Farrell O. Mendelsohn教授  普林斯顿医学中心

　　<International Circulation>：As we know， you have done a histologic study about the anatomic substrate of renal denervation. Would you please tell us what is the anatomic substrate of renal denervation?

　　Prof. Mendelsohn：What that means， is to understand how renal denervation works， you have to understand what the target of renal denervation is. In other words， when you do radio frequency energy delivery to the artery wall， or you enter the artery wall by other mechanisms， what tissue are you actually trying to effect? And that’s the meaning behind the anatomic substrate of renal denervation. Because the target of all of these therapies are the renal sympathetic nerves that travel to and from the kidneys. When you injure the artery wall， you are also injuring other cells. You are injuring the lining of the blood vessel to a small extent， you’re injuring smooth muscle cells in the artery wall， fat cells and connective tissue. But those are not the anatomic targets of the this therapy. The target of the therapy is the nerves.

　　《国际循环》：据我们所知，您曾做过有关肾脏去神经治疗的组织学研究。请您介绍一下肾脏去神经治疗的解剖学基础是什么？

　　Mendelsohn教授：这意味着要想理解肾脏去神经治疗是如何发挥作用的，你首先要理解肾脏去神经治疗的靶标是什么。换句话说，当你将射频能量传递至动脉壁或你通过其他机制进入动脉壁时，你实际上想要影响的是什么样的组织。这就是肾脏去神经治疗解剖学基础的意义所在。因为所有这些治疗的靶标都是传入及传出肾脏的肾交感神经。当你损伤动脉壁时，你也会损伤其它细胞。你同时会轻微地损伤血管，损伤动脉壁中的平滑肌细胞、脂肪细胞及结缔组织。而这些都不是肾脏去神经治疗的解剖学目标。该治疗的靶标是神经。

　　<International Circulation>：What products about renal denervation have been put into use or are being developed at present?

　　Prof. Mendelsohn:That is a very interesting question because there are so many products out there. There are really three leading products that are already commercialized. The simplicity system from Medtronic. The Vessix renal denervation system from Boston Scientific， and the enlightened system from St. Jude Medical， but there are many other companies working on this technology， both worldwide and domestically， in China.

　　《国际循环》：目前，已经投入使用和正在研发的肾脏去神经治疗相关产品有哪些？

　　Mendelsohn教授：这是一个非常有趣的问题，因为已经有很多相关的产品。目前已经上市的主要有三种产品，它们是美敦力的Simplicity系统、Boston Scientific的Vessix肾脏去神经系统和圣犹达医药的EnligHTN系统。当然全世界及中国的很多其他公司也在研发相关产品。

　　<International Circulation>：What is the mechanism of autologous CD34+ cells treating refractory angina? And how do you think about its application prospects?

　　Prof. Mendelsohn:The CD34 cells actually serve as a mechanism for delivering multiple growth factors to the tissue， and the concept is that these cells will stimulate new blood vessel growth， and collateral growth. The prospects for this therapy are very good for both refractory angina and significant peripheral artery disease. There are many other stem cell products and gene therapy products that are being investigated for these clinical applications. Much research， however， still needs to be done to find a therapy that consistently works for patients and can be approved for routine clinical use.

　　《国际循环》：自体CD34+细胞治疗顽固性心绞痛的机制是什么？您如何看待其在顽固性心绞痛中的应用前景？

　　Mendelsohn教授：CD34+细胞实际上可向组织分泌多种生长因子，能促进新生血管生长及侧枝形成。该疗法治疗顽固性心绞痛及外周动脉疾病的前景非常好。目前还有很多的干细胞产品及基因治疗产品也正在进行临床应用研究。但是，亟需大量的研究来找到能为患者带来持续获益并能被常规应用于临床的治疗方法。