÕ ñ ïðåîáëàäàíèåì
ïîðàæåíèÿ òêàíè ïå÷åíè. Òðàíñïëàíòàöèÿ ÌÌÑÊ æèðîâîé
òêàíè ïîçâîëèëà ìèíèìèçèðîâàòü ðàçâèâøååñÿ îñëîæíåíèå
â òå÷åíèå áëèæàéøèõ òðåõ íåäåëü.
Òàêèì îáðàçîì, àâòîðû äåëàþò çàêëþ÷åíèå îá ýôôåêòèâíîñòè àóòîòðàíñïëàíòàöèè ÌÌÑÊ æèðîâîé òêàíè ó ïàöèåíòîâ
ñ ÐÒÏÕ è ïîñëåäóþùåì ñíèæåíèè äîç ãëþêîêîðòèêîèäîâ è
öèòîñòàòèêîâ, ÷òî áëàãîïðèÿòíî ñêàçûâàåòñÿ íà ïðèæèâëåíèè
àëëîòðàíñïëàíòàòîâ ãåìîïîýòè÷åñêèõ êëåòîê ó äåòåé â óñëîâèÿõ íåâîçìîæíîñòè ïîëó÷åíèÿ ÌÌÑÊ èç êîñòíîãî ìîçãà.
ËÈÒÅÐÀÒÓÐÀ:
1. Bacigalupo A., van Lint M., Frassoni F. et al. High dose bolus
methylprednisolone for the treatment of acute graft versus host disease. Blut.
1983; 46(3): 125-32.
2. Blaise D., Bay J., Faucher C. et al. Treatment of steroid-resistant acute
graft-versus-host disease with anti-thymocyte globulin. Bone Marrow
Transplant. 2001; 27: 1059–64.
3. Chen X., Armstrong M., Li G. Mesenchymal stem cells in
immunoregulation. Immunol. Cell Biol. 2006; 84(5): 413-21.
4. Haniffa M., Wang X., Holtick U. et al. Adult human fibroblasts are potent
immunoregulatory cells and functionally equivalent to mesenchymal stem cells.
J. Immunol. 2007; 179(3): 1595-604.
5. Lazarus H., Haynesworth S., Gerson S., Rosenthal N., Caplan A.. Ex vivo
expansion and subsequent infusion of human bone marrow-derived stromal
progenitor cells (mesenchymal progenitor cells): Implications for therapeutic use.
Bone Marrow Transplant. 1995; 16: 557–64.
Ïîäãîòîâèë À.Â. Âîëêîâ
Ïî ìàòåðèàëàì: Fang B., Song Y., Lin Q. et al. Human adipose tissue-derived mesenchymal stromal cells as salvage therapy for
treatment of severe refractory acute graft-vs.-host disease in two children. Pediatric Transplantation 2007; 11: 814-17
Êëåòî÷íàÿ òðàíñïëàíòîëîãèÿ è òêàíåâàÿ èíæåíåðèÿ Òîì II, ¹ 4, 2007