Résumé
BACKGROUND:Stem cell transplantation has been used in the clinical treatment of spinal cord injury.However,the efficacy and safety are still controversial.Although there are many approaches for stem cell transplantation,which one is better is unclear as yet.OBJECTIVE:To systematically evaluate the efficacy and safety of stem cell transplantation for spinal cord injury,and to compare the therapeutic difference in stem cell transplantation via different approaches.METHODS:A computer-based online search was conducted in PubMed,The Cochrane Library (Issue 4,2016),Embase,CNKI,VIP,CBM,and Wan-Fang databases up to May 13,2016 to screen the relevant randomized clinical controlled trials of stem cells in the treatment of spinal cord injury.Two reviewers independently selected the studies,extracted information,and assessed the quality of included trials.Data extracted from eligible studies was pooled and meta-analyzed using Stata13.1 and Gemtc0.14.3 software.RESULTS AND CONCLUSION:A total of 10 randomized controlled trials involving 546 patients (294 in stem cells group and 252 in rehabilitation treatment group) were included.The results of meta-analysis showed that stem cell transplantation had an advantage over rehabilitation treatment in increasing American Spinal Cord Injury Association (ASIA) motor score,ASIA sensory score,Barthel Index,and decreasing the bladder residual urine volume.The incidence of low fever,abdominal distension,headache,lower limb numbness,and meningeal irritation was 14％,7％,7％,8％,and 7％,respectively.Taking the rehabilitation treatment as a common reference,the results of the network meta-analysis showed that there were no significant differences in ASIA motor score,ASIA sensory score,Barthel Index,and incidence of complications among subarachnoid injection,intravenous injection,and intralesional injection.Compared with the rehabilitation treatment,only stem cell transplantation via subarachnoid injection had significant differences in ASIA motor score [MD=9.77,95％CI (0.26,21.46)],and ASIA sensory score [MD=25.79,95％CI (10.07,45.27)].To conclude,the stem cells transplantation via subarachnoid injection is considered the most effective transplantation method.Due to the limitations of the included studies,more high-quality randomized controlled trials are required to verify the above conclusion.In addition,future studies should focus on the long-term efficacy and safety of stem cell transplantation in the treatment of spinal cord injury,and should investigate the clinical effects on spinal cord injury with different ASIA grades,types of stem cells,and transplantation time.
Résumé
<p><b>OBJECTIVE</b>This study is aimed at developing a simple and easy way to generate dendritic cells (DCs) from human peripheral blood monocytes (PBMCs) in vitro.</p><p><b>METHODS</b>PBMCs were isolated directly from white blood cell rather than whole blood and purified by patching methods (collecting the attached cell and removing the suspension cell). DCs were then generated by culturing PBMCs for six days with 30 ng/ml recombinant human granulocyte-macrophage stimulating factor (rhGM-CSF) and 20 ng/ml recombinant human interleukin-4 (rhIL-4) in vitro. On the sixth day, TNF-alpha (TNFalpha) 30 ng/ml was added into some DC cultures, which were then incubated for two additional days. The morphology was monitored by light microscopy and transmission electronic microscopy, and the phenotypes were determined by flow cytometry. Autologous mixed leukocyte reactions (MLR) were used to characterize DC function after TNFalpha or lipopolysaccharide (LPS) stimulations for 24 h.</p><p><b>RESULTS</b>After six days of culture, the monocytes developed significant dendritic morphology and a portion of cells expressed CD1a, CD80 and CD86, features of DCs. TNFalpha treatment induced DCs maturation and up-regulation of CD80, CD86 and CD83. Autologous MLR demonstrated that these DCs possess potent T-cell stimulatory capacity.</p><p><b>CONCLUSION</b>This study developed a simple and easy way to generate DCs from PBMCs exposed to rhGM-CSF and rhIL-4. The DCs produced by this method acquired morphologic and antigenic characteristics of DCs.</p>