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研究生: 陳俊宏
Chun-Hung Chen
論文名稱: 片狀間葉幹細胞於心肌組織工程上之應用
Novel Mesenchymal-Stem-Cell Sheet for Myocardial Regenerative Medicine
指導教授: 宋信文
Hsing-Wen Sung
口試委員:
學位類別: 博士
Doctor
系所名稱: 工學院 - 化學工程學系
Department of Chemical Engineering
論文出版年: 2007
畢業學年度: 96
語文別: 英文
論文頁數: 103
中文關鍵詞: 細胞片心肌梗塞血管新生間葉幹細胞細胞治療術
外文關鍵詞: Cell sheet, myocardial infarction, angiogenesis, mesenchymal stem cell, cell therapy
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  • 心肌梗塞是缺血性心臟病中最致命與最典型的病症,亦是工業化國家中首要的死因。然而目前的治療方式只有傳統的冠狀動脈繞道手術、心導管氣球擴張術、左心室輔助裝置、心室補綴片成形術或心臟移植等,每一種皆有其風險及限制。根據以上的文獻回顧及先前的研究結果,我們可以推測細胞片組織工程的特點對於運用成體幹細胞治療心肌梗塞的再生醫學技術上,將可改進了許多傳統細胞注射治療及補綴片修補技術無法解決的問題。故本論文主要的目的,為應用溫度敏感性高分子甲基纖維素的成膠特性,研發一新穎片狀活細胞生產系統,並以此生產成體幹細胞片(MSC sheet)做為細胞片組織工程運用於心肌治療上。
    在體外實驗裡,我們探討了不同黏度值的MC,於室溫下溶解在不同的鹽類組成或PBS及細胞培養基,並探討其成膠之溫度以及滲透壓。其主要原理是利用鹽析作用來增加MC的疏水性作用力,降低其成膠溫度以符合培養細胞的需求。其鹽類組成包括了NaCl, Na2SO4, Na3PO4。此外我們也探討了利用collagen、poly-L-lysine 等生物巨分子修飾成膠後的MC水膠表面,並在修飾後,進一步分析其成膠溫度與其成膠後的表面性質的改變以及對細胞的生物相容性質。為了符合細胞培養的環境,只有在37℃下能夠形成膠狀的高分子黏度與鹽類的條件並且符合其生理特性者,才會被挑出來做後續的研究。
    在第一部份的體內實驗裡,我們利用外科手術方式將老鼠左冠狀動脈(left coronary artery)結紮後,製造出急性心肌梗塞。然後將片狀的MSC sheet注射到心肌梗塞區域的邊緣,探討幹細胞片在壞死的心肌區域中,其增生及分化情形,並對於左心室及整體心臟功能的影響進行評估。實驗中,我們以生理實驗水、sham operated做為空白對照組,而以傳統繼代培養所獲得的MSCs為正對照組。在急性心肌梗塞症狀出現25分鐘後進行注射。並在心肌注射後的四週、八週及十二週,以心臟超音波,心電圖及心室壓力量測以觀察左心室與心臟整體功能的變化情形。注射十二週後取樣,取樣後,我們以巨觀觀察及組織切片來分析壞死心肌內細胞的分佈及其植入細胞的分化後的特性。
    在第二部份的體內實驗裡,我們將先利用外科手術方式將老鼠左冠狀動脈(left coronary artery)結紮後,四周後製造出慢性心肌梗塞產生心室肥大的症狀。然後將夾有片狀的MSC sheet的去細胞牛心包膜利用EVCPP置換其擴大的心室部位。實驗中,我們將以sham operated及去細胞牛心包膜做為空白對照組,而以種有非片狀MSCs的去細胞牛心包膜為正對照組。我們於植入四週後取樣,並在執行EVCPP前以及取樣的前一天,同第三部份實驗分析方法,以觀察左心室及整體心臟功能,並進一步利用組織切片分析其細胞分化與血管新生的情形。


    Myocardial infarction (MI) progresses from the acute death of cardiomyocytes and the infiltration of inflammatory cells into granulation, followed by scars. Recently, the identification of stem cells capable of contributing to tissue regeneration has raised the possibility that cell therapy could be employed for repair of damaged myocardium. It was shown that cell transplantation via local intramuscular injection is a promising therapy for patients with myocardial infarction. However, following injection of the dissociated cells, retention of the transplanted cells in the injected area remains a central issue. These facts can be deleterious to cell-transplantation therapy.
