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#1
09.04.2007, 19:07
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Нарасти сердечную мышцу!
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#2
10.04.2007, 00:34
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Может я и излишне придирчив, но не будет ли являться утолщение стенки правого желудочка при аномалии Эбштейна результатом протезирования дефектного клапана (и уменьшения дилатации правого желудочка), а не введения стволовых клеток? Почему во всем мире стволовые клетки для этой цели даже не подумали применить? Если все соответствует действительности, то почему данную инфу следует обкатывать в "Газете", а не в нормальной мед. периодике?
Тем более, что опыт изложения имеется: Eur J Cardiothorac Surg. 2005 Oct;28(4):536-40. Advantages and disadvantages of one-stage and two-stage surgery for arrhythmias and Ebstein's anomaly. Bockeria L, Golukhova E, Dadasheva M, Revishvili A, Levant A, Bazaev V, Rzaev F, Kakuchaya T. Bakoulev Scientific Center for Cardiovascular surgery, Rublevskoe shosse 135, Moscow 121552, Russian Federation. Интересно, родители ребенка хотя бы знали, что их чаду проводится экспериментальная терапия? Подробнее о патологии: [Ссылки доступны только зарегистрированным пользователям ]
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#3
10.04.2007, 17:37
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Цитата:
С уважением, Остроумов ЕН.
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#4
10.04.2007, 18:33
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Мне больше понравился опыт британцев при АЛ-амилоидозе на комбинации циклофосфан+дексаметазон+талидомид: сравните - 3-летняя выживаемость - более 80%, смертность, обусловленная лечением, - 4%, (при ТКМ в представленном Вами наблюдении эти показатели соответственно 56% и 18%)
(Blood. 2007 Jan 15;109(2):457-64) [Ссылки доступны только зарегистрированным пользователям ]
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#5
10.04.2007, 20:02
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Возвращаясь к первопубликации - судя по прошлогоднему обзору
Thus, though it can be speculated that cardiac disorders of infancy and childhood might profit from stem cell therapy, direct experimental evidence is sparse. Probably the clinical use of either embryonic or adult stem cell technology in paediatric cardiology is still many years in the future. /Stem cells and their potential relevance to paediatric cardiology. Cardiology in the Young (2006), 16: 117-124/ пока еще НИКТО в мире в кардиопрактике не рискнул провести введение каких-либо стволовых клеток ребенку, пожалуй многим бы зарубежным кардио-педиатрам было бы интересно узнать о подробностях столь новаторского подхода (ведь 30 лет назад Чазов не постеснялся представить результаты по введению интракоронарной стрептокиназы при ИМ) - предполагаю эффектное заглавие публикации на страницах NEJMa или Ланцета: перекликаясь с последней фразой предыдущего обзора Salvage stem cell transplantation for Ebstein anomaly in X-years old child: What was suggested as many years in the future is today reality in Russia!
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#6
10.04.2007, 20:28
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К сожалению, стволовые клетки уже давно стали в России реальностью. В некоторых федеральных институтах в Москве вполне практикуют лечение ИБС стволовыми клетками.
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#7
10.04.2007, 20:56
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Согласен, уважаемый Артемий, и за рубежом стволовые клетки при ИБС у взрослых пытаются применять (пока еще) экспериментально с 2001, в том то и фишка, что в Газете обнародован уникальный эксперимент со всех сторон: на ребенке и при врожденной аномалии. Почему в Газете? и вообще "был ли мальчик"?
