avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2018-8-2-150-160avk-773Research ArticleРАЗБОР КЛИНИЧЕСКИХ СЛУЧАЕВANALYSIS OF CLINICAL CASESМОНИТОРИНГ МОРФОЛОГИЧЕСКИХ ЭФФЕКТОВ АУТОЛОГИЧНЫХ МЕЗЕНХИМАЛЬНЫХ СТВОЛОВЫХ КЛЕТОК, ТРАНСПЛАНТИРОВАННЫХ В ПЕЧЕНЬ ПРИ ВИРУСНОМ ЦИРРОЗЕ (клиническое наблюдение)MONITORING OF MORPHOLOGICAL EFFECTS AUTOLOGICAL MESENCHIMAL STEM CELLS, TRANSPLANTED IN LIVER WITH VIRUS CYRROSIS (clinical observation)ЛукашикС. П.LukashykS. P.

кафедра инфекционных болезней

Department of Infectious Diseases

svetlanalukashik@mail.ruАлениковаО. В.AleinikovaO. V.ЦыркуновВ. М.TsyrkunovV. M.

кафедра инфекционных болезней

Department of Infectious Diseases

ИсайкинаЯ. И.IsaikinaY. I.КравчукР. И.КravchukR. I.

научно-исследовательская лаборатория

Research Laboratory

УО «Белорусский государственный медицинский университет»БеларусьBelarusian stat medical universityBelarusГУ «Республиканский научно-практический центр детской онкологии, гематологии и иммунологии»БеларусьBelarusian research center for pediatric oncology, hematology and immunologyBelarusУО «Гродненский государственный медицинский университет»БеларусьGrodno stat medical universityBelarus20182903201882150160Copyright © Лукашик С.П., Аленикова О.В., Цыркунов В.М., Исайкина Я.И., Кравчук Р.И., 20182018Лукашик С.П., Аленикова О.В., Цыркунов В.М., Исайкина Я.И., Кравчук Р.И.Lukashyk S.P., Aleinikova O.V., Tsyrkunov V.M., Isaikina Y.I., Кravchuk R.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/773

Введение. Актуальность инфекции, вызванной вирусом гепатита С (ВГС), определяется широким распространением, прогрессирующим течением, формированием цирроза печени (ЦП) и гепатоцеллюлярной карциномы. Остаются не до конца изученными механизмы воздействия вируса на печеночные клетки, процессы фиброгенеза и фибролиза, механизмы обратного развития ЦП. Отсутствует эффективная патогенетическая терапия. Цель — определить эффективность и безопасность внутрипеченочной трансплантации мезенхимальных стволовых клеток (МСК) при хронической ВГС-инфекции на стадии цирроза печени. Материалы и методы. Пациентка с ВГС-ЦП, имеющая вторичный (вызванный ВГС) геморрагический васкулит, которой была произведена трансплантация аутологичных МСК в ткань печени. Исследование биоптата печени проведено методом световой и электронной микроскопии, иммуногистохимии. Результаты. Введение аутологичных МСК и пострансплантационный период протекали без осложнений. После введения МСК сохранялись признаки сформированного микронодулярного ЦП. На отдельных участках образцов септы выглядели истонченными, иногда — перфорированными, свидетельствуя о резорбции в этом месте фиброзной ткани. Наблюдалось снижение выраженности трансдифференцировки ЗКИ в миофибробласты, уменьшение количества фиброцитов и фибробластов, отсутствовали иммунные реакции в виде отложения аморфных и волокнистых масс умеренной электронной плотности вдоль синусоидных капилляров, которые были значительно выражены в первичной биопсии. Эти изменения сочетались с появлением гетерогенности гепатоцитов по плотности цитоплазматического матрикса, состоянию и количеству органелл и включений, структурным улучшением внутриклеточных органелл. Выводы. Трансплантация МСК из костного мозга уменьшает степень деструктивных изменений гепатоцитов, выраженность фиброза и способствует улучшению морфофункционального состояния печени, в связи с чем, может быть рекомендована в качестве важного компонента лечебных мероприятий. 

Introduction. The importance of the HCV-infection is determined by the wide spread, progressive course, the formation of liver cirrhosis (LC) and hepatocellular carcinoma. The mechanisms of the effect of the virus on hepatic cells, the processes of fibrogenesis and fibrolysis, mechanisms of the reverse development of the LC remain unexplored. There is no effective pathogenetic therapy. The aim of the study — determination of the effectiveness and safety of intrahepatic transplantation of mesenchymal stem cells (MSC) in chronic HCV-infection at the stage оf LC. Methods. A patient with HCV-LC who has a secondary hemorrhagic vaculities who underwent autologous MSC transplantation into the liver tissue. The liver biopsy specimens were studied in dynamics by light and electronic microscopy and by immunohistochemistry. Results. The transplantation and posttransplantation period proceeded without complications. After the introduction of MSC the features of the formed micronodular LC remained. In some parts of the samples, the septa looked thin, sometimes perforated, indicating a resorption in this place of fibrous tissue. There was a decrease in the degree of transdifferentiation of stellate cells into myofibroblasts, a decrease in the number of fibroblasts and fibroblasts, there were no immune reactions in the form of deposition of amorphous and fibrous masses of moderate electron density along the sinusoidal capillaries that were significantly expressed in the primary biopsy. These changes were combined with the appearance of hepatocyte heterogeneity in the density of the cytoplasmic matrix, the state and quantity of organelles and inclusions, and the structural improvement of intracellular organelles. Conclusion. Autologous transplantation of mesenchymal bone marrow stem cells reduces the degree of destructive changes in hepatocytes, the severity of fibrosis and contributes to the improvement of the morpho-functional state of the liver, and therefore, it can be recommended as an important component of medical interventions. 

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The authors declare that there are no conflicts of interest present.