Применение клеточных технологий при лечении неврологических нарушений, вызванных COVID-19 SARS-CoV-2

В обзоре систематизированы результаты исследований, посвященных лечению и реабилитации пациентов с неврологическими последствиями постковидного синдрома и с сосудистыми, поствоспалительными и травматическими поражениями нервной системы с применением стволовых клеток взрослого типа.

Материал и методы: проведен поиск литературных источников, включая опубликованные в рецензируемых журналах, индексируемые в PubMed, Wos, Scopus и РИНЦ. Проанализированы 72 статьи, посвященные клеточным технологиям и иммунотерапии в неврологии, из которых 63 включены в данный обзор.

Результаты. Включение стволовых клеток (СК) в программы реабилитации пациентов с разнообразными повреждениями и заболеваниями ЦНС – новое перспективное направление исследований. Возможные механизмы терапии травмы спинного мозга, базирующиеся на использовании стволовых плюрипотентных клеток взрослого типа из костного мозга, в том числе СД34+, включают множество аспектов. На фоне трансплантации СК могут восстанавливаться поврежденные нервные клетки и окружающие ткани, включая нейроны и глиальные клетки, что помогает обеспечить целостность путей нервной проводимости и, таким образом, восстановить нервную функцию. Терапия СК может подавлять гены, участвующие в воспалении и апоптозе, а также активировать гены с нейропротектерным действием, тем самым защищая спинномозговые нейроны от вторичного повреждения. Доза аутоСД34+ СК определяется по содержанию СД34+ клеток и составляет не менее 1 × 10⁶ СД34+ клеток на 1 введение. Аутологичные гемопоэтические стволовые клетки (ГСК), полученные от самого пациента, не вызывают иммунологических конфликтов, и, соответственно, не требуют проведения иммуносупрессивной терапии в отличие от донорских (аллогенных) и ксеногенных клеток. Таким образом, у больного не происходит нарушений в естественных механизмах противоинфекционного и противоопухолевого контроля. При этом аутологичные ГСК относительно легко получить и культивировать при необходимости, а при применении данного типа клеток врачи не сталкиваются с этическими и законодательными вызовами.

Заключение. Учитывая ранее полученные данные об эффективности применения аутологичных ГСК СД34+ для реабилитации больных с различными типами повреждения нервной системы и универсальность патофизиологических механизмов в ЦНС, можно предположить, что данное направление клеточной терапии может быть использовано для лечения постковидного синдрома.

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