| Aplastic anemia (AA) is a syndrome caused by chemical, physical, biological or other unidentified factors characteristic with stem cell defect, failure of stromal microenvironment, and pancytopenia. Clinical feature of acute aplastic anemia is fever, infection and bleeding. Chronic aplastic anemia is eharaceristic of fatigue, bleeding, poor appetite, dizzy.According to the theory of traditional Chinese medicine, aplastic anemia is caused by defection of spleen and kidney, complicated with thrombosis, heat evil and humidity in different stage. It should be treated with the method of strengthen spleen and kidney, activate circulation and a little exclude heat evil.According to modern medical theory, the mechanisms of pathogenesis of AA include intrinsic stem cell defect, failure of stromal microenvironment, immune suppression of marrow. Marrow transplantation, immunosuppressive therapy, and androgen are the main treatment, which has little effect on stromal microenvironment. Failure of stromal microenvironment is a relatively important mechanism in chronic AA(CAA). TCM has advantage in treating CAA because of its high efficacy, low side-effect incidence, and long efficacy. However, research in the effect of TCM on stromal microenvironment of AA is not sufficient and deep. So we decided do more work in this direction and hope to provide new clew for promote the curative effect of AA.Huo Shui tab is formed on base of years of clinical experiment by hemorrhage institution of our hospital. The main function is strengthen kidney and spleen, activate circulation and nourish blood. It was demonstrated that Huo Shui tab can adjust stem cell, immune suppression and microenvironment in AA, but research is focused on two formal part, the last part hasn't been explored fully.We have treated 13 cases with Huo Shui tab in three years. The result indicated that Huo Shui tab could improve quality of life, alleviate clinical symptoms, increase count of blood cells and reticular red cell. In this group, 2 of 13 cases were cured, 5 cases alleviated, 3 cases progressed, 3 cases has no effect, total effect ratio is 77%.In laboratory research, we observed effect of Huo Shui tab on the bone marrow micro-environment of immune-mediated aplastic anemia on mice by in vitro culture of bone marrow stromal cell. Result: AA mice were close to death 9-12 days post-model, with pancytopenia, and decreasing of BMMNC by 10 times. Stromal cell culture demonstrate poor growth status and blocked cell cycle in Go/Gi, lowered expression of adherent molecule and its receiver, which lead to the adherent ability defection, and defect in the function of stromal cell layer to support hemapoietic cell. Huo Shui tab can 1. increase blood cell count and bone marrow mono-nuclear cell. 2. improve the growth of bone marrow stromal cell. 3. up-regulate the expression of cell adhesion molecule (VCAM-1) on bone marrow stromal cell and that of its receiver VLA-4 on bone marrow mono-nuclear cell(BMMNC), thus improve the adherent ability of BMMNC to bone marrow stromal cell layer. 4. increase hemapoietic factor secretion of stromal cell, which in turn, support the growth of BMMNC in stomal cell culture supernatant, and that of CFU-GM on the stromal cell layer. We concluded that Huo Shui tab can improve the hemapoietic and adherent ability of bone marrow stromal cell in aplastic anemia, protect bone marrow micro-environment, and increase the hemapoietic function of bone marrow. Stanzole has limited effect on stromal microenvironment of AA mice, which resulted in less improvement of curative effect of Stanzole man Huo Shui tab.Our research designed a quality of life qustionare for AA patients based on a international qustionare for AA patient lived through two years post bone marrow transplantation, developed a method to scale the clinical symptom relative to TCM typology, and also explored the molecular mechanism of the effect of Huo Shui tab on bone marrow micro-environment on aplastic anemia, provided a new direction to improve the curative effect of a...
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