According to the World Health Organization, the number of people with chronic obstructive pulmonary disease (COPD) in the world is about 600 million. COPD is the fourth leading cause of death in the world. In conventional therapy, COPD is an incurable disease, but in the field of regenerative medicine, there have been many clinical studies and applications of stem cell therapy for COPD, and stem cell therapy has brought the possibility of recovery for COPD patients.
COPD is a relatively common chronic lung disease, including chronic bronchitis and/or emphysema. Its biggest feature is that the patient gasps after exercising, and finally even during daily life or even rest. He also had difficulty breathing, and the most terrifying thing was that the disease progressed irreversibly, eventually leading to respiratory failure and death.
Smoking is the most important risk factor for COPD. In addition, indoor and outdoor air pollution, occupational dust and fumes, respiratory infections, genetic factors, and long-term asthma are also risk factors for COPD. The repeated effects of tobacco smoke can cause the aggregation, activation and production of inflammatory mediators, oxidative damage in the body, and directly lead to the occurrence of chronic obstructive pulmonary disease.
People with COPD experience chronic cough, phlegm, chest tightness, and shortness of breath. It can also lead to pulmonary heart disease and respiratory failure in the later stage. A good breath of air is a luxury.
Over the next 20 years, the World Health Organization expects total COPD mortality to more than double. So far, the treatment of COPD has mainly focused on relieving symptoms and improving the quality of life of patients as much as possible. However, in the long term, there is no clinical evidence that these drugs can improve patients' declining lung function and reduce mortality. Stem cell therapy is a brand new research field in the treatment of COPD. In recent years, many stem cell therapies have gone out of the laboratory and entered the clinical stage.
In recent years, many clinical trials of stem cell therapy for COPD are being carried out in full swing. As early as 2008, the world's first stem cell drug Prochymal™ (derived from bone marrow mesenchymal stem cells) has been launched for the treatment of moderate to severe chronic obstructive pulmonary disease. , a placebo-controlled study.
The results showed that during the follow-up period, no related serious adverse reactions occurred, and mesenchymal stem cell therapy can significantly reduce the C-reactive protein of patients and significantly improve their clinical manifestations. This trial preliminarily confirmed that mesenchymal stem cells are safe and effective in the treatment of chronic obstructive pulmonary disease. This lays the foundation for subsequent larger studies.
Since then, various clinical trials related to stem cell therapy for COPD have been registered. Up to now, clinical trials related to stem cell therapy for COPD have been registered on the website http://clinicaltrials.gov, the largest clinical trial registry of the National Institutes of Health. There are 30 research projects.
The effect of stem cells in the treatment of chronic obstructive pulmonary disease
Many clinical studies and application results have shown that stem cell therapy for COPD is safe and will not cause sequelae and adverse reactions. After learning about the safety of stem cell therapy, many studies began to explore the effect of stem cell therapy on COPD.
In 2019, our clinic admitted a 57-year-old patient with COPD and performed adipose-derived stem cell therapy for him. Before admission, the patient had experienced two acute exacerbations of COPD. After inhalation bronchiectasis, his forced expiratory volume in 1 second (FEV1) was 21% and FEV1/(FVC) was 40%. During the one-year follow-up period after treatment, the patient's dyspnea and quality of life improved without any exacerbations, and freedom of breathing was achieved.
Inflammatory response is an important mechanism that can make the body's internal environment reach a balance state. When abnormal, it will lead to the occurrence of disease, and the production of inflammatory factors and the aggregation and activation of inflammatory cells are involved in the progression of COPD. Studies have shown that stem cells can interact with macrophages to regulate inflammatory responses.
The repeated effects of tobacco smoke can directly cause tissue cell damage. In addition, smoking can cause an imbalance between protease and anti-protease in the body. The normal extracellular matrix can be degraded by protease in the body, thereby destroying the integrity of the alveoli and aggravating the damage of lung tissue. Formation of emphysema.
In the experiment, it was concluded that the differentiation function of MSC contributes to tissue repair to prevent the deterioration of COPD. MSCs can also repair damaged tissues through paracrine action.
At present, hydroxyl radicals and thousands of oxides have been detected in tobacco. Long-term smoking can increase the oxidative burden in the body. When the body has an oxidative/antioxidative imbalance, reactive oxygen species can interact with lipids, proteins, DNA, RNA and other biomolecules A reaction occurs that leads to cell damage and death, which greatly contributes to the development of COPD.
MSC has the effect of regulating oxidative stress response. MSC can reduce the damage of oxidative reaction to lipids, proteins and DNA, and effectively reduce the concentration of oxidative stress products.
COPD is characterized by abnormal immune responses in the lower respiratory tract, in which the formation of lymphoid follicles and the infiltration of innate and adaptive immune cells are related to the progression and severity of the disease. Studies have shown that adaptive immune responses play an important role in the development of COPD. . Mainly involved in its response are T cells and B cells.
MSCs can inhibit the migration of DC cells by reducing the expression of DC cell-associated migration factors. and regulate T cells through paracrine action.
Apoptosis is an important reason for the rupture of alveolar septa and the destruction of alveolar structure. The apoptosis of various cells is involved in the formation of emphysema. In patients with COPD caused by smoking, apoptosis of endothelial cells and alveolar epithelial cells can occur at the same time.
MSCs can secrete VEGF (vascular endothelial growth factor) to reduce hypoxia-induced apoptosis of endothelial and epithelial cells.
Updated: May 26, 2022
