Indima yeeplatelet kumongo wethambo aspiration concentrate
I-PRP kunye ne-bone marrow aspiration concentrate (BMAC) isetyenziselwa uchungechunge lwezonyango zonyango kwindawo yeofisi kunye nokuhlinzwa ngenxa yeenzuzo zabo zokuvuselela kwi-MSK kunye nezifo zomgogodla, ulawulo lweentlungu ezingapheliyo kunye nezibonakaliso zezicubu ezithambileyo.I-PRP ayilawuli kuphela ukufuduka kweeseli kunye nokwanda kweeseli, kodwa igalelo kwi-angiogenesis kunye ne-ECM ukulungiswa kwakhona ukudala i-microenvironment efanelekileyo kunye nokukhuthaza ukulungiswa kwezicubu kunye nokuvuselelwa.
Inkqubo yokulungisa i-BMAC
Ii-BMACs ziziintlobo zeeseli ezingafaniyo eziqulathe ii-BMMSCs, zizenza umthombo weseli ongapheliyo wonyango lokubuyisela amayeza.Badlala indima ngokunciphisa i-apoptosis yeseli, i-fibrosis kunye nokuvuvukala;Kwaye uvule i-cascade reaction ekhokelela ekwandeni kweeseli.Ukongezelela, ii-BMMSC zinamandla okuhlula kwiindidi ze-cell lineages, kubandakanywa i-osteoblasts, i-adipocytes, i-myoblasts, iiseli ze-epithelial kunye ne-neurons.Bakwakhuthaza i-angiogenesis ngokusebenzisa i-paracrine kunye neendlela ze-autocrine.Kwakhona kubalulekile ukuba i-BMMSC ibe negalelo kulawulo lwe-immune oluzimeleyo kwiiseli ze-immune ezithile, ezithatha inxaxheba kwinqanaba lokuvuvukala lokulungiswa kwesilonda.Ukongeza, ii-BMMSCs zixhasa ukufunwa kweeseli kwiindawo ezintsha zonyango ze-angiogenesis ukukhawulezisa ukwakhiwa kwakhona kokuhamba kwegazi.Jin et al.Kwangqinwa ukuba ngokungabikho kwezikafula ezaneleyo, izinga lokusinda kwe-BMMSC kunye nokulungiswa kwayo nokwahlula amandla okukhuthaza ukuphiliswa konakele.Nangona ukuqokelela kwezicubu, ukulungiswa kwe-specimen kunye nendlela yokusebenza ye-PRP kunye ne-BMAC yahlukile, uphando lubonisa ukuba banokuncedisana.Enyanisweni, ukudibanisa i-PRP kunye ne-BMAC kwimveliso yezinto eziphilayo kunokuba neenzuzo ezongezelelweyo.
Ukudibanisa i-PRP kunye ne-BMAC
Ngokophando oluncinci olwaziwayo, umgaqo osisiseko wokudibanisa i-PRP kunye ne-BMAC isekelwe kwiindawo ezininzi.Okokuqala, i-PRP inokubonelela nge-microenvironment efanelekileyo apho i-BMSC inokunyusa ukwanda kweeseli kunye nokwahlula kunye nokwandisa i-angiogenesis.Okwesibini, i-PRP isetyenziswe njenge-scaffold yezi seli kunye ne-BMAC.Ngokuchasene noko, indibaniselwano ye-PRP kunye ne-BMAC inokuba sisixhobo esinamandla sebhayoloji ukutsala abantu be-BMMSC.Ikhompawundi ye-PRP-BMAC isetyenziselwe ukunyanga i-tendinosis, amanxeba, ukulimala kwentambo yomgogodla, iidiski ze-intervertebral degenerative kunye ne-osteochondral defects enamandla amakhulu okuvuselela.Ngelishwa, nangona amacandelo e-heterogeneous bone marrow cell abandakanya iiplatelet, iingxelo ezimbalwa zikhankanya ukuxinwa kweeplatelet kumongo okhutshiweyo kunye nasemva konyango lwe-BMAC, kodwa zinokukhutshwa ngeendlela ezifanelekileyo zokulangazelela.Uphando olongezelelweyo luyafuneka ukuze kuqondwe ukuba ingaba i-platelet eyongezelelweyo igxininisa kufuneka isetyenziswe ngokudibeneyo ne-BMAC.Okwangoku, akukho datha malunga nomlinganiselo ofanelekileyo weeplatelet kwi-MSC (okanye ezinye iiseli zomongo) iiseli, ezinefuthe elihle kwindlela yokutya ye-MSC ekulungisweni kwezicubu.Ngokufanelekileyo, izixhobo zokuqokelela umongo wethambo kunye netekhnoloji inokuphuculwa ukukhupha iiplatelets zomongo ezaneleyo.
Ukukhula kwe-PRP kunye nefuthe le-BMAC yesondlo
I-PRP yeplatelet yokukhula iprotheni ephambili echaphazelekayo kwinkqubo yokulungiswa kwe-BMAC.Ukwahluka kwe-PGF kunye nezinye ii-cytokines ezibandakanyekayo kwinkqubo yesondlo se-BMAC inokuqalisa ukulungiswa kwezicubu ngokunciphisa i-apoptosis yeseli, i-anabolism kunye nemiphumo yokuchasana nokuvuvukala, kunye ne-activated cell proliferation, ulwahlulo kunye ne-angiogenesis ngokusebenzisa i-paracrine kunye ne-autocrine pathways.
I-Platelet-derived factor growth kunye ne-dense granule components zibandakanyeka ngokucacileyo kwinkqubo yesondlo se-BMAC kunye nokuxhasa ukulungiswa kwezicubu kunye nokuvuselelwa okubangelwa yi-MSC.Ushunqulelo: MSC: mesenchymal stem cells, HSC: hematopoietic stem cells.
Ngokucacileyo, kunyango lwe-OA, i-PDGF idlala indima ethile ekuhlaziyweni kwe-cartilage kunye nokugcinwa kwe-homeostasis ngokunyuka kwe-MSC kunye nokuvinjelwa kwe-IL-1-induced chondrocyte apoptosis kunye nokuvuvukala.Ukongezelela, ezintathu ze-TGF- β I-subtypes zisebenza ekukhuthazeni ukubunjwa kwe-cartilage kunye nokuvimbela ukuvuvukala, kwaye zibonisa amandla okukhuthaza ukuphulukiswa kwezicubu ezinxulumene ne-MSC ngokusebenzisa i-intermolecular interaction.Umphumo wezondlo we-MSC unxulumene nomsebenzi we-PGF kunye nemfihlo yokulungisa i-cytokines.Ngokufanelekileyo, zonke ezi cytokines kufuneka zibekho kwibhotile yonyango ye-BMAC kwaye zihanjiswe kwindawo yokulimala kwezicubu ukukhuthaza ukuphulukiswa kwezicubu zonyango ezinxulumene ne-MSC.
Kuphononongo oludibeneyo lwe-OA, Mui ñ os-L ó pez et al.Ibonisa ukuba i-MSC evela kwizicubu ze-synovial iye yatshintsha umsebenzi, okukhokelela ekuphulukaneni namandla ayo okubuyisela.Kuyathakazelisa ukuba i-injection ngqo ye-PRP kwi-subchondral bone ye-osteoarthritis ibangele ukunciphisa i-MSC kwi-synovial fluid, ebonisa ukuphuculwa kwekliniki.Impembelelo yonyango idibene ngokunciphisa inkqubo yokuvuvukala kwi-synovial fluid yezigulane ze-OA.
Kukho ulwazi oluncinci olukhoyo malunga nobukho okanye ugxininiso lwe-PGF kwi-BMAC okanye umlinganiselo ofanelekileyo ofunekayo ukuxhasa umsebenzi wesondlo we-BMMSC.Abanye oogqirha badibanisa i-PRP ephezulu kunye ne-BMAC ukufumana i-grafts esebenzayo ye-biologically, ekulindeleke ukuba yandise iziphumo zonyango lweyeza lokuvuselela.Nangona kunjalo, zimbalwa ezikhoyo zokhuseleko kunye neenkcukacha ezisebenzayo, ezibonisa ukuba ukudibanisa i-PRP ephezulu kunye ne-BMAC yindlela yonyango esebenzayo.Ke ngoko, sikholelwa ukuba akunakufaneleka ukukhohlisa i-BMMSC ngokuyivula ngoxinzelelo oluphezulu lweplatelet kweli nqanaba.
Ukusebenzisana kweeplatelet kunye neziyobisi ze-antiplatelet kunye ne-NSAID
I-PRP iqulethe uluhlu olubanzi lwamacandelo e-secretory kwaye iqulunqwe ngamajelo amaninzi e-biological.Impembelelo yonyango ye-PRP ibangelwa ngaba balamli.Nangona abalamli bonyango kwiiplatelet baziwa kakuhle, ukuqulunqwa okufanelekileyo kunye ne-kinetics yala machiza e-anabolic kunye ne-catabolic ayicacanga ngokupheleleyo.Omnye weyona mida iphambili ekufezekiseni imixube yonyango kukoyisa ukuguquguquka kwaba balamli bebhayoloji ukuze kujongwe iziphumo ezilawulwa kakuhle zomlambo ezihlala ziphinda-phinda kwaye ziluncedo ngokwezonyango.Ngenxa yesi sizathu, iziyobisi (ezifana ne-non-steroidal anti-inflammatory drugs (NSAIDs)) zinokuchaphazela ukukhululwa kwamaqela e-secretory secretory platelet.Kuphando olutshanje oluvulekileyo lwe-label fixed-sequence, ukuthathwa kwansuku zonke kwe-81 mg ye-aspirin (ASA) kunciphise ukubonakaliswa kwabalamli abaphambili, njenge-TGF- β 1. PDGF kunye ne-VEGF.
Ezi ziphumo zibangelwa inhibition engaguqukiyo ye-cyclooxygenase-1 (COX-1) kunye ne-adjustable inhibition ye-cyclooxygenase-2 (COX-2), eziyi-enzymes ezimbini ezifunekayo kwi-platelet degranulation ephantsi.Uphononongo olucwangcisiweyo lwamva nje lufumene ukuba iziyobisi ze-antiplatelet zinokunciphisa i-curve factor release release ngendlela ye-COX-1 kunye ne-COX-2 exhomekeke, kunye ne-8 yezifundo ze-15 zifumene ukuba izinto zokukhula zehla.
Iziyobisi (umz. ii-NSAID) zidla ngokusetyenziselwa ukuthomalalisa iintlungu nokunciphisa ukudumba okubangelwa sisifo se-MSK.Indlela ye-NSAID kukuthintela ukusebenza kweplatelet ngokuzibophelela ngokungenakuguqulwa nge-COX enzyme kunye nokulawula indlela ye-arachidonic acid.Ngoko ke, umsebenzi weeplatelet uya kutshintsha ngexesha lokujikeleza kobomi beplatelet, ngaloo ndlela ukuthintela ukuhanjiswa kwesignali yePGF.I-NSAID inqanda ukuveliswa kwe-cytokine (umzekelo, i-PDGF, i-FGF, i-VEGF, kunye ne-IL-1 β, i-IL-6, kunye ne-IL-8), ngelixa iphucula i-TNF- α. Nangona kunjalo, kukho idatha encinci kwimpembelelo ye-molecular ye-NSAID kwi-PRP.Akukho mvumelwano ngexesha elifanelekileyo lokulungiselela kunye nokulawulwa kwe-PRP kwizigulane ezisebenzisa ii-NSAID.UMannava kunye noogxa balinganisa i-anabolic kunye ne-catabolic biological factor kwi-leucocyte-rich PRP yamavolontiya anempilo athatha i-naproxen.Bafumanisa ukuba emva kokusebenzisa i-naproxen kwiveki enye, amanqanaba e-PDGF-AA kunye ne-PDGF-AB (i-mitogen esebenzayo yokukhuthaza i-angiogenesis) yancitshiswa kakhulu.Emva kweveki enye, inqanaba lokukhula libuyele kufutshane nenqanaba lesiseko.Emva kokusebenzisa i-naproxen kwiveki enye, inqanaba le-LR-PRP ye-proinflammatory kunye ne-catabolic factor IL-6 nayo iyancipha, kwaye ibuyele kwinqanaba lokuqala emva kwexesha leveki enye.Okwangoku, akukho sifundo seklinikhi ukubonisa ukuba izigulane ezine-naproxen emva konyango lwe-PRP zineziphumo ezibi;Nangona kunjalo, kucetyiswa ukuba kuqwalaselwe ixesha lokuhlamba iveki enye ukubuyisela ixabiso le-PDGF-AA, PDGF-BB kunye ne-IL-6 kwinqanaba lesiseko sokuphucula umsebenzi wabo we-biological.Uphando olongezelelweyo luyafuneka ukuze kuqondwe ngokupheleleyo imiphumo ye-antiplatelet kunye ne-NSAID kwiqela le-PRP secretion kunye neethagethi zayo ezisezantsi.
Hlanganisa ukusetyenziswa kweplasma ecebileyo yeplatelet kunye nokubuyisela
Nangona uphando olusisiseko lwesayensi lubonisa ukuba unyango lomzimba kunye nomthwalo womatshini unendima ecacileyo ekubuyiselweni kwesakhiwo se-tendon emva kwe-injection ye-PRP, akukho mvumelwano malunga nesicwangciso esilungileyo sokubuyisela isifo se-MSK emva kokunyanga kwe-PRP.
Unyango lwe-PRP lubandakanya i-injection yeeplatelet ezigxininisiweyo kwindawo ye-tissue yendawo yokulawula intlungu kunye nokukhuthaza ukulungiswa kwezicubu.Ubungqina obunamandla beklinikhi bukhona kwi-OA yamadolo.Nangona kunjalo, ukusetyenziswa kwe-PRP kunyango lwe-tendinosis ye-symptomatic kuphikisana, kwaye iziphumo ezichazweyo ziyahluka.Izifundo zezilwanyana zihlala zibonisa ukuphuculwa kwe-histological ye-tendinosis emva kokungena kwe-PRP.Ezi zifundo zibonisa ukuba umthwalo womatshini unokuvuselela i-tendon, kwaye umthwalo kunye ne-injection ye-PRP isebenza kunye ukukhuthaza ukuphulukiswa kwe-tendon.Ukwahluka kumalungiselelo e-PRP, amalungiselelo e-biological, amalungiselelo, izikimu ze-injection kunye ne-tendon yokulimala kwe-tendon subtypes kunokukhokelela ekuhlukeni kwiziphumo zeklinikhi.Ukongezelela, nangona ubungqina bezenzululwazi buxhasa iinzuzo zezicwangciso zokuvuselela, ezimbalwa uphando lweklinikhi olupapashiweyo luzama ukulawula nokudibanisa izicwangciso ezihambelanayo zokubuyisela emva kwe-PRP.
Kutshanje, u-Onishi et al.Indima yomthwalo womatshini kunye ne-PRP ye-biological effect kwi-Achilles tendon isifo yahlaziywa.Bavavanya isigaba se-I kunye nesigaba sesi-II sophando lwezonyango lwe-Achilles tendon isifo esiphathwe nge-PRP, sigxile kwisicwangciso sokubuyisela emva kwesitofu se-PRP.Iinkqubo eziphantsi kolawulo lokubuyisela kwisimo sangaphambili zibonakala ziphucula ukuthotyelwa komthambo kunye nokuphucula iziphumo kunye nokukwazi ukubeka iliso kwidosi yomthambo.Izilingo ezininzi ze-Achilles ze-Achilles ezenziwe kakuhle ze-PRP zidibanise unyango lwe-post-PRP kunye nesicwangciso sokubuyisela umthwalo womatshini njengenxalenye ebalulekileyo yesicwangciso sokuvuselela.
Imbono yekamva kunye nezigqibo
Inkqubela phambili yobugcisa bezixhobo ze-PRP kunye neendlela zokulungiselela zibonisa iziphumo ezithembisayo zesigulane, nangona inkcazo yee-agent ze-biological ze-PRP ezahlukeneyo kunye neempawu ezifanelekileyo ze-biological zemveliso yokugqibela ayikacaci.Ukongezelela, amandla apheleleyo ezibonakaliso ze-PRP kunye nezicelo ayikagqitywa.Kuze kube kutshanje, i-PRP ithengiswe ngokurhweba njengemveliso ye-autologous yegazi, enokubonelela oogqirha ngokukwazi ukusebenzisa i-autologous platelet growth factor technology kwi-pathology ebonakalisiweyo kunye nezifo.Ekuqaleni, i-criterion kuphela yokusetyenziswa ngempumelelo kwe-PRP edla ngokucatshulwa yisampuli elungiselelwe, i-concentration yayo yeplatelet iphezulu kunexabiso legazi elipheleleyo.Namhlanje, ngethamsanqa, iingcali zinