骨髓干细胞在急性肺损伤后肺修复中.ppt

Stem Cell Therapy for ARDS 顏至慶 指導教授：陳全木教授 中興大學生命科學系 中國醫藥大學附設醫院 Introduction - ARDS - Stem Cells Plasticity Berlin Definition of ARDS Trend of Incidence of ARDS 58/100000 per year in USA (2005) Declining (2001-2008) perhaps due to: Lung protective ventilation Reduction of nosocomial Inf Conservative use of blood products Trend of Mortality of ARDS Mortality: 36-44% up to 2006 Declining (1997-2009) Perhaps due to Lung protective ventilation Supportive Tx: Early antibiotics, Ulcer prevention, Better fluid Tx, Nutritional organ support Management for ARDS Early recognition and avoidance of risk factors Initial intervention Lung protective ventilation Conservative fluid management Tx for life-threatening hypoxemia = check Pplat Pplat 30 = Recruitment and/or High PEEP alone Pplat 30 = Prone position or HFV No improvement = Inhaled NO ? Low dose steroid after evaluation ECMO (Crit Care Med 2010; 38:1644-1650) Directions of Tx. for ARDS Treat underlying diseases Inhibition of inflammation Provide adequate oxygenation Lung Protective Ventilatory Strategies Hemodynamic support Adequate general supportive Tx: Infection control, Early enteral nutrition, Stress ulcer prophylaxis Speed lung healing Hematopoietic Mesenchymal Stem Cells (MSCs) Plasticity of Adult Stem Cells Stem Cell Tx in Other Systems BMCs Improved LVEF – Meta-Analysis Stem Cells Tx for ARDS - Stem Cells in Lung Parenchyma - Our recent report - Important reports Our Recent Report- Amniotic Fluid Stem Cells (AFSCs) from EGFP Transgenic Mice Attenuate Hyperoxia-Induced Acute Lung Injury(PLOS One 2013) AFSCs improved survivalBetter than BM-MSC embryonic fibroblast cells AFSCs Attenuate Lung Injury Stem Cell Tx for ARDS (review articles) Critical Care 2012, 16: 205 Current Opinion of Critical Care 2014, 20: 122-131 Key Points Mesenchymal stem cells, bone marrow-derived mononuclear cells, endothelial progenitor cells, and embryonic or induced