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#8
10.04.2007, 21:45
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Цитата:
Артемий писал не о зарубежных исследованиях Цитата:
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#9
10.04.2007, 22:27
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Уважаемый Евгений Николаевич,
Именно так и понял, что Артемий Никитич, упоминает отечественные исследования - вот пример: Kardiologiia. 2004;44(9):16-22. [First experience with the use of bone marrow stem cells for regeneration therapy of ischemic heart disease.] Bokeriia LA, Buziashvili IuI, Matskeplishvili ST, Kamardinov DKh. A. N. Bakulev Research Center for Cardiovascular Surgery; Rublevskoye sh., 135, 121552 Moscow, Russia. AIM: To elucidate feasibility of the use of autologous bone marrow stem cells in candidates to myocardial revascularization- patients with ischemic heart disease and cardiosclerosis after myocardial infarction. METHODS: Between January 2003 and January 2004 25 men aged 56.3+/-5.4 years with ischemic heart disease were subjected to cell therapy including 4 patients with heart failure and 5 - with acute coronary syndrome. Subgroup of patients with postinfarction cardiosclerosis consisted of 16 men satisfying the following criteria: (1) history of myocardial infarction with scar formation; (2) class III-IV angina; (3) presence of indications for endovascular or surgical intervention on coronary arteries. Study protocol included clinical examination, coronary angiography; dobutamine stress-, contrast- and tissue echocardiography with assessment of segmental myocardial perfusion, systolic and diastolic left ventricular function. RESULTS: There were no complications during bone marrow sampling and administration of cells. All patients were restudied 1 month after transplantation. Improvement of clinical state without complications and adverse effects of the procedure noted in all patients was associated with lowering of mean angina class (from 3.4 to 1.4, p<0.05); decrease of NYHA heart failure class (from 3.1 to 1.5); rise of left ventricular ejection fraction (from 42.9 to 56.3%); decrease of average number of asynergic segments (from 5.3+/-0.7 to 2.1+/-0.3, p<0.01). Systolic velocity before intervention was 2.3 cm/s, after procedure in segments subjected to isolated revascularization it increased up to 4.8 cm/s, while in those subjected to revascularization combined with administration of stem cells - up to 6.2 cm/s. Contrast echocardiography in 9 patients demonstrated augmented myocardial perfusion in regions exposed to cell therapy. CONCLUSION: Transplantation of autologous bone marrow stem cells to ischemic heart disease patients - candidates for myocardial reperfusion - turned out to be safe and well tolerated procedure. Combination of myocardial revascularization with administration of stem cells into regions of postinfarction scars was associated with improvement of total and local myocardial contractility and normalization of left ventricular diastolic filling. Cell therapy facilitated augmentation of myocardial perfusion. А вот эта публикация может пролить свет по основной теме дискуссии (выделено мной) Vestn Ross Akad Med Nauk. 2004;(9):48-55 Бокерия Л.А., Георгиев Г.П., Голухова Е.З., Еремеева М.В., Ким А.И., Киселев С.Л., Лагарькова М.А., Асланиди И.П., Вахромеева М.Н., Шаталов К.В., Какучая Т.Т., Полякова Э.С., Лукашкин М.А., Волковская И.В., Демидова О.А., Сухих Г.Т., Гольдштейн Д.В., Репин В.С., Ржанинова А.А. Клеточные и интерактивные технологии в лечении врожденных и приобретенных пороков сердца и ишемической болезни сердца. опять таки, ни тезисов ни полного текста в наличии, только слив в Газету: "Группа исследователей из Научного центра сердечно-сосудистой хирургии им. А. Н. Бакулева РАМН во главе с известным кардиохирургом, академиком РАМН Лео Бокерией, а также ЗАО «Реметэкс» попытались придумать способ повысить регенерационную способность сердца путем имплантирования в него стволовых клеток, полученных из костного мозга. Как пояснили «Газете.Ru» представители центра, в костном мозге человека из стволовых клеток образуются красные кровяные тельца на протяжении всей жизни. Поэтому костный мозг считается одним из наиболее перспективных мест получения стволовых клеток этическим путем (без выращивания и убивания эмбрионов). Полученные стволовые клетки медики имплантировали в миокард. Первые опыты проводились на крысах, а с 2002 года ученые проводили клинические испытания методики на людях. 110 пациентов опробовали на себе новую методику. Как показали исследования, такая операция повышает регенеративную способность сердца. Правда, происходит это не сразу. Только через полгода после операции наблюдается достоверный эффект. У больных достоверно улучшается перфузия (кровоснабжение) сердца, снижается уровень сердечной недостаточности, они намного легче переносят физические нагрузки." (29 МАЯ 2006 13:10)
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#10
10.04.2007, 23:48
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В то время как при отсутствии рандомизации отечественный опыт показывает превосходные результаты после 6 мес. наблюдения, зарубежные исследования по интракоронарной трансплантации стволовых клеток, полученных из КМ реципиента, более чем скромны - или нет значимой разницы или ранняя 6-месячная значимость к теряется к 18-му месяцу:
