16 Íîâîñòè êëåòî÷íûõ òåõíîëîãèé ËÈÒÅÐÀÒÓÐÀ: 1. Folkman J., Hochberg M. Self-regulation of growth in three dimensions. J. Exp. Med. 1973; 138: 745-53. 2. Polykandriotis E., Arkudas A., Horch R. et al. Autonomously vascularized cellular constructs in tissue engineering: opening a new perspective for biomedical science. J. Cell Mol. Med. 2007; 11(1): 6-20. 3. Arkudas A., Tjiawi J., Bleiziffer O. et al. Fibrin gel-immobilized VEGF and bFGF efficiently stimulate Angiogenesis in the AV Loop Model. Mol. Med. 2007; 13(9-10): 480-7. 4. Ahrendt G, Chickering D., Ranieri J. Angiogenic growth factors: a review for tissue engineering. Tissue Eng. 1998; 2: 117-30. 5. Khouri R., Upton J., Shaw W. Prefabrication of composite free flaps through staged microvascular transfer: an experimental and clinical study. Plast. Reconstr. Surg. 1991; 87: 108-15. 6. Lokmic Z., Stillaert F., Morrison W. et al. An arteriovenous loop in a protected space generates a permanent, highly vascular, tissue-engineered construct. FASEB J. 2007; 21(2): 511-22. 7. Arkudas A., Beier J., Heidner K. et al. Axial prevascularization of porous matrices by an arteriovenous loop promotes survival and differentiation of transplanted autologous osteoblasts. Tissue Eng. 2007; 13(7): 1549-60. 8. Kneser U., Polykandriotis E., Ohnolz J. et al. Engineering of vascularized transplantable bone tissues: induction of axial vascularization in an osteoconductive matrix using an arteriovenous loop. Tissue Eng. 2006; 12: 1721-31. 9. Kuznetsov S.A., Robey P.G. A look at the history of bone marrow stromal cells. Graft. 2000; 3(6): 278-83. 10. Casabona F., Martin I., Muraglia A. et al. Prefabricated engineered bone flaps: an experimental model of tissue reconstruction in plastic surgery. Plast Reconstr Surg. 1998; 101(3): 577-81. Ïîäãîòîâèë È.ß. Áîçî Ïî ìàòåðèàëàì: Arkudas A., Beier J., Heidner K. et al. Axial prevascularization of porous matrices by an arteriovenous loop promotes survival and differentiation of transplanted autologous osteoblasts. Tissue Eng. 2007; 13(7): 1549-60 HUMAN STUDY Âîññòàíîâëåíèå ñëèçèñòîé îáîëî÷êè ïîëîñòè ðòà ïóòåì òðàíñïëàíòàöèè àóòîãåííûõ êåðàòèíîöèòîâ: êëèíè÷åñêîå èññëåäîâàíèå Êîìïëåêñ çàáîëåâàíèé ñëèçèñòîé îáîëî÷êè ïîëîñòè ðòà èíîãäà òðåáóåò ïðèìåíåíèÿ àêòèâíîé õèðóðãè÷åñêîé òàêòèêè. Ñîñòîÿíèÿ ïîñëå ðåçåêöèè ëåéêîïëàêèè, ïëîñêîêëåòî÷íîãî ðàêà, à òàêæå àòðîôèè ñëèçèñòîé îáîëî÷êè àëüâåîëÿðíîãî ãðåáíÿ, ñîïðîâîæäàþùèåñÿ ïîòåðåé èëè ïîðàæåíèåì åå ó÷àñòêà íà ïëîùàäè áîëåå 1 ñì2, òðåáóþò âîññòàíîâëåíèÿ äåôåêòà.  