WO2014075592A9 - 一种间充质干细胞注射液及其制备方法和在制备治疗儿童扩张型心肌病药物中的应用 - Google Patents

一种间充质干细胞注射液及其制备方法和在制备治疗儿童扩张型心肌病药物中的应用 Download PDF

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WO2014075592A9
WO2014075592A9 PCT/CN2013/086832 CN2013086832W WO2014075592A9 WO 2014075592 A9 WO2014075592 A9 WO 2014075592A9 CN 2013086832 W CN2013086832 W CN 2013086832W WO 2014075592 A9 WO2014075592 A9 WO 2014075592A9
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mesenchymal stem
stem cell
cells
cell injection
medium
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WO2014075592A1 (zh
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黄玉香
高宏
王丽
胡建霞
张学峰
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贾在美
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    • CCHEMISTRY; METALLURGY
    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12NMICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N5/00Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
    • C12N5/06Animal cells or tissues; Human cells or tissues
    • C12N5/0602Vertebrate cells
    • C12N5/0652Cells of skeletal and connective tissues; Mesenchyme
    • C12N5/0662Stem cells
    • C12N5/0668Mesenchymal stem cells from other natural sources
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00Drugs for disorders of the cardiovascular system
    • A61P9/04Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure
    • CCHEMISTRY; METALLURGY
    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12NMICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N5/00Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
    • C12N5/06Animal cells or tissues; Human cells or tissues
    • C12N5/0602Vertebrate cells
    • C12N5/0652Cells of skeletal and connective tissues; Mesenchyme
    • C12N5/0662Stem cells
    • C12N5/0665Blood-borne mesenchymal stem cells, e.g. from umbilical cord blood
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/12Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
    • A61K35/48Reproductive organs
    • A61K35/50Placenta; Placental stem cells; Amniotic fluid; Amnion; Amniotic stem cells

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  • the invention belongs to the field of biomedicine, and particularly relates to a mesenchymal stem cell injection solution, a preparation method thereof and application thereof in preparing medicine for treating dilated cardiomyopathy in children. Background technique
  • Dilated cardiomyopathy is a enlargement of one or both sides of the heart chamber accompanied by cardiac hypertrophy, pumping blood dysfunction during myocardial contraction, and producing congestive heart failure. This type is characterized by enlargement of the left or right ventricle or bilateral ventricles, accompanied by cardiac hypertrophy.
  • Ventricular systolic dysfunction with or without congestive heart failure. The condition is progressively aggravated and death can occur at any stage of the disease. Ventricular or atrial arrhythmia is more common, for the first time or the main performance, and a variety of arrhythmia combined to form a more complex heart rhythm, can occur repeatedly.
  • A-S syndrome which is one of the causes of death.
  • embolizations in the brain, kidneys, and lungs There are still embolizations in the brain, kidneys, and lungs.
  • Current medical treatment or heart transplantation does not improve the patient's condition and mortality.
  • the development of stem cell technology has brought hope to the treatment of this disease.
  • DCM Dilated cardiomyopathy
  • the incidence rate in China is about 84/100,000.
  • the course of DCM is progressive, the prognosis is extremely poor, and it is a serious hazard to children's health.
  • the 1-year survival rate is 60% to 90%, and the 5-year survival rate is 20% to 80%.
  • the basic drugs including digitalis, diuretics, vasodilators, neuroendocrine blockers, growth hormone, high-dose immunoglobulin, etc. can improve the prognosis of some children with DCM. But still can't solve the problem fundamentally.
  • DCM patients account for about 44%; although some researchers believe that left ventricular volume reduction can significantly improve left ventricular function, the hospital mortality rate is still as high as 10 ⁇ 20%, 2
  • the treatment of children with dilated cardiomyopathy mainly solves the prevention and treatment of arrhythmia and cardiac insufficiency, as well as symptomatic supportive treatment. It cannot fundamentally treat diseases. Patients need to take a large number of drugs to correct arrhythmia and maintain heart function. In this case, the condition is still prone to aggravation, and fatigue, cold, infection, and other incentives are prone to heart failure, endangering the patient's life. Current drug and surgical treatments are not good at avoiding these conditions. Changing the patient's enlarged heart and restoring normal heart structure are fundamental to the treatment of dilated cardiomyopathy.
  • MSCs Mesenchymal stem cells
  • the source of bone marrow mesenchymal stem cells is limited, and the access route is traumatic; and with the increase of age, the mesenchymal stem cells with differentiation potential in the bone marrow are gradually reduced; in addition, the induced bone marrow mesenchymal stem cells are transformed into cardiomyocyte-like cells.
  • the efficiency is lower. It is extremely inconvenient for children to take bone marrow, children and parents are not highly accepted, and the amount of bone marrow extracted from children is small.
  • umbilical cord tissue and placenta are rich in mesenchymal stem cells
  • Placenta and umbilical cord-derived MSCs have the characteristics of large differentiation potential, strong proliferative ability, low immunogenicity, convenient materials, no moral and ethical problems, and easy industrial preparation, making it possible to regulate tissue repair and immune disorders. And pluripotent stem cells with the most clinical application prospects for metabolic disease cell therapy.
  • the current treatment of children with dilated cardiomyopathy mainly depends on the control of arrhythmia, improving cardiac function and other drug treatments. These drugs can not effectively improve the structure and function of the heart. When the condition is serious, it can only rely on heart transplantation, but due to limited heart source. , and the difficulty of matching, many patients and other studies of non-cardiomyopathy.
  • embryonic stem cells and induced pluripotent stem cells are ideal seed cells for cell myocardoplasty in children with cardiomyopathy; however, the source of the former is limited and there may be ethical issues; the latter requires induction during culture.