BMPCs Variable results have been reported in the first clinical trials, four of which are at present complete. Probably the most important trial is the BOOST trial, which used MRI to determine LVEF and infarct size. In this study 30 patients were treated with BMSC intracoronarily within 1 week of the MI and 30 patients received standard treatment. The early results at 6 months showed a significant improvement of LVEF in the stem cell treated group compared to the controls (Wollert et al. 2004). This beneficial effect was in part due to an increased end-diastolic volume in the stem cell group. More importantly, however, by 18 months the control group had undergone a gradual recovery of LVEF and there was no longer a significant difference between the stem cell treated and control groups (Meyer et al. 2006). The early modest positive effect that had been observed (6.7%) was therefore apparently not sustained. In the much larger REPAIR AMI trial, which included 95 patients in the stem cell group, a much smaller early beneficial effect was reported (Cleland et al. 2006). Although unfortunately, the LVEF was determined by angiography, a technique not ideal for the assessment of LVEF or infarct size (Schachinger et al. 2006). A third trial with a neutral outcome was conducted in Norway. In this ASTAMI trial 49 patients received stem cells with a similar number as controls. The treatment was safe and, as in the previous studies, no adverse events were reported. However no beneficial effects of the additional treatment on heart function were observed by nuclear imaging or MRI. Interestingly, a group in Leuven reported on a fourth, smaller, trial (n = 33) where no benefit on LVEF was measured by MRI in the stem cell treated group versus controls (Janssens et al. 2006). However a reduction of infarct size was observed, together with local improvement in of cardiac wall motion. This last study was in fact the only one of the four with a correct placebo control group. Although all four of these trials had shown no adverse effects of stem cell treatment on patients and the consensus was that they appeared safe, enthusiasm was tempered somewhat by a recent report which showed that the application of selected BMSC enhanced atherosclerotic lesion formation in vessels treated with stem cells (Mansour et al. 2006). Overall, however, it seems that intracoronary BMSC injections are safe and if they have a beneficial effect it is small and not sustained. For the future, larger trials with proper placebo controls will be necessary for a definitive conclusion. Guidelines for such trials were recently published and some of these trials are ongoing (HEBE in the Netherlands, and BOOST II in Germany) (Bartunek et al. 2006). J Physiol. 2006 Dec 1;577(Pt 2):467-78. Heart repair and stem cells.
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#11
10.04.2007, 23:54
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Пока же, к сожалению, в Ланцет попадают лишь следующие материалы по отечественной "клеточной трансплантологии":
The Lancet Volume 365, Issue 9466 , 2 April 2005-8 April 2005, Pages 1219-1220 World Report Russian scientists voice concern over “stem-cell cosmetics” Tom Parfitt Beauty salons in Russia are exploiting a legal loophole that allows them to offer stem-cell treatments for cosmetic purposes. Scientists are now rallying against the unregulated use of these treatments to stop the practice undermining legitimate research. Tom Parfitt reports. The Russian Ministry of Health is in the process of setting an expert council to investigate the country's huge and unregulated trade in stem-cell treatment at private clinics and beauty salons. Officials were forced to take action at the end of March after a group of 13 eminent scientists wrote to parliament pleading for it to introduce a law prohibiting the clinical use of stem cells from embryos and aborted fetuses. Under current Russian legislation, stem cells of any kind can only be extracted or stored, but commercial clinics get around the regulations by arguing their use in treatment is not expressly forbidden. Research institutes are allowed greater latitude, but the guidelines are unclear and open to abuse from institutes that have partnerships with commercial organisations. Across the world, research into stem cells is still at an early stage and clinical trials on humans are rare. However, treatments using the cells—or purporting to use them—are easily available in Russia, despite being officially prohibited. Some unscrupulous scientists are thought to be in league with private boutiques and clinics in a shady but hugely lucrative business. A slew of recent media reports has exposed the extent of the trade and there are growing fears that patients are paying tens of thousands of dollars for “wonder cures” that could cause them long-term damage. Medical professionals are hoping the expert council will rein in the trade by issuing tough new guidelines for use of stem cells in both research and clinical use. Dozens of private clinics in Moscow offer stem-cell treatment for diseases such as Parkinson's disease and Alzheimer's disease, for diabetes, impotency, and a raft of other ailments. Among them are beauty salons that provide stem-cell treatments to cure baldness or smooth out wrinkles on the skin. The treatment can cost up to £10 000 (US$18 740) for a series of injections. Clinics openly advertise their services in newspaper advertisements under headlines such as “Immortality is almost possible” and “The youth injection”. “All this—everything which is being done in Russia at the moment in terms of clinical application of fetal, embryonic, or adult stem cells—is illegal”, says Vladimir Smirnov, a professor and director of the Institute of Experimental Cardiology, who is leading the campaign for a new law. The professor, whose institute runs a state-authorised adult stem-cell bank using cells taken from umbilical cords, says he is in favour of responsible stem-cell research. However, he and his colleagues are anxious that patients are effectively paying to be guinea pigs for untested treatments. One major concern is that patients are being injected with a blend of tissues from aborted fetuses or other material whose origin is doubtful. The Cosmeton Clinic in Moscow, for example, says it uses cells from pigs and sheep in its injections. Smirnov compared this kind of treatment to the 19th century Brown-Sequard “organotherapy” whereby human diseases were treated using extracts from animal organs. “The only reason people feel a positive effect for a month or 6 weeks after the injection is because introducing foreign