    The purpose of study I was to evaluate using a thermoreversible hydrogel system, treated as a coating on tissue culture polystyrene (TCPS) dishes and developed for harvesting living cell sheets. The hydrogel system was prepared by simply pouring aqueous methylcellulose (MC) solutions blended with distinct salts on TCPS dishes at 20℃. To improve cell attachments, the MC/PBS hydrogel at 37℃ was evenly spread with a neutral aqueous collagen at 4℃. The spread aqueous collagen gradually reconstituted with time and thus formed a thin layer of collagen (the MC/PBS/Collagen hydrogel). After cells reached confluence, a continuous monolayer cell sheet was formed on the surface of the MC/PBS/Collagen hydrogel. Additionally, the developed hydrogel system can be used for culturing a multi-layer cell sheet.
    Study II examined the hypothesis that the thermo-responsive hydrogel was used as a coating on TCPS dishes and developed for harvesting living cell sheets. The obtained MSC sheets preserved the intercellular junctions and endogenous extracellular matrix and kept their cell phenotype. After injection through a needle, the fragmented MSC sheets maintained intact and retained their activity upon transferring to another growth surface, while the complete cell sheets were torn into pieces. Transplantation of fragmented MSC sheets in the skeletal muscle of a syngeneic rat model via local injection was evaluated. The transplanted MSC sheets were mainly localized at the site of injection, while the dissociated MSCs were scattered around. Additionally, there were more MSCs retained in the local skeletal muscles for the group injected with fragmented MSC sheets than that injected with dissociated MSCs. These results indicated that the fragmented cell sheets may be used as a novel therapeutic cell-carrier for intramuscular administration.
    In study III, we hypothesized that the use of cell-sheet fragments, with the preservation of extracellular matrix (ECM), may significantly increase cell retention and thus improve cell therapy. Mesenchymal-stem-cell (MSC) sheet fragments with ECM were fabricated. Using a rat model with experimental myocardial infarction, an intramyocardial injection was conducted with a needle directly into the peri-infarct areas. There were four treatment groups (n ≧ 10): sham; PBS; dissociated MSCs; and MSC sheet fragments. The results obtained in the echocardiography and pressure measurements revealed a superior heart function in the MSC-sheet-fragment group compared with the dissociated-MSC group (P < 0.05). The MSC sheet fragments were able to conform and align their inherent ECM along with the interstices of the muscular tissues at the injection sites, while only a few cells were identified in the dissociated-MSC group at 12 weeks postoperatively. Additionally, transplantation of the MSC sheet fragments stimulated a significant increase in vascular density (P < 0.05) and enhanced the graft/host cell connection.
    Myocardial infarction often leads to left ventricular dilation, thus impairing cardiac functions. To restore the dilated LV, a possible strategy is to replace the infarcted myocardium with bioengineered tissue grafts. The goal of tissue engineering is to repair or replace the damaged organ or tissues by delivering functional cells on supporting scaffolds to areas in need. Therefore, in study IV, a novel bioengineered tissue graft, a porous acellular bovine pericardium sandwiched with multilayered sheets of MSC, was developed for the treatment of MI. It was previously shown by our group that the acellular bovine pericardium fixed with genipin can provide a natural microenvironment for host cell migration and may be used as a tissue-engineering scaffold. We hypothesized that this newly developed tissue graft can provide the required mechanical strength to support the sandwiched multilayered sheets of MSC for tissue regeneration to restore the dilated LV and improve cardiac functions in a syngeneic rat model. The implanted samples were retrieved at 12-week postoperatively (n ≧ 10 per group at each time point) and were used for gross and histological examinations.