  • the effects of substances and culture fluids on seed cells and on cardiomyocytes are not clear, which greatly limits their clinical application and is limited to animal experiments. Summary of the invention
  • the present invention provides a mesenchymal stem cell injection, a preparation method thereof, and the use thereof in the preparation of a medicament for treating dilated cardiomyopathy in children.
  • the invention can fundamentally change the heart structure of patients with dilated cardiomyopathy, improve the survival rate of patients, and thoroughly treat dilated cardiomyopathy.
  • the balance is a compound electrolyte solution.
  • the mesenchymal cells are derived from a human umbilical cord and/or a human placenta.
  • the present invention also provides a method for preparing the mesenchymal stem cell injection, which comprises preparing a umbilical cord mesenchymal stem cell and preparing a placental mesenchymal stem cell.
  • the present invention also provides the use of the mesenchymal stem cell injection for the preparation of a medicament for treating dilated cardiomyopathy in children.
  • the drug containing mesenchymal stem cell injection is contained in an amount of 1 ⁇ 10 6 -1 ⁇ 10 8 /ml mesenchymal stem cells.
  • the present invention uses human mesenchymal stem cell injection to treat children with dilated cardiomyopathy, and selects the placenta and umbilical cord to prepare mesenchymal stem cell injection, the mesenchymal stem cell yield is large, the preparation system is easy to control, and easy to industrialize. .
  • the injection can be directly cooled by program-controlled cooling, and can be directly used for clinical injection after resuscitation, which is safe and reliable.
  • Mesenchymal stem cells have low immunogenicity and need no matching for allogeneic use. After injection of mesenchymal stem cells into patients, they can secrete many cell growth factors, angiogenesis factors and stem cell activating factors, promote the recovery of diseased myocardium, activate cardiac stem cell regeneration and repair the heart structure, thus fundamentally treating dilated cardiomyopathy. the goal of.
  • the invention can reverse the course of dilated cardiomyopathy, change the dilated myocardial structure, and fundamentally change the heart structure of patients with dilated cardiomyopathy.
  • Correction page (Article 91) ISA/CN Restores heart function, improves blood supply to all tissues of the body, improves patient survival, improves patient quality of life, and thoroughly treats dilated cardiomyopathy. Thereby, the patient can get rid of the serious complications caused by a large number of medications and limited life activities and poor control of the disease.
  • Fig. 1 is a graph showing the comparison of pathological changes after treatment of rat myocardial tissue in the present invention.
  • Figure 2 is a partial flow test result of cells in the present invention.
  • Fig. 3 is a photograph of day 9 and day 13 of the primary cells of the present invention.
  • Figure 4 is a photograph of Days 1 and 4 of the 6th generation cells of the present invention.
  • Figure 5 is an echocardiogram of a patient in the present invention.
  • Figure 6 is a chest X-ray of a patient in the present invention. detailed description
  • the shredded tissue is added to the L-DMEM medium for washing, centrifuged at 500-700 g for 5 minutes, and the supernatant is discarded;
  • the placental tissue block is mixed with the above-mentioned DMEM medium containing penicillin and streptomycin, and centrifuged at 700-900 g for 10 min;
  • the cells were fused to 80-90% for cell passage, and the passage medium was MSC-specific serum-free medium.
  • the injection is prepared in proportion to the following ingredients:
  • the number of mesenchymal stem cells per ml of injection is 2 ⁇ 10 5 -1 ⁇ 10 7 ;
  • the balance is the pulse force (combined electrolyte solution).
  • DMSO DMSO
  • Clinical grade DMSO is non-toxic to cells and can better protect cells. It does not need to be rinsed after cell resuscitation. It can be used directly.
  • Human serum albumin is a clinically used injection that provides nutrients to cells and facilitates cell metabolism.
  • Bourgeois can maintain the osmotic pressure of cells and facilitate cell survival.
  • the injection component is a common clinical electrolyte solution, which is convenient for clinical infusion.
  • the injection can be stably stored at a temperature of -196 °C. When thawed and resuscitated, it can be directly infused into the patient.
  • the cells remain in a single cell suspension state, and the cell viability remains above 85%, and does not cause uncomfortable reaction.
  • This kind of injection is very beneficial to the preservation, transportation and survival of mesenchymal stem cells, and the clinical infusion is safe.
  • the cells can maintain high vitality in this injection for a long time, and it is easy to transport without being restricted by the time of use. The problem of long-term cell transport affecting cell viability when used by patients in different places.
  • mesenchymal stem cell injection is as follows: 100 ml of stem cell injection is prepared, the injection is composed of human mesenchymal stem cells, clinical grade DMSO 5 ml, human albumin stock solution (the mass ratio of the stock solution is 20%) 25 ml, Bomag (complex electrolyte solution) 70ml composition. The number of mesenchymal stem cells per ml of injection is 2 ⁇ 10 5 -1 ⁇ 10 7 .
  • Mesenchymal stem cell injection can maintain a single cell suspension at -196 ⁇ ambient temperature, and the cell viability remains above 85% after resuscitation, which can be directly used for clinical injection.
  • a model of dilated cardiomyopathy was prepared by continuous injection of isoproterenol 170 mg/(kg*d) for 4 days. The model was established after 4 weeks of successful umbilical cord mesenchymal stem cell injection. Muscle hypertrophy rat treatment groups at the extremities of the injection of 0.1ml mesenchymal stem cell injection (including 2 ⁇ 10 6 cells), by the limbs, muscle hypertrophy model control group and each control group injected 0.1ml PBS.
  • Rats were observed daily for signs and symptoms after the start of the experiment. All three groups were corrected after the last dose of the model 4 (Article 91) ISA/CN The left ventricular structure and function of each group were measured by the chest wall and the anterior wall of the chest. The indexes included left ventricular end-diastolic diameter, left ventricular end-systolic diameter, ejection fraction and shortening score. At the same time, cardiac morphological examination was performed: the left ventricular free wall tissue was taken for routine pathological section, the pathological changes of myocardial tissue were observed under hematoxylin-eosin staining, and the tissue collagen fibers were observed by Masson trichrome staining.
  • the left ventricular end-systolic diameter increased significantly, and the ejection fraction and shortening fraction decreased significantly in the cell-treated group and the model control group, and the difference was significant (P ⁇ 0.01).
  • echocardiography was performed in each group. The results showed that the left ventricular end-systolic diameter decreased significantly, and the ejection fraction and shortening fraction increased significantly at 4 weeks after treatment in the cell-treated group.
  • Significant significance P ⁇ 0.01).
  • the left ventricular end-diastolic diameter and left ventricular end-systolic diameter increased, ejection fraction and shortening score decreased, but the difference was not significant (P > 0.05).
  • Fine monthly treatment group 20 5.37 ⁇ 0.50 3.69 ⁇ 0.36 a 29.56 ⁇ 6.59 a 53.36 ⁇ 10.32 a
  • Model control group 20 5.32 ⁇ 0.65 3.59 ⁇ 0.51 b 30.26 ⁇ 4.96 a 55.26 ⁇ 8.65 a
  • Blank control group 10 5.12 ⁇ 0.72 2.89 ⁇ 0.36 42.36 ⁇ 3.69 79.03 ⁇ 6.59
  • Fine monthly treatment group 20 5.03 ⁇ 0.68 2.87 ⁇ 0.46 cd 41.35 ⁇ 7.23 cd 79.68 ⁇ 8.23 cd
  • Model control group 20 5.32 ⁇ 0.52 3.89 ⁇ 0.65 31.98 ⁇ 8.79 59.37 ⁇ 9.65
  • Correction page (Article 91) ISA/CN a ⁇ 0.01, V ⁇ 0.05, vs blank control group; ⁇ 0.05, vs model control group; d P ⁇ 0.01 vs cell treatment group.
  • LVDd left ventricular end diastolic diameter
  • LVDs left ventricular end systolic diameter
  • FS shortened score
  • EF ejection fraction.
  • HE staining of the model control group showed extensive edema and vacuolar degeneration of cardiomyocytes, steatosis and necrosis of some cardiomyocytes, interstitial edema, scattered inflammatory cell infiltration, fibroblast proliferation in the interstitial; cell treatment group and In comparison, various impaired performance is reduced.
  • Masson trichrome staining showed collagen fibers in blue, cytoplasm, muscle fibers and red blood cells in red, and nuclei in black and blue, see Figure 1.
  • the left picture shows the normal myocardial histopathology of the blank control group; the middle picture shows the model control group, the myocardial tissue pathology of the rats, a large number of myocardial fibrosis can be seen under the microscope, and the normal myocardial tissue is rare; the right picture shows the cell treatment group.
  • Myocardial histopathology was observed 4 weeks after treatment in rats, and neonatal cardiomyocytes were microscopically reduced in myocardial tissue.
  • the expression of cardiac collagen in the cell-treated group was significantly lower than that in the model control group (P ⁇ 0.05). This indicates that mesenchymal stem cell therapy can inhibit the progression of myocardial fibrosis.
  • the experimental results show that human mesenchymal stem cell injection is safe and feasible for the treatment of rats with dilated cardiomyopathy.
  • the living conditions, cardiac function and cardiac structure of the diseased rats after treatment with mesenchymal stem cells are obviously improved, and the curative effect is remarkable.
  • Mesenchymal stem cell injection can reverse the changes of heart structure in patients with dilated cardiomyopathy, improve the survival rate of patients and improve the quality of life.
  • 100ml stem cell injection is prepared, which consists of human mesenchymal stem cells, clinical grade DMS0 8ml, human serum albumin stock solution (20% of the original solution mass concentration) 30ml, and Boehm (complex electrolyte solution) 62ml.
  • the number of mesenchymal stem cells per ml of injection is 2 ⁇ 10 5 -1 ⁇ 10 mesenchymal stem cell injections can maintain a single cell suspension at -196 ° C ambient temperature, and the cell viability remains 85% after resuscitation. Above, it can be directly used for clinical injection.
  • the mass to volume ratios of the present invention all represent the ratio of mass (g) to volume (ml).
  • Example 3 Culture and detection of umbilical cord mesenchymal stem cells The umbilical cord mesenchymal stem cells prepared in Example 1 were used for amplification. Cell culture amplification
  • the cells are evenly arranged and arranged in a swirling shape.
  • the number of primary cells harvested is > 1 X 10 7 ; cell viability (Trypan blue staining): frozen
  • the pre-preservation cell viability rate was 90%, and the cell viability rate was 85% after cryopreservation; the cells were continuously transferred to the 6th generation, and the cells were stable in shape, fusiform, distributed, and arranged neatly; the cell proliferation rate was stable after continuous passage to the 6th generation;
  • Comply with MSC identification criteria (CD73, CD 105, CD44 or CD90 positive, positive rate is not less than 95%; CD3 K CD34> CD45, HLA-DR is negative, the positive rate should not be higher than 2%.);
  • Cell cycle detection 70-80% of cells are in the G0G1 phase of the cell cycle; Pl and P6 cells have multi-directional differentiation ability; karyotype
  • the average average culture days is 13 days, and the total number of harvested cells can reach 1.6 ⁇ 10 7 .
  • the cells grow well, showing a uniform small spindle shape, arranged in a swirling manner, and the primary cells are shown in Figure 3 (p. Photographs of 9 and 13 days), the 6th generation cells are shown in Figure 4 (photos on days 1 and 4).
  • Figure 3 Photographs of 9 and 13 days
  • Figure 4 photos on days 1 and 4
  • the patient was treated with dilated cardiomyopathy using the stem cell injection prepared in Example 2.
