JP5367672B2 - Cardiomyopathy treatment with cardiomyocyte sheet - Google Patents
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本発明は温度応答性高分子が表面に被覆された培養皿で哺乳動物の心筋細胞を培養して得られる、移植可能な哺乳動物の心筋細胞シートおよびその製造方法に関する。また、本発明は、心臓移植療法にかわる心筋再生療法として、心筋細胞シートを使用する重症心不全や重症心筋症の効果的な治療方法に関するものである。 The present invention relates to a transplantable mammalian cardiomyocyte sheet obtained by culturing mammalian cardiomyocytes in a culture dish having a surface coated with a temperature-responsive polymer, and a method for producing the same. The present invention also relates to an effective treatment method for severe heart failure and severe cardiomyopathy using a cardiomyocyte sheet as a myocardial regeneration therapy in place of heart transplantation therapy.
近年、胚性幹細胞（ＥＳ細胞）や骨髄間質細胞から心筋細胞を分化誘導する研究が盛んに行われており、一部の動物ではすでに可能となっている（Ｍａｋｉｎｏ，Ｓ．ら、Ｊ．Ｃｌｉｎ．Ｉｎｖｅｓｔ．、１０３、６９７−７０５（１９９９））。さらに、心筋細胞を実験動物へ移植することについても多くの報告がなされている。移植心筋細胞はホスト心筋へ生着すると共に、電気的結合（ｇａｐ ｊｕｎｃｔｉｏｎ）を行うことが確認されている（Ｒｅｉｎｌｉｂ，Ｌ．ら、Ｃｉｒｃｕｌａｔｉｏｎ、１０１、ｅ１８２−ｅ１８７（２０００））。これらのことから、近い将来、心筋細胞の移植による治療の可能性が予測されている。 In recent years, researches for inducing differentiation of cardiomyocytes from embryonic stem cells (ES cells) and bone marrow stromal cells have been actively conducted, and this is already possible in some animals (Makino, S. et al., J. Biol. Clin. Invest., 103, 697-705 (1999)). In addition, many reports have been made on transplanting cardiomyocytes into experimental animals. It has been confirmed that the transplanted cardiomyocytes engraft in the host myocardium and perform electrical junction (Reinlib, L. et al., Circulation, 101, e182-e187 (2000)). From these facts, the possibility of treatment by transplantation of cardiomyocytes is predicted in the near future.
一方、これとは別に、体外で組織工学手法を用いて心筋組織を構築した上で、体内に戻すという研究も始まっている。これまでに、コラーゲン、ポリ乳酸、ゼラチンからなる３次元の支持体を用いて新生仔ラットの心筋細胞を培養することにより、心筋組織様構造が構築されたと報告されている（Ｅｓｃｈｅｎｈａｇｅｎ，Ｔ．ら、ＦＡＳＥＢ Ｊ．、１１、６８３−６９４（１９９７）、 Ｂｕｒｓａｃ，Ｎ．ら、Ａｍ．Ｊ．Ｐｈｙｓｉｏｌ．、２２７、Ｈ４３３−Ｈ４４４（１９９９）、 Ｌｉ，Ｒ．ら、 Ｊ．Ｔｈｏｒａｃ．Ｃａｒｄｉｏｖａｓｃ．Ｓｕｒｇ．、１１９、３６８−３７５（２０００） ）。しかし、全身に血液を送り出すような収縮弛緩機能を持つ心筋組織の構築にはいくつもの障害があり、新たなバイオマテリアルや新規の培養技術が必要と考えられている。 On the other hand, apart from this, research has also begun on building myocardial tissue outside the body using tissue engineering techniques and then returning it to the body. It has been reported so far that a myocardial tissue-like structure has been constructed by culturing neonatal rat cardiomyocytes using a three-dimensional support composed of collagen, polylactic acid and gelatin (Eschenhagen, T. et al. , FASEB J., 11, 683-694 (1997), Bursac, N. et al., Am. J. Physiol., 227, H433-H444 (1999), Li, R. et al., J. Thorac. 119, 368-375 (2000)). However, there are a number of obstacles in the construction of myocardial tissue having a contraction / relaxation function that pumps blood throughout the body, and it is considered that a new biomaterial and a new culture technique are necessary.
このような中、特開平０５−１９２１３８号公報には、水に対する上限若しくは下限臨界溶解温度が０〜８０℃であるポリマーで基材表面を被覆した細胞培養支持体上にて、皮膚細胞を上限臨界溶解温度以下又は下限臨界溶解温度以上で培養し、その後上限臨界溶解温度以上又は下限臨界溶解温度以下にすることにより培養皮膚細胞が剥離されることを特徴とする皮膚細胞培養法が記載されている。この方法においては、温度応答性ポリマーを被覆した培養基材から温度により細胞を剥離させているが、この方法では剥離性が悪く、得られた細胞シートは構造欠陥の多いものであった。したがって、特開平０５−１９２１３８号公報に記載の方法をｉｎ ｖｉｔｒｏでの心筋様組織構築に適用することも困難であった。 In such a situation, Japanese Patent Application Laid-Open No. 05-192138 discloses an upper limit of skin cells on a cell culture support having a base surface coated with a polymer having an upper or lower critical solution temperature of 0 to 80 ° C. A skin cell culture method characterized by culturing at or below the critical dissolution temperature or above the lower critical dissolution temperature and then peeling the cultured skin cells above the upper critical solution temperature or below the lower critical solution temperature is described. Yes. In this method, cells are detached from the culture substrate coated with the temperature-responsive polymer by temperature. However, this method has poor releasability, and the obtained cell sheet has many structural defects. Therefore, it has been difficult to apply the method described in JP-A No. 05-192138 to the construction of myocardial tissue in vitro.
本発明の目的は、効率的な哺乳動物の心筋細胞シートの取得方法を提供することである。また、本発明では、心筋細胞シートを使用する重症心不全や重症心筋症の効果的な治療方法を提供することである。 An object of the present invention is to provide an efficient method for obtaining a mammalian cardiomyocyte sheet. Another object of the present invention is to provide an effective treatment method for severe heart failure and severe cardiomyopathy using a cardiomyocyte sheet.
本発明者らは、鋭意検討の結果、温度応答性培養皿を用いて哺乳動物の拍動する心筋細胞シートを作製し、これを障害を受けた心臓に移植することを試みた。その結果、移植された心筋細胞が障害心臓に接着し、心拡張収縮能を向上、及び／または心臓のリモデリングを抑制させられることを見出し、本発明を完成することができた。 As a result of intensive studies, the present inventors made a cardiac beating cardiomyocyte sheet of a mammal using a temperature-responsive culture dish and attempted to transplant it to a damaged heart. As a result, it was found that the transplanted cardiomyocytes adhere to the damaged heart, improve the diastolic contraction ability, and / or suppress the remodeling of the heart, and have completed the present invention.
さらに、本発明者らは、肝実質細胞増殖因子（以下、ＨＧＦという。）を心筋移植部位に同時に投与することにより、心筋細胞シートの定着と心機能の機能向上が見られることを明らかにした。 Furthermore, the present inventors have clarified that the hepatocyte growth factor (hereinafter referred to as HGF) is simultaneously administered to the myocardial transplantation site, whereby the myocardial cell sheet is fixed and the cardiac function is improved. .
すなわち本発明は、心拡張収縮能を向上、及び／または心臓のリモデリングを抑制させる移植可能な哺乳動物心筋細胞シートを提供する。
また、本発明は、温度応答性高分子が被覆された培養器材で哺乳動物の心筋細胞を培養して得られる移植可能な哺乳動物心筋細胞シートを提供する。That is, the present invention provides an implantable mammalian cardiomyocyte sheet that improves diastole contractility and / or suppresses cardiac remodeling.
