BRAIN and NERVE－神経研究の進歩62巻10号

2010年10月発行

総説

間葉系幹細胞を利用したグリオーマの治療戦略

著者： 難波宏樹¹

所属機関： ¹浜松医科大学脳神経外科

ページ範囲：P.1075 - P.1082

文献概要

はじめに

　過去数十年における神経腫瘍学の発展にもかかわらず，悪性グリオーマに対する画期的な治療法はいまだ開発されていない。手術および放射線・化学療法は悪性グリオーマ患者の予後を明らかに改善してはいるものの，治癒に至る例は極めて少なく，放射線療法や化学療法は限られた治療効果しかない^1－3）。WHO grade IV膠芽腫の生存中間値は1年程度であり，grade IIIでも約3年である^1，3，4）。グリオーマ細胞が脳内を浸潤性に発育し，時には対側脳にまで遊走することが，積極的切除後においても再発する一因と考えられる。

　近年では脳腫瘍は脳腫瘍幹細胞と呼ばれるsubpopulationによって維持され^5，6），この脳腫瘍幹細胞が浸潤能や治療抵抗性に関係していることが示唆されている^7）。脳腫瘍幹細胞には正常の神経幹細胞（neural stem cell：NSC）と類似した特徴があり，これらの脳腫瘍幹細胞が正常なNSCより発したのか，分化した成熟神経細胞の変異によって起こるのかはまだ明らかでない^8）。脳腫瘍幹細胞とNSCに共通点があるということは腫瘍形成の面から興味深いが，また一方，その両者に共通する遊走能を治療戦略に応用しようという試みも最近注目されている。

　しかしながらNSCの臨床応用における重大な問題の1つは，治療に用いるのに十分な量のNSCをどこから得るかということである。成人脳腫瘍患者自身の脳から十分量のNSCを得て，治療に用いる方法は，細胞採取自体が侵襲的であり，成人NSCは採取後の培養・増殖に時間がかかるため，進行の速い悪性グリオーマの治療には必ずしも適当でない。本稿では主に骨髄などから採取されるNSCに類似した細胞を利用した治療につき考察する^9）。なおここではこれらの細胞を間葉系幹細胞（mesenchymal stem cell：MSC）と呼ぶことにする。

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