  • Correction page (Article 91) ISA/CN Case 1, male, 11 years old, clinical symptoms: dyspnea, cyanosis, NYHA class II (NYHA class II); electrocardiogram (ECG) test: left ventricular enlargement, mitral and tricuspid regurgitation, LVEF (left Ventricular ejection fraction) 38%; X-ray/MRI detection: left ventricular enlargement, cardiothoracic ratio 0.57.
  • ECG electrocardiogram
  • Example 2 Using the stem cell injection prepared in Example 2 (4 passages), the extremity skeletal muscle was intramuscularly injected. Four times, the number of mesenchymal cells per ml of injection was 2.5 ⁇ 10 6 , and no complications or side effects were observed after the injection. After treatment, cardiac function tests are performed regularly. See Figure 5 and Figure 6 for the effect. In Figure 5, the patient's echocardiogram is shown. A, B, C, and D represent the situation before and 3, 6, 12 months before and after the injection. . Figure 6 shows a chest X-ray of the patient, A for pre-injection and B for 12 months after injection. Obviously, after the injection, the patient's dilated cardiomyopathy improved significantly.
  • ECG results showed that before injection: sinus rhythm, left ventricular enlargement, QRS interval 0.106 s; sinus rhythm, left ventricular enlargement improved (heart size) 6 months after injection.
  • the specific values are as follows: LVEF 38% before injection, LVEF 50% 6 months after injection.
  • SV stroke volume
  • SV 80ml stroke volume
  • LVIDS left ventricular systolic diameter
  • LVIDd left ventricular diastolic diameter

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Abstract

本发明提供了一种间充质干细胞注射液及其制备方法和在制备治疗儿童扩张型心肌病药物中的应用。本发明采用的间充质干细胞来源于人脐带和胎盘,间充质干细胞注射液含有2×105-1×107个/ml间充质干细胞、体积比为5%-8%的临床级DMSO、质量体积比为1%-6%的人血白蛋白和复方电解质溶液。

Description

一种间充庸干细胞注射液及其制备方法和在制备治疗儿童 扩张型心肌病药物中的应用 技术领域
本发明属于生物医药领域,尤其涉及一种间充质干细胞注射液及其制备 方法和在制备治疗儿童扩张型心肌病药物中的应用。 背景技术
扩张型心肌病是一侧或双侧心腔扩大并伴有心肌肥厚, 心肌收缩期泵 血功能障碍, 产生充血性心力衰竭。 本型的特征为左或右心室或双侧心室 扩大, 并伴有心肌肥厚。 心室收缩功能减退, 伴或不伴充血性心力衰竭。 病情呈进行性加重, 死亡可发生于疾病的任何阶段。 室性或房性心律失常 多见, 为首见或主要的表现, 并有多种心律失常合并存在而构成比较复杂 的心律, 可以反复发生。 高度房室传导阻滞、 心室颤动、 窦房阻滞或暂停 可导致阿 -斯综合征, 成为致死原因之一, 此外, 尚可有脑、 肾、 肺等处的 栓塞。 目前的药物治疗或心脏移植不能很好的改善患者的病情及死亡率。 干细胞技术的发展为此疾病的治疗带来了希望。
儿童扩张型心肌病 (dilated cardiomyopathy, DCM )是一类原因不明的 心肌疾病, 国内其发病率约为 84/10万人。 DCM的病程呈进行性, 预后极 差, 严重危害儿童健康, 其 1 年的存活率为 60% ~ 90%, 5年的存活率为 20% ~ 80%。 目前, DCM仍无特效治疗, 基础药物包括洋地黄、 利尿剂、 血管扩张剂、 神经内分泌阻滞剂, 生长激素、 大剂量免疫球蛋白等在内的 治疗措施虽可改善部分 DCM患儿的预后,但仍不能从根本上解决问题。在 世界各地所作的心脏移植病例中, DCM病人约占 44%; 虽然有研究者认为 左室减容术可明显提高左心室功能,但其住院死亡率仍高达 10 ~ 20%,其 2
1