The present invention also provides an implantable mammalian cardiomyocyte sheet obtained by culturing mammalian cardiomyocytes with a culture device coated with a temperature-responsive polymer.
更に、本発明は、自律拍動する重層化した移植可能な哺乳動物心筋細胞シートを提供する。
また、本発明は、上記いずれかの心筋細胞シートを使用することを特徴とする心筋再生療法用の心筋細胞シートを提供する。Furthermore, the present invention provides a layered, implantable mammalian cardiomyocyte sheet that autonomously beats.
The present invention also provides a cardiomyocyte sheet for myocardial regeneration therapy, characterized by using any of the cardiomyocyte sheets described above.
加えて、本発明は、得られた心筋細胞シートを利用した障害心臓の治療法を提供する。
更に加えて、本発明は、心筋細胞シートを利用する際に肝実質細胞増殖因子を併用した障害心臓の治療法を提供する。In addition, the present invention provides a method for treating a damaged heart using the obtained cardiomyocyte sheet.
In addition, the present invention provides a method for treating a damaged heart using hepatocyte growth factor in combination with the use of a cardiomyocyte sheet.
更に、本発明は、哺乳動物の心筋細胞をポリ−Ｎ−イソプロピルアクリルアミドを被覆した培養皿を用いてコンフルエント（ｃｏｎｆｌｕｅｎｔ）に培養し、低温処理後、剥離することを含む哺乳動物心筋細胞シートの製造方法を提供する。 Furthermore, the present invention provides a method for producing a mammalian cardiomyocyte sheet, comprising culturing mammalian cardiomyocytes confluently using a culture dish coated with poly-N-isopropylacrylamide, chilling and then peeling off. Provide a method.
本発明の第１様態は、移植可能な哺乳動物心筋細胞シートに関するものである。 The first aspect of the present invention relates to a transplantable mammalian cardiomyocyte sheet.
本発明における哺乳動物心筋細胞シートとは、例えば、「医学のあゆみ、１９５、２０３−２０４（２０００）」記載の方法で、ヒト、ウシ、ラット等の哺乳動物の心筋細胞を、温度応答性高分子であるポリ−Ｎ−イソプロピルアクリルアミドを被覆した培養皿を用いてコンフルエントに培養し、低温処理後、剥離されるシート状の心筋細胞組織のことを言う。 The term “mammalian cardiomyocyte sheet” in the present invention refers to, for example, the method described in “Medical History, 195, 203-204 (2000)”, which is used to convert mammalian cardiomyocytes such as humans, cows, rats, etc. This refers to a sheet-like cardiomyocyte tissue that is cultured confluently using a culture dish coated with molecules, poly-N-isopropylacrylamide, and is exfoliated after low-temperature treatment.
本発明の心筋細胞シートは、移植可能な哺乳動物からなる心筋細胞から培養されたシートであれば良く、好ましくは、上記温度応答性高分子を被覆した培養皿を用いて細胞、細胞外基質より構成される三次元構造を持った心筋細胞シートがあげられる。 The cardiomyocyte sheet of the present invention may be a sheet cultured from transplantable mammalian cardiomyocytes, preferably using a culture dish coated with the above-described temperature-responsive polymer from cells and extracellular matrix. An example is a cardiomyocyte sheet having a three-dimensional structure.
本発明の「移植可能」とは、哺乳動物の心臓に移植された心筋細胞シートが定着し、心臓の心拡張収縮能を向上させる機能、及び／または心臓のリモデリングを抑制させる機能を示すことをいう。 The term “implantable” in the present invention refers to a function in which a cardiomyocyte sheet transplanted into a mammalian heart is established and improves the diastole contractility of the heart and / or a function of suppressing heart remodeling. Say.
本発明の第２の様態は、心筋細胞シートを心筋再生療法用に用いることに関するものである。
本発明の「傷害心臓」とは、心筋梗塞、狭心症等の虚血性疾患により、障害を受けた心臓のことを表す。The second aspect of the present invention relates to the use of a cardiomyocyte sheet for myocardial regeneration therapy.