íàñòîÿùåå âðåìÿ õèðóðãè÷åñêàÿ òàêòèêà ñâîäèòñÿ ê ïåðåìåùåíèþ ñâîáîäíûõ ëîñêóòîâ. Îäíàêî íå âñåãäà îïåðàöèÿ ìîæåò áûòü óñïåøíà. Ýòî ñëó÷àåòñÿ ëèáî â ñâÿçè ñ ðàçâèòèåì îñëîæíåíèé (íåêðîç òðàíñïëàíòàòà), èëè êîãäà äåôåêò íå ïîçâîëÿåò âûïîëíèòü îïåðàòèâíîå âìåøàòåëüñòâî, íå íàíåñÿ óùåðá òêàíÿì â ìåñòå çàáîðà [1, 2]. Àëüòåðíàòèâîé àóòîòðàíñïëàíòàöèè èëè ïëàñòèêè ñëèçèñòîé îáîëî÷êè ìîãóò áûòü èìïëàíòàöèè áèîëîãè÷åñêè àêòèâíûõ ìàòåðèàëîâ â çîíó äåôåêòà ñ ïîñëåäóþùèì îæèäàíèåì ýïèòåëèçàöèè ñêàôôîëäà ñ êðàåâûõ çîí ðàíû.  êëèíè÷åñêîé ïðàêòèêå ñòîìàòîëîãîâ, äåðìàòîëîãîâ è õèðóðãîâ â ÑØÀ øèðîêî èñïîëüçóåòñÿ äåöåëëþëèðîâàííàÿ, ñïåöèàëüíî î÷èùåííàÿ îò àíòèãåíîâ, ÷åëîâå÷åñêàÿ äåðìà AlloDerm, êîòîðàÿ ïðåäíàçíà÷åíà äëÿ ñòèìóëÿöèè ïðîöåññîâ çàæèâëåíèÿ ñëèçèñòûõ îáîëî÷åê è êîæè [3, 4]. Êðîìå òîãî, ïîìèìî ñêàôôîëäîâ äëÿ âîññòàíîâëåíèÿ êîæè â øèðîêóþ ïðàêòèêó áûëè âíåäðåíû è êëåòî÷íûå àëëîòðàíñïëàíòàòû, ÿðêèì ïðèìåðîì êîòîðûõ ìîæåò ñëóæèòü Apligraf. ßâëÿÿñü æèâûìè ýêâèâàëåíòàìè êîæè, îíè çàðåêîìåíäîâàëè ñåáÿ õîðîøî êàê â ýñòåòè÷åñêîé ìåäèöèíå, òàê è â êîìáóñòèîëîãèè [5, 6]. Èñïîëüçîâàíèå êëåòî÷íûõ òåõíîëîãèé â õèðóðãè÷åñêîé ñòîìàòîëîãèè êàæåòñÿ ñàìî ñîáîé ðàçóìåþùèìñÿ äåëîì. Êëåòî÷íàÿ òðàíñïëàíòîëîãèÿ è òêàíåâàÿ èíæåíåðèÿ Òîì II, ¹ 4, 2007 Èññëåäîâàòåëüñêàÿ ãðóïïà Óíèâåðñèòåòà Êîáý (ßïîíèÿ) ïðîäåìîíñòðèðîâàëà âîçìîæíîñòü èñïîëüçîâàíèÿ àóòîòðàíñïëàíòàòîâ äëÿ âîññòàíîâëåíèÿ äåôåêòîâ ñëèçèñòîé îáîëî÷êè ïîëîñòè ðòà ó ïÿòíàäöàòè ïàöèåíòîâ ñ ëåéêîïëàêèåé, ïëîñêîêëåòî÷íûì ðàêîì ïîëîñòè ðòà è àòðîôèåé ñëèçèñòîé îáîëî÷êè â îáëàñòè àëüâåîëÿðíîãî ãðåáíÿ. Êëåòî÷íûé ìàòåðèàë ïîëó÷àëè ïóòåì áèîïñèè, êåðàòèíîöèòû âûäåëÿëè, êóëüòèâèðîâàëè è íàíîñèëè íà AlloDerm. Ñðåäíèé ðàçìåð äåôåêòîâ ñîñòàâëÿë ïîðÿäêà 6 ñì2. Ýïèòåëèçàöèÿ íàñòóïàëà â ñðåäíåì ÷åðåç 28 äíåé, ÷òî, ïî íàáëþäåíèÿì àâòîðîâ, áûñòðåå è ýôôåêòèâíåå, ÷åì ïðîñòî èìïëàíòàöèÿ AlloDerm. Êðîìå êëèíè÷åñêèõ äàííûõ ýôôåêòèâíîñòü ìåòîäà áûëà ïîäòâåðæäåíà áèîïñèåé. Ðåçóëüòàòû ãèñòîëîãè÷åñêîãî èññëåäîâàíèÿ ïðîäåìîíñòðèðîâàëè íàëè÷èå ðàçâèòîãî ýïèòåëèàëüíîãî ñëîÿ ó ïàöèåíòîâ ïîñëå àóòîòðàíñïëàíòàöèè, òîãäà êàê ýïèòåëèàëüíîé âûñòèëêè íà ïîâåðõíîñòè áåñêëåòî÷íîé ìàòðèöû AlloDerm âûÿâëåíî íå áûëî.  êîíöå ñðîêà íàáëþäåíèÿ (1 ìåñ.) òàêæå áûëà âûÿâëåíà ìèíèìàëüíàÿ êîíòðàêòóðà ó ïàöèåíòîâ ïîñëå àóòîòðàíñïëàíòàöèè. Òàêèì îáðàçîì, äàííîå íàáëþäåíèå ñâèäåòåëüñòâóåò î êëèíè÷åñêîé ýôôåêòèâíîñòè ìåòîäà òðàíñïëàíòàöèè àóòîãåííûõ êåðàòèíîöèòîâ íà áåñêëåòî÷íîé äåðìàëüíîé ìàòðèöå AlloDerm â ñðàâíåíèè ñ èìïëàíòàöèåé òîé æå ìàòðèöû íîñèòåëÿ, íî áåç êëåòîê. Îäíàêî â èññëåäîâàíèè îñòàëñÿ íåðàñêðûòûì âîïðîñ: áåçîïàñíî ëè èñïîëüçîâàòü ïîäîáíûå êëåòî÷íûå òðàíñïëàíòàòû ó îíêîëîãè÷åñêèõ ïàöèåíòîâ. Âíåäðåíèå â êëèíè÷åñêóþ ïðàêòèêó äàííîãî ìåòîäà â ßïîíèè ñèëüíî îãðàíè÷åííî â ñâÿçè ñ îòñóòñòâèåì ðàçðåøåíèÿ íà èñïîëüçîâàíèå ìàòðèöû AlloDerm, î ÷åì è çàÿâèëè àâòîðû. 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 17 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: 105964. 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: 55764. 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