更正页 (细则第 91条) ISA/CN 年生存率仅为 60%; 几乎 50%的有症状的儿童心肌病患者需要接受心脏移 植或在 2年内死亡。 因此, 创新性探索儿童 DCM治疗的新方法, 对改善儿 童 DCM的预后具有重要的临床意义。
目前儿童扩张型心肌病的治疗主要解决的是防治心律失常和心功能不 全, 以及对症支持治疗, 不能从根本上治疗疾病, 患者需服用大量纠正心 律失常及维护心脏功能的药物, 日常活动严格受限, 在此情况下病情仍然 容易加重, 疲劳、 受凉、 感染等诱因下很容易发生心力衰竭, 危及患者生 命。 目前的药物与手术治疗并不能很好的避免这些情况的发生, 改变患者 扩大的心脏, 恢复正常心脏结构才是治疗扩张型心肌病的根本。
理论上, 胚胎干细胞和诱导的多能分化干细胞是儿童心肌病患者细胞 性心肌成形术的理想种子细胞; 但前者的来源有限, 且可能存在伦理学问 题; 而后者在培养过程中需要添加的诱导物质以及培养液本身对种子细胞 以及对心肌细胞的作用尚未明确, 因此大大限制了其临床应用, 多限于动 物实验研究。 间充质干细胞(Mesenchymal stem cells, MSCs )是一类具有 自我更新能力的多能分化干细胞, 分布在骨髓、 脐带、 胎盘和成人的许多 其他组织中。 可分化为多种细胞, 如骨细胞、 脂肪细胞、 软骨细胞、 肌细 胞和肌腱细胞。 因此, MSCs被称为通用捐献细胞。 近年来, 应用骨髓间 充质干细胞移植修复受损心肌成为国内外研究的热点; 研究证实间充质干 细胞可以抑制心肌内的炎症反应、 抑制心肌细胞的凋亡、 刺激心肌内血管 新生; 在 DCM动物模型中有明显的治疗效果, 在临床研究中显示间充质干 细胞治疗早期可明显改善成人 DCM的心室功能。但骨髓间充质干细胞的来 源有限, 获取途径具有创伤性; 且随年龄的增长, 骨髓中有分化潜能的间 充质干细胞逐渐减少; 另外, 诱导后的骨髓间充质干细胞转化为心肌样细 胞的效率较低。 对儿童来说抽取骨髓极不方便, 儿童本人和家长接受度不 高, 同时小儿骨髓的抽取量较少。
后来研究者相继发现脐带组织和胎盘中含有丰富的间充质干细胞, 且
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更正页 (细则第 91条) ISA/CN 经诱导后可分化为神经细胞、 成骨细胞、 脂肪细胞以及心肌细胞等。 Yoo 等比较了来源于成人骨髓、睾丸组织和脐带组织的 MSCs的免疫调节作用, 发现它们的免疫抑制作用和分泌因子基本一致, 认为来源于脐带组织的间 充质干细胞可作为骨髓来源的 MSCs的替代者用于同种异体干细胞治疗。 脐带 MSCs具有低免疫原性和独特的免疫调节作用, 能调节体内过激或较 弱的免疫反应, 减少自身异常免疫反应对自身组织而破坏。 胎盘、 脐带来 源的 MSCs具有分化潜力大、 增殖能力强、 免疫原性低、 取材方便、 无道 德伦理问题的限制、 易于工业化制备等特征, 使其有可能成为用于组织修 复、 免疫紊乱的调节和代谢性疾病细胞治疗最具临床应用前景的多能干细 胞。
综上, 目前儿童扩张型心肌病的治疗主要依赖于控制心律失常、 改善 心脏功能等药物治疗, 这些药物不能有效地改善心脏结构及功能, 病情严 重时只能靠心脏移植, 但由于心脏来源有限, 且配型困难, 很多患者等不 型心肌病的研究。 理论上, 胚胎干细胞和诱导的多能分化干细胞是儿童心 肌病患者细胞性心肌成形术的理想种子细胞; 但前者的来源有限, 且可能 存在伦理学问题; 而后者在培养过程中需要添加的诱导物质以及培养液本 身对种子细胞以及对心肌细胞的作用尚未明确, 因此大大限制了其临床应 用, 多限于动物实验研究。 发明内容
针对现有技术中存在的治疗儿童扩张型心肌病的上述缺点, 本发明提 供了一种间充质干细胞注射液及其制备方法和在制备治疗儿童扩张型心肌 病药物中的应用。 本发明可以从根本上改变扩张型心肌病患者的心脏结构, 提高患者的生存率, 彻底治疗扩张型心肌病。
为实现上述发明目的, 本发明采用下述技术方案予以实现:
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更正页 (细则第 91条) ISA/CN 一种间充质干细胞注射液, 它包括以下组分:
含量为 2χ 105-1 χ 107个 /ml的间充质干细胞;
体积比为 5-8%的临床级 DMSO;
质量体积比为 1 -6%的人血白蛋白;
余量为复方电解质溶液。
对上述技术方案的进一步改进: 所述间充质千细胞来源于人脐带和 /或 人胎盘。
对上述技术方案的进一步改进: 所述间充质干细胞活力保持在 85%以 上。
本发明还提供了所述的间充质干细胞注射液的制备方法,包括脐带间充 质干细胞的制备和胎盘间充质干细胞的制备。
本发明还提供了所述的间充质干细胞注射液在制备治疗儿童扩张型心 肌病药物中的应用。
对上述技术方案的进一步改进:含有间充质干细胞注射液药物的用量为 含有 1 χ 106-1 χ 108个 /ml间充质干细胞。
与现有技术相比, 本发明的优点和积极效果是:
1.本发明用人间充质干细胞注射液来治疗儿童扩张型心肌病,选择用胎 盘和脐带来制备间充质干细胞注射液, 此间充质干细胞产量较大, 制备体 系易于质控, 易于产业化。
2. 本注射液可以直接经程控降温冻存, 复苏后可直接用于临床注射, 安全可靠。
3. 间充质干细胞免疫原性低, 异体使用无需配型。 间充质干细胞注射 到患者体内后, 可分泌很多细胞生长因子、 血管新生因子及干细胞激活因 子, 促进病变心肌的恢复, 激活体内心脏干细胞再生修复心脏结构, 从而 达到从根本上治疗扩张型心肌病的目的。 本发明可以逆转扩张型心肌病的 病程,改变扩张的心肌结构,从根本上改变扩张型心肌病患者的心脏结构,