The “injured heart” of the present invention represents a heart that has been damaged by an ischemic disease such as myocardial infarction or angina.
本発明の「梗塞性障害心筋部位」とは、心筋梗塞、狭心症等で虚血性の障害を受けた心筋組織のことを表す。
本発明の第３の様態は、ＨＧＦを併用することによる心筋再生療法に関するものである。The “infarct disorder myocardial site” of the present invention refers to myocardial tissue that has undergone ischemic disorder due to myocardial infarction, angina pectoris, and the like.
The third aspect of the present invention relates to a myocardial regeneration therapy using HGF in combination.
本発明で使用される「ＨＧＦ」はすでに市販されているが（例えば、東洋紡（株）ＨＧＦ−１０１等）、医薬として使用できる程度に精製されたものであれば、種々の方法で調製されたものを用いることができる。ＨＧＦを産生する初代培養細胞や株化細胞を培養し、培養上清等から分離、精製して該ＨＧＦを得ることもできる。或いは、遺伝子工学的手法によりＨＧＦをコードする遺伝子を適切なベクターに組み込み、これを適当な宿主に挿入して挿入して形質転換し、この形質転換体の培養上清から目的とする組み換えＨＧＦを得ることができる（例えば、Ｎａｔｕｒｅ、３４２、４４０（１９８９）、特開平５−１１１３８３号公報、Ｂｉｏｃｈｅｍ．Ｂｉｏｐｈｙｓ．Ｒｅｓ．Ｃｏｍｍｕｎ．、１６３、９６７（１９８９）等を参照）。上記の宿主細胞は特に限定されず、従来から遺伝子工学的手法で用いられている各種の宿主細胞、例えば大腸菌、酵母または動物細胞などを用いることができる。このようにして得られたＨＧＦは、天然型ＨＧＦと実質的に同じ作用を有する限り、そのアミノ酸配列中の１若しくは複数のアミノ酸が置換、欠失及び／または付加されていても良い。 The “HGF” used in the present invention is already commercially available (for example, Toyobo Co., Ltd. HGF-101 etc.), but it has been prepared by various methods as long as it has been purified to the extent that it can be used as a medicine. Things can be used. It is also possible to obtain primary HGF cells by culturing primary cultured cells or established cell lines that produce HGF, and separating and purifying them from the culture supernatant. Alternatively, a gene encoding HGF is incorporated into an appropriate vector by genetic engineering techniques, inserted into an appropriate host, inserted and transformed, and the desired recombinant HGF is obtained from the culture supernatant of the transformant. (See, for example, Nature, 342, 440 (1989), JP-A-5-111383, Biochem. Biophys. Res. Commun., 163, 967 (1989), etc.). The host cell is not particularly limited, and various host cells conventionally used in genetic engineering techniques such as Escherichia coli, yeast or animal cells can be used. As long as the HGF thus obtained has substantially the same action as that of natural HGF, one or more amino acids in the amino acid sequence may be substituted, deleted and / or added.
本発明の心筋細胞シートは、以下のような障害心臓への導入方法、導入形態及び導入量が使用され得る。
すなわち、本発明の心筋細胞シートの投与方法としては、例えば心筋梗塞、狭心症等で虚血性の障害を受けた心筋組織の障害部位への直接貼付、貼付後に縫合、挿入等の方法があげられる。For the cardiomyocyte sheet of the present invention, the following introduction method, introduction form and introduction amount into a damaged heart can be used.
That is, the administration method of the myocardial cell sheet of the present invention includes, for example, methods such as direct attachment to a damaged part of myocardial tissue that has been subjected to ischemic damage due to myocardial infarction, angina pectoris, and the like, suturing and insertion after application. It is done.