material into the body causes immuno-stimulation”, he told The Lancet. “In fact, it is potentially very harmful. Firstly, it can cause teratomas (tumours) which could turn malignant. Secondly, you introduce infection because you cannot check all the viruses when you take material from an embryo which is developing and where the origin is unknown.” Some patients have already spoken out about the adverse effects they have suffered. Svetlana Galiyeva, a 40-year-old gynaecologist from Perm, thought she had found the answer to her prayers when she discovered a Moscow clinic offering to treat her multiple sclerosis with embryonic stem cells. After a series of injections costing about 560 000 rubles (£10 000) she is still confined to a wheelchair. In the beginning, her body initially rejected the treatment. Her limbs then regained some sensation, but only for a short period. Doctors later advised her there was no proof her injections had anything to do with stem cells. Another patient, the pharmaceuticals magnate Vladimir Bryntsalov, described his face being left covered with tiny tumours after supposed stem-cell treatment. Many scientists are worried that such scandals could hinder genuine research into stem cells. “There is a real risk that the state will decide to cut off funding as a result”, says Alexei Ivanov, a professor and deputy director of the Research Institute of Molecular Medicine at Moscow's Sechenov Medical Academy. His institute is studying mechanisms of differentiation of stem cells, under the auspices of the Ministry of Health. While some smaller private clinics are reluctant to discuss their methods of stem-cell treatment, others claim they are merely exploiting a legal loophole. One of the highest-profile experts in the field is Alexander Teplyashin, head of the Moscow's chain of elite Beauty Plaza salons. He offers “absolutely unique stem cell technology” with which “it is possible to eradicate [diseases] and create a completely healthy human being”. The treatment, his website boasts, can “stop the process of ageing”. Teplyashin and his colleagues agreed to show The Lancet around his salon in central Moscow, an immaculate building with frosted glass doors, chrome fittings, and a spiral staircase. “We understood that people were interested in their appearance and in a long life and at the same time we realised that in stem cells there are huge resources for regeneration”, he explained. The salon uses mesenchymal stem cells taken from adipose tissue during liposuction (or a simple operation under local anaesthetic) which are isolated, cultivated, and stored. They are then administered as injections to treat hepatitis, diabetes, eye disorders, and skin problems. Most of the treatment is autologous—a procedure that is likely to be permitted under new guidelines expected to be issued by the health ministry's new expert council later this month. However, some of the cells used are from donors. Laboratory assistants at Beauty Plaza gave a slideshow that demonstrated rapid healing of cuts and scratches on a woman's face after a car accident, achieved by applying a mask of stem cells in a gel. Another woman underwent the same procedure as a cosmetic exercise to “lift” her skin. Teplyashin admits that such clinical uses are a grey area under current legislation but says all patients are rigorously checked and monitored before and after treatment. “The law permits one to extract these cells and to keep them, that's all”, he says. “But what is not forbidden, is allowed.” Several other clinics contacted by The Lancet offered stem-cell treatment for a range of ailments, with prices ranging from £90 for a skin rejuvenation injection to £45 000 for a full course of treatment. While different clinics acquire their material from different sources, the area of greatest controversy remains the use of material from aborted human fetuses. Smirnov believes there is a criminal trade in these fetuses, which are obtained from poor women in Russia and Ukraine who are persuaded to have late abortions. “The women are paid about $200 to have a caesarean at about 15 weeks and the fetus is then passed on to a clinic”, he said. One Moscow-based “Stem Cells hotline” claims regular treatment with its embryonic stem cells, starting when the patient was 20, would allow him or her to live until they were 150 years old. Andrei Loshak, a well-known investigative reporter from the NTV television channel, discovered last month that inquiries to the hotline were redirected to a state-run obstetrics centre where a series of injections into the stomach costs about £4000. Gennady Sukhikh, director of the centre's immunology department, admitted that fetal cells were used, but told Loshak: “We work with embryos obtained from social abortions, when the termination of the pregnancy is the voluntary decision of the mother.” Many experts insist the controversy around clinical stem cell use must not detract from the cells' real potential. “These are truly magic cells”, said Ivanov from the Sechenov Academy. “The problem is, there is still so much we don't know about them and the effects they have on the body. That's why we have to get all this unregulated practice under control.”
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#12
11.04.2007, 08:01
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На месте модератора я бы перенес ветку об успехах отечественной stem cells терапии из раздела "Кардиология" в раздел "Разное" или "Предложения по оказанию медицинских услуг" или еще куда-нибудь подальше.
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#14
21.04.2007, 14:52
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Я так понимаю, что проблема не в стволовых клетках как таковых, а в полупиратских исследованиях с непонятным дизайном за немалые деньги самих пациентов.
Вот довольно большой обзор на эту тему в свободном доступе: [Ссылки доступны только зарегистрированным пользователям ]
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Линейный вид
