[Blood Products and Stem Cells in Osteoarthritis Therapy].

Zeitschrift fur Orthopadie und Unfallchirurgie Pub Date : 2024-10-01 Epub Date: 2024-09-25 DOI:10.1055/a-2192-8330
Alexander Otahal, Markus Neubauer, Stefan Nehrer
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Abstract

The principle of regenerative medicine in the treatment of osteoarthritis pursues a functional restoration of cartilage tissue instead of just repairing cartilage defects. The use of blood products is intended to inhibit chronic inflammatory processes and promote tissue regeneration. Intraarticular injection of autologous platelet-rich plasma (PRP) is a prominent procedure. Clinical evidence supports PRP injection over hyaluronic acid or glucocorticoid injection. Comparability of studies is difficult due to missing standardisation of production procedures, dosing and donor variability. In particular, whether presence of residual leukocytes is required or should be avoided is an open debate. In contrast, stem cell therapies in osteoarthritis therapy are often based on mesenchymal stem cells (MSC) from adipose tissue or bone marrow aspirate. Different sources of MSC might render the cells more suitable for application in a given context. Nevertheless, it became evident that their secretome rather than the cells themselves are responsible for observed regenerative processes. Research on the mechanisms of action have focused on growth factors. However, an overlooked component of blood products called extracellular vesicles (EV) came to the center of attention, which are also released by MSC as intercellular signal carriers. EV cargo molecules such as miRNAs open up new dimensions in the investigation and explanation of clinically observed anti-inflammatory and regenerative effects.

[骨关节炎治疗中的血液制品和干细胞]。
再生医学治疗骨关节炎的原则是追求软骨组织的功能恢复,而不仅仅是修复软骨缺损。使用血液制品的目的是抑制慢性炎症过程,促进组织再生。关节内注射自体富血小板血浆(PRP)是一种重要的治疗方法。临床证据表明,PRP 注射优于透明质酸或糖皮质激素注射。由于缺乏标准化的生产程序、剂量和供体的差异性,研究的可比性很难保证。特别是,是否需要或应避免残留白细胞的存在是一个公开辩论的问题。相比之下,骨关节炎治疗中的干细胞疗法通常以脂肪组织或骨髓抽吸物中的间充质干细胞(MSC)为基础。间充质干细胞的不同来源可能会使细胞更适合在特定情况下应用。尽管如此,在观察到的再生过程中,显然是细胞的分泌物而不是细胞本身在起作用。对作用机制的研究主要集中在生长因子上。然而,血液制品中一种被忽视的成分--细胞外囊泡(EV)成为了关注的焦点,它也是间充质干细胞释放的细胞间信号载体。EV载货分子(如 miRNAs)为研究和解释临床观察到的抗炎和再生效应开辟了新的领域。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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