本発明の心筋細胞シートは、移植可能な哺乳動物からなる心筋細胞から培養されたシートであれば良く、好ましい形態は、三次元構造を持った心筋グラフトがあげられる。それらの面積、体積等は障害部位に応じて適宜変更して用いることができる。 The cardiomyocyte sheet of the present invention may be a sheet cultured from transplantable mammalian cardiomyocytes, and a preferred form is a myocardial graft having a three-dimensional structure. Their area, volume, etc. can be appropriately changed according to the obstacle site.
本発明の哺乳動物は、例えば、ヒト、サル、ブタ、イヌ、ネコ、ラット、マウスなどがあげられるが、何ら制限されるものではない。
本発明の心筋再生療法とは、以下のような方法があげられ、同時にＨＧＦを投与することができる。Examples of the mammal of the present invention include, but are not limited to, humans, monkeys, pigs, dogs, cats, rats, mice and the like.
Examples of the myocardial regeneration therapy of the present invention include the following methods, and HGF can be administered simultaneously.
すなわち、患者への導入方法としては、例えば、本発明においてＨＧＦの導入方法として、安全かつ効率の良い遺伝子導入法であるセンダイ・ウィルス（ＨＶＪ）リポゾーム法（Ｍｏｌｅｃｕｌａｒ Ｍｅｄｉｃｉｎｅ、３０、１４４０−１４４８（１９９３）、実験医学、１２、１８２２−１８２６（１９９４））、 電気的遺伝子導入法、 ショットガン方式遺伝子導入法等があげられる。好ましくは、ＨＶＪリポゾーム法があげられる。 That is, as an introduction method to a patient, for example, as a method for introducing HGF in the present invention, Sendai virus (HVJ) liposome method (Molecular Medicine, 30, 1440-1448 (1993), which is a safe and efficient gene introduction method. ), Experimental medicine, 12, 1822-1826 (1994)), electrical gene transfer method, shotgun method gene transfer method and the like. The HVJ liposome method is preferable.
以下、実施例により本発明を具体的に説明するが、本発明はこれらの実施例により何ら限定されるものではない。 EXAMPLES Hereinafter, although an Example demonstrates this invention concretely, this invention is not limited at all by these Examples.
ラット心筋細胞シートの作製
図１に示すように、ラット新生仔の心筋細胞をポリ−Ｎ−イソプロピルアクリルアミドが固定された培養皿（固定化量 １．９μｇ／ｃｍ２）で培養し、３７℃でコンフルエントになるまで培養した。その後、低温処理を行い、シート状になった心筋細胞を脱着させ、それを２層重ねて重層化した。得られた心筋細胞シートは自律的に収縮、拍動していた。
心筋梗塞モデルラットの梗塞心への心筋細胞シートの移植
Ｌｅｗｉｓ ラット（３００ｇ、雄）の心臓の左前下行枝をリゲーション（ｌｉｇａｔｉｏｎ）し、心筋梗塞モデルを作製した。梗塞モデルの作製の２週間後、上の心筋細胞シートをモデルの梗塞心に貼付することで移植した（移植群（Ｔ群）：ｎ＝７、実施例１）。また、心筋細胞シートを貼付しない無治療の群をコントロール群（Ｃ群）とした（ｎ＝１０、比較例１）。1. Preparation of rat cardiomyocyte sheet As shown in FIG. 1, neonatal rat cardiomyocytes were cultured in a culture dish (immobilized amount: 1.9 μg / cm 2 ) on which poly-N-isopropylacrylamide was immobilized at 37 ° C. Cultured until confluent. Thereafter, a low-temperature treatment was performed to desorb the cardiomyocytes in the form of a sheet, and two layers were stacked to form a multilayer. The obtained cardiomyocyte sheet contracted and pulsated autonomously.
Transplantation of cardiomyocyte sheet into infarcted heart of myocardial infarction model rat The left anterior descending branch of the heart of Lewis rat (300 g, male) was ligated to prepare a myocardial infarction model. Two weeks after the preparation of the infarct model, the above cardiomyocyte sheet was attached to the infarcted heart of the model and transplanted (transplant group (T group): n = 7, Example 1). In addition, an untreated group to which a cardiomyocyte sheet was not attached was designated as a control group (Group C) (n = 10, Comparative Example 1).
実施例１、比較例１における結果を表１、表２、図３、図４、図５、図６に示す。
移植後のそれぞれの心臓の拍動の様子を超音波により確認した（図２）。図２から、心筋細胞シートを貼付した心臓は拍動しているのに対し（図２、右下図矢印）、無治療の心臓では拍動の弱いことが分かる（図２、左下図矢印）。The results in Example 1 and Comparative Example 1 are shown in Table 1, Table 2, FIG. 3, FIG. 4, FIG.
The state of pulsation of each heart after transplantation was confirmed by ultrasound (FIG. 2). From FIG. 2, it can be seen that the heart to which the cardiomyocyte sheet is attached is pulsating (FIG. 2, lower right arrow), whereas the untreated heart has weak pulsation (FIG. 2, lower left arrow).
移植２週後に、Ａｇｉｌｅｎｔ Ｔｅｃｈｎｏｌｏｇｉｅｓ社製 ＳＯＮＯＳ５５００を用いて、左室駆出率、心拍出量、左室収縮末期断面積、Ｅ波をそれぞれ測定した。 Two weeks after transplantation, left ventricular ejection fraction, cardiac output, left ventricular end-systolic cross-sectional area, and E wave were measured using SONOS 5500 manufactured by Agilent Technologies.
Ｔ群において、著明に心拡張収縮能は向上し（表１、図３、図４）、左室リモデリングの抑制を確認した（表２、図４）。また、移植した心筋細胞は梗塞心に接着しており、移植した心筋細胞シートは均一な構造を持っていた（図５、６）。 In the T group, the diastolic contractility was markedly improved (Table 1, FIG. 3, FIG. 4), and suppression of left ventricular remodeling was confirmed (Table 2, FIG. 4). The transplanted cardiomyocytes were adhered to the infarcted heart, and the transplanted cardiomyocyte sheet had a uniform structure (FIGS. 5 and 6).
実施例１と同様な方法で Ｌｅｗｉｓ ｒａｔ心筋梗塞モデルを作製した。梗塞モデルの作製２週間後に、実施例１の心筋シートをモデルの梗塞心に移植した後、ラット１匹あたり、ＨＧＦを組み込んだベクター２０μｇを移植部に投与した群（Ｔ２群、ｎ＝５、実施例２）、また、無治療のコントロール群（Ｃ群、ｎ＝８、比較例２）を作製した。 A Lewis rat myocardial infarction model was prepared in the same manner as in Example 1. Two weeks after the preparation of the infarct model, the myocardial sheet of Example 1 was transplanted into the infarcted heart of the model, and then 20 μg of a vector incorporating HGF per rat was administered to the transplanted part (T2 group, n = 5, Example 2) and an untreated control group (Group C, n = 8, Comparative Example 2) were prepared.
移植２週間後に、再び開胸し、それぞれの群の患部を観察した。得られた結果を表３に示す。 Two weeks after transplantation, thoracotomy was performed again, and the affected area of each group was observed. The obtained results are shown in Table 3.
本発明により、自動収縮能を持った哺乳動物の心筋細胞シートが提供される。特に、本発明の心筋細胞シートを使用した心筋再生療法は、心筋梗塞、重症心不全、重症心筋症等の治療方法として有効であり、さらには、ＨＧＦを同時併用することにより、より効果的な心筋再生療法として有用である。 According to the present invention, there is provided a mammalian cardiomyocyte sheet having an automatic contraction ability. In particular, the myocardial regeneration therapy using the cardiomyocyte sheet of the present invention is effective as a treatment method for myocardial infarction, severe heart failure, severe cardiomyopathy and the like, and more effective myocardium by simultaneously using HGF. Useful as regenerative therapy.
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