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更正页 (细则第 91条) ISA/CN 恢复心脏功能, 改善全身各组织供血状态, 提高患者的生存率, 改善患者 的生活质量, 彻底治疗扩张型心肌病。 从而使患者摆脱大量服药及生命活 动受限以及病情控制不佳导致的严重并发症。
结合附图阅读本发明的具体实施方式后,本发明的其他特点和优点将变 得更加清楚。 附图说明
图 1是本发明中大鼠心肌组织治疗后病理变化比较图。
图 2是本发明中细胞的部分流式检测结果。
图 3是本发明中原代细胞第 9和 13天的照片。
图 4是本发明中第 6代细胞第 1和 4天的照片。
图 5是本发明中患者的超声心动图。
图 6是本发明中患者的胸部 X光片。 具体实施方式
下面结合附图和具体实施方式对本发明的技术方案作进一步详细的说 明。
实施例 1
一、 脐带间充质干细胞的制备
1. 新鲜足月健康胎儿脐带, 用 PBS緩沖液沖洗; 所述 PBS緩冲液含 100 kU/ L青霉素及 100 mg/ L链霉素;
2. 剪取 3-15cm长脐带, 将脐带剪成 l-2cm长的小段, 用 PBS緩沖液 反复冲洗; 所述 PBS緩冲液含 100 kU/ L青霉素及 100 mg/ L链霉素;
3. 将脐带组织块剪碎成 5mm3小块;
4. 将剪碎组织加入 L-DMEM培养基洗涤, 在 500-700g条件下离心 5 分钟, 弃上清;
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更正页 (细则第 91条) ISA/CN 5. 将组织块和培养基按体积比 2-3: 1比例混匀,接种至细胞培养孤中, 置培养箱培养; 所述的培养基为 MSC专用无血清培养基;
6. 每 3天换一次培养基, 细胞达 80%左右融合时传代; 传代培养基为 MSC专用无血清培养基。
二、 胎盘间充质干细胞的制备
1. 用含青霉素 (100 kU/ L )、 链霉素 00 mg/ L )和肝素钠 ( 50u/ml ) 的 PBS緩沖液沖洗胎盘, 将胎盘剪成 3-10mm3小块;
2. 将胎盘组织块用上述含青霉素和链霉素的 DMEM培养基混勾, 在 700-900g条件下离心 lOmin;
3. 弃上清, 每管加含体积比 0.25%胰蛋白酶的 DMEM培养基于 37°C 消化 lOmin, 在 850g条件下离心 lOmin;
4. 保留上清, 过滤网后收集的滤过液在 2200rpm条件下离心 lOmin;
5. 弃上清, 用 MSC 专用无血清培养基重悬细胞, 接种于培养 , 在 培养箱培养; 每 3天进行半量换液;
6. 细胞融合至 80-90%, 进行细胞传代, 传代培养基为 MSC专用无血 清培养基。
三、 间充质干细胞注射液的制备
该注射液是由以下成分按比例配制而成:
1、 来源于人脐带和 /或胎盘间充质干细胞, 每毫升注射液中间充质干细 胞的数量为 2χ 105-1 χ 107;
2、 体积比为 5-8%的 DMSO (临床级);
3、 质量体积比为 1 -6%的人血白蛋白;
4、 余量为勃脉力(复方电解质溶液)。
普通 DMSO, 在细胞冻存过程中起到防冻剂的作用, 防止冷冻过程中 细胞内形成冰晶, 但细胞复苏后最好漂洗掉。 临床级 DMSO对细胞无毒, 可以更好地起到保护细胞的作用, 在细胞复苏后无需漂洗, 可直接用于临
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更正页 (细则第 91条) ISA/CN 床注射, 对患者安全无毒。
人血白蛋白为临床常用注射液, 可为细胞提供营养, 利于细胞的新陈 代谢。
勃脉力(复方电解质溶液), 可以保持细胞的渗透压, 利于细胞的存活。 该注射液组份为临床常用电解质溶液, 可方便临床输注。
所述注射液可在 -196°C温度中稳定保存。使用时解冻复苏后可直接输注 到患者体内, 细胞保持为单细胞悬液状态, 细胞活力保持在 85%以上, 且 不会引起患者不适反应。 这种注射液非常利于间充质干细胞的保存、 运输 及存活, 且临床输注安全, 细胞可在此注射液中长时间保持较高的活力, 便于运输而不受使用时间的苛刻限制, 解决了异地患者使用时细胞长时间 运输影响细胞活力的问题。
间充质干细胞注射液的具体配制过程为:如配制 100ml干细胞注射液, 该注射液由人间充质干细胞、 临床级 DMSO 5ml、 人血白蛋白原液(原液 质量体积比浓度为 20% ) 25ml、 勃脉力 (复方电解质溶液) 70ml组成。 每 毫升注射液中间充质干细胞的数量为 2χ 105-1 χ 107。 间充质干细胞注射液在 -196Ό环境温度中,仍可保持单细胞悬液状态,复苏后细胞活力保持在 85% 以上, 可直接用于临床注射。
四、 间充质干细胞注射液对扩张型心肌病大鼠治疗的安全性和有效性 实验
健康清洁级雄性 SD大鼠 50只, 体重 200-250g, 随机分为三组: 空白 对照组 10只, 模型对照组 20只, 细胞治疗组 20只。 采用异丙基肾上腺素 170mg/(kg*d)连续注射 4天制备扩张型心肌病模型。模型建立成功 4周后行 人脐带间充质干细胞注射治疗。 细胞治疗组大鼠四肢肌肉肥厚处各注射 0.1ml间充质干细胞注射液(含 2χ 106细胞), 空白对照组与模型对照组大鼠 经四肢肌肉肥厚处各注射 0.1ml PBS。
实验开始后每天定时观察大鼠活动及体征。三组均于造模末次给药后 4 更正页 (细则第 91条) ISA/CN 周和治疗后 4周经胸前壁测定各组动物左心结构及功能, 指标包括左室舒 张末期内径、 左室收缩末期内径、 射血分数和缩短分数。 同时进行心脏形 态学检测: 取心脏左室游离壁组织做常规病理切片, 苏木精-伊红染色光镜 下观察心肌组织的病理学改变, Masson三色染色显示组织胶原纤维。
结果: 整个实验过程未见大鼠出现急性休克或死亡。
1. 超声图像测定各组大鼠心脏功能