    ABSTRACT…...………………………………………………………..I TABLE OF CONTENT………………………………………………....III LIST OF FIGURES…………………………………………………..VIII LIST OF TABLES…….………………………………………..…….XII Chapter 1. Introduction.............................. 1 Chapter 2. A Novel Living-Cell-Sheet Harvest System Composed of Thermoreversible Methylcellulose Hydrogels 2-1 Materials and Methods................. 6 2-1-1 Preparation of Aqueous MC Solutions .........6 2-1-2 Gelation Temperatures of Aqueous MC Solutions 7 2-1-3 Preparation of the MC-Hydrogel Coated TCPS Dish ..............................................7 2-1-4 Cell Culture..................................8 2-1-5 Detachment of Cell Sheets.....................8 2-1-6 Immunofluorescence Staining ...................9 2-1-7 Statistical Analysis...........................9 2-2 Results and Discussion........................10 2-2-1 Gelation of Aqueous MC Solutions..............10 2-2-2 Stability of the Coated MC Hydrogel...........15 2-2-3 Cell Culture on the Surface of the MC Hydrogel ..............................................19 2-2-4 Detachment of Cell Sheets.....................21 2-2-5 Applications of the Developed Technique.......24 2-3 Conclusions...................................26 Chapter 3. Construction and characterization of fragmented mesenchymal-stem-cell sheets with a uniform size for intramuscular injection 3-1 Materials and Methods..........................27 3-1-1 Preparation of Aqueous MC......................27 3-1-2 Preparation of the Collagen/MC-coated TCPS Dish ...............................................28 3-1-3 Culture of MSCs on the Collagen/ MC-coated TCPS Dish ...............................................29 3-1-4 Construction and Characterization of Fragmented Sheets of MSCs..........................................30 3-1-5 Animal Study...................................30 3-1-6 Morphometry....................................30 3-1-7 Statistical Analysis...........................32 3-2 Results and Discussion.........................32 3-2-1 Characterization of Aqueous MC blended with PBS ...............................................32 3-2-2 Culture of MSCs on the Collagen/MC-coated Surface ...............................................35 3-2-3 Construction and Characterization of Fragmented MSC Sheets..............................................27 3-2-4 Animal study...................................42 3-3 Conclusions.....................................44 Chapter 4. Direct Intramyocardial Injection of Mesenchymal Stem-Cell Sheet Fragments Improves Cardiac Functions after Infarction 4-1 Materials and Methods...........................45 4-1-1 Preparation of the Cell-Sheet Culture System....45 4-1-2 Characterization of MSC Sheets..................46 4-1-3 Construction and Characterization of MSC Sheet Fragments ................................................47 4-1-4 Animal Study....................................48 4-1-5 LV Function Assessment by Echocardiography......49 4-1-6 LV Catheterization ..............................50 4-1-7 Histological Examinations.......................50 4-1-8 Statistical Analysis............................51 4-2 Results.........................................42 4-2-1 Characteristics of MSCs in Cell Sheets..........52 4-2-2 Characterization of MSC Sheet Fragments.........52 4-2-3 Animal Study....................................56 4-2-4 LV Function Assessment by Echocardiography and Catheterization..........................................56 4-2-5 Morphological and Histological Findings.........56 4-3 Discussion......................................63 4-4 Conclusions.....................................66 Chapter 5. Porous Tissue Grafts Sandwiched with Multilayered Mesenchymal Stem Cell Sheets Induced Neovascularization and Tissue Regeneration for Cardiac Repair 5-1 Materials and Methods...........................67 5-1-1 Production of Multilayered Cell Sheets..........67 5-1-2 Preparation of Porous Tissue Scaffolds..........68 5-1-3 Porous Tissue Grafts Sandwiched with Multilayered Cell Sheets..............................................69 5-1-4 Animal Study....................................69 5-1-5 LV Function Assessment by Echocardiography......70 5-1-6 LV Catheterization..............................71 5-1-7 Histological Examinations.......................71 5-1-8 Statistical Analysis............................72 5-2 Results.........................................73 5-2-1 Characteristics of Porous Tissue Grafts Sandwiched with Multilayered Sheets of MSC...............73 5-2-2 Animal Study....................................74 5-2-3 LV Function Assessment..........................74 5-2-4 Gross Examination...............................75 5-2-5 Histological Findings...........................75 5-3 Discussion......................................82 5-4 Conclusions.....................................86 References...............................................87 著作目錄.................................................98 作者簡歷................................................103

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