与空白对照组相比, 细胞治疗组和模型对照组治疗前左室收缩末期内 径明显增加, 射血分数和缩短分数明显下降, 差异有非常显著性意义 (P < 0.01)。 治疗后 4周各组大鼠进行超声心动图检查, 结果显示, 细胞治疗组 治疗后 4周和治疗前相比, 左室收缩末期内径明显下降、 射血分数和缩短 分数明显升高, 差异有显著性意义 (P < 0.01)。 模型对照组治疗后和治疗前 相比, 左室舒张末期内径和左室收缩末期内径增加、 射血分数和缩短分数 下降, 但差异无显著性意义 (P > 0.05)。 空白对照组治疗后和治疗前相比, 左室舒张末期内径、 左室收缩末期内径、 缩短分数和射血分数差异均无显 著性意义 (P > 0.05), 见表 1和 2。 表 1 各组大鼠造模后 4周心脏功能治疗前后分析
造模后 4周
组别 n LVDd(mm) LVDs(mm) FS(%) EF(%)
细月包治疗组 20 5.37士 0.50 3.69±0.36a 29.56±6.59 a 53.36±10.32 a
模型对照组 20 5.32±0.65 3.59±0.51 b 30.26±4.96 a 55.26±8.65 a
空白对照组 10 5.12士 0.72 2.89士 0.36 42.36±3.69 79.03士6.59
表 2 各组大鼠治疗后 4周心脏功能治疗前后分析
治疗后 4周
组别 n LVDd(mm) LVDs(mm) FS(%) EF(%)
细月包治疗组 20 5.03士0.68 2.87±0.46 cd 41.35±7.23 cd 79.68士8.23 cd
模型对照组 20 5.32±0.52 3.89±0.65 31.98±8.79 59.37±9.65
空白对照组 10 5.13±0.68 2.86±0.44 42.69±5.61 80.06±7.29
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更正页 (细则第 91条) ISA/CN a <0.01 , V<0.05, vs空白对照组; <0.05, vs模型对照组; dP<0.01 vs细胞治疗组。 LVDd: 左室舒张末期内径; LVDs: 左室收缩末期内径; FS: 缩短分数; EF: 射血分数。
2. 心 H几组织病理变 4匕
模型对照组 HE染色可见心肌细胞呈广泛的水肿和空泡变性, 部分心 肌细胞脂肪变性和坏死, 组织间质水肿, 有散在炎性细胞浸润, 间质内可 见成纤维细胞增生; 细胞治疗组与之相比, 各种受损表现减轻。 Masson三 色染色示胶原纤维呈蓝色, 胞浆、 肌纤维和红细胞呈红色, 胞核呈黑蓝 色, 见图 1。 其中左图为空白对照组, 大鼠的正常心肌组织病理; 中图为模 型对照组, 大鼠心肌组织病理, 镜下可见大量心肌纤维化, 正常心肌组织 很少; 右图为细胞治疗组, 大鼠治疗后 4周后心肌组织病理, 镜下新生心 肌细胞, 心肌组织纤维化程度减少。 细胞治疗组心脏胶原的表达明显低于 模型对照组 (P < 0.05)。 说明间充质干细胞治疗可抑制心肌纤维化的进展。
实验结果表明:人间充质干细胞注射液治疗扩张型心肌病大鼠安全可行, 经间充质干细胞治疗后患病大鼠的生活状态、 心脏功能及心脏结构均有明 显好转, 疗效显著。 间充质干细胞注射液可以逆转扩张型心肌病患者的心 脏结构改变, 提高患者的生存率, 改善生活质量。
实施例 2
如配制 100ml 干细胞注射液, 该注射液由人间充质干细胞、 临床级 DMS0 8ml、 人血白蛋白原液(原液质量体积比浓度为 20% ) 30ml、 勃脉力 (复方电解质溶液) 62ml 组成。 每毫升注射液中间充质干细胞的数量为 2χ 105-1 χ 10 间充质干细胞注射液在 -196°C环境温度中, 仍可保持单细胞 悬液状态, 复苏后细胞活力保持在 85%以上, 可直接用于临床注射。 本发 明所述质量体积比均代表质量 (g)与体积 (ml)的比例。 实施例 3 脐带间充质干细胞的培养及检测 采用实施例 1 制备的脐带间充质干细胞进行扩增。 细胞培养扩增按照
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更正页 (细则第 91条) ISA CN 1.0-1.2 x 104/cm2的密度接种,加入完全无血清培养基,细胞融合度达 80-90% 后, 用 0.05%胰蛋白酶(不含 EDTA )室温消化收集细胞。 细胞不可过度融 合, 否则不但会发生生长接触抑制, 也可促使干细胞自发分化, 严重影响 传代后细胞生长状态。 脐带间充质干细胞的免疫表型测定:
分别收集 1 X 106 P1、 P6细胞数, 加入小鼠抗人 PE-IgGl , FITC-IgGl 同型对照,加入 PE、 FITC标记小鼠抗人流式抗体,检测 CD 34、 CD 45 (造 血细胞标志), CD31 (内皮细胞特异性抗原标志), CD14 (单核巨噬细胞表 面标志), CD 90、 CD 44、 CD 105 (间充质抗原标志)、 HLA-DR (移植免 疫排斥相关抗原)等免疫表型。 细胞培养结果及检测:
显微镜下细胞贴壁生长, 形态均应呈梭形、 折光度高, 细胞分布均匀 排列整齐,呈漩涡状,原代细胞收获数> 1 X 107; 细胞活率(台盼兰染色): 冻存前细胞活率 90%, 冻存后细胞活率 85%; 连续传至 6代细胞形态 稳定, 呈梭形、 分布均勾、 排列整齐; 连续传至 6代细胞增殖速度稳定; 表型均符合 MSC鉴定标准(CD73 、 CD 105 、 CD44或 CD90呈阳性, 阳 性率不低于 95%; CD3 K CD34> CD45、 HLA-DR呈阴性, 阳性率不应高 于 2%。); 细胞周期检测: 70-80%细胞处于细胞周期 G0G1期; Pl、 P6细 胞均具有多向分化能力; 染色体核型分析无异常; 连续 5-6代的扩增细胞总 数可达到 101 Q~10 。 部分流式检测结果见图 2。
其中, 原代平均培养天数为 13天, 收获细胞总数可达 1.6 χ 107, 连续 传 6代后细胞生长状态良好, 呈均一小梭形, 漩涡状排列整齐, 原代细胞 参见图 3(第 9和 13天的照片),第 6代细胞参见图 4(第 1和 4天的照片)。 实施例 4
利用实施例 2制备的干细胞注射液,对患者进行扩张型心肌病的治疗。
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更正页 (细则第 91条) ISA/CN 病例 1 ,男, 1 1岁,临床症状:呼吸困难、发绀, NYHA class II ( NYHA 二级); 心电图(ECG )检测: 左心室增大, 二尖瓣及三尖瓣返流, LVEF (左 心室射血分数) 38% ; X-光 /MRI 检测: 左心室增大, 心脏胸廓系数 ( cardiothoracic ratio ) 0.57。
利用实施例 2制备的干细胞注射液( 4代),四肢骨骼肌进行肌肉注射。 四次, 每次每毫升注射液中间充质千细胞的数量为 2.5χ 106, 注射后观察无 相关的并发症及副作用。 治疗后, 定期进行心脏功能检测。 效果参见图 5 和图 6, 其中在图 5中, 显示的是患者的超声心动图, A、 B、 C, D分别 表示的是在注射前和注射后 3, 6, 12个月时的情况。 图 6表示的是患者的胸 部 X光片, A表示的是注射前, B表示注射后 12个月时的情况。 显然, 在 注射后, 患者的扩张型心肌病明显好转。
ECG结果显示,在注射前:窦性心律,左心室增大, QRS 间隔 0.106 s; 注射后 6个月, 窦性心律, 左心室增大情况好转(心脏尺寸)。 具体数值如 下: 注射前 LVEF 38%, 注射后 6个月 LVEF50%。 注射前, SV (每搏输出 量) 62ml, 注射后 6个月, SV 80ml。 注射前, LVIDS (左心室收缩期内径) 5.1cm, LVIDd (左心室舒张期内径) 6.1 cm; 注射后 6个月, LVIDS 4.0cm, LVIDd 5.0cm。 以上实施例仅用以说明本发明的技术方案, 而非对其进行限制; 尽管参 照前述实施例对本发明进行了详细的说明, 对于本领域的普通技术人员来 说, 依然可以对前述实施例所记载的技术方案进行修改, 或者对其中部分 技术特征进行等同替换; 而这些修改或替换, 并不使相应技术方案的本质 脱离本发明所要求保护的技术方案的精神和范围。
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更正页 (细则第 91条) ISA/CN

Claims

权利要求
1、 一种间充质干细胞注射液, 其特征在于它包括以下组分:
含量为 2xl05-lxl07个 /ml的间充质干细胞;
体积比为 5-8%的临床级 DMSO;
质量体积比为 1-6%的人血白蛋白;
余量为复方电解质溶液。
2、根据权利要求 1所述的间充质干细胞注射液, 其特征在于: 所述间充质 干细胞来源于人脐带和 /或人胎盘。
3、根据权利要求 1所述的间充质干细胞注射液, 其特征在于: 所述间充质 干细胞活力保持在 85%以上。
4、根据权利要求 1所述的间充质干细胞注射液的制备方法,其特征在于配 制体积比为 5-8%的 DMSO、 质量体积比为 1-6%的人血白蛋白和复方电解质溶 液, 将间充质干细胞重悬于上述溶液中制成单细胞悬液, 使干细胞数量为 2xl05-lxl07个 /ml。
5、 根据权利要求 4所述的间充质干细胞注射液的制备方法, 其特征在于 所述脐带间充质干细胞的制备包括以下步骤:
(1) . 新鲜足月健康胎儿脐带, 用含 100 kU/ L青霉素及 100 mg/ L链霉素 的 PBS緩沖液沖洗;
(2) . 剪取 3-15cm长脐带, 将脐带剪成 l-2cm长的小段, 用所述 PBS緩沖 液反复沖洗;
(3) . 将脐带组织块剪碎成 5mm3小块;
(4) . 将剪碎组织加入 L-DMEM培养基洗涤, 在 500-700g条件下离心 5分 钟, 弃上清;
(5) . 将组织块和培养基按体积比 2-3: 1比例混匀,接种至细胞培养亚中, 置培养箱培养; 所述的培养基为 MSC专用无血清培养基;
(6) . 每 3 天换一次培养基, 细盹达 80%左右融合时传代; 传代培养基为 MSC专用无血清培养基。
6、 根据权利要求 4所述的间充质干细胞注射液的制备方法, 其特征在于 所述胎盘间充质干细胞的制备包括以下步骤:
(1) . 用含 100 kU/ L青霉素、 100 mg/ L链霉素和 50u/ml肝素钠的 PBS緩 沖液沖洗胎盘, 将胎盘剪成 3-10mm3小块;
(2) . 将胎盘组织块用上述含青霉素和链霉素的 DMEM培养基混勾, 在 700-900g条件下离心 lOmin;
(3) . 弃上清, 每管加含体积比 0.25%胰蛋白酶的 DMEM培养基于 37°C消 化 lOmin, 在 850g条件下离心 lOmin;
(4) . 保留上清, 过滤网后收集的滤过液在 2200rpm条件下离心 lOmin;
(5) . 弃上清, 用 MSC 专用无血清培养基重悬细胞, 接种于培养 培养; 每 3天进行半量换液;
(6) . 细胞融合至 80-90%进行细胞传代,传代培养基为 MSC专用无血清培 养基。
7、根据权利要求 1所述的间充质干细胞注射液在制备治疗儿童扩张型心肌 病药物中的应用。
8、根据权利要求 7所述的间充质干细胞注射液在制备治疗儿童扩张型心肌 病药物中的应用, 其特征在于: 含有间充质干细胞注射液药物的用量为含有 1χ106-1χ108个 /ml间充质干细胞。
PCT/CN2013/086832 2012-11-14 2013-11-11 一种间充质干细胞注射液及其制备方法和在制备治疗儿童扩张型心肌病药物中的应用 WO2014075592A1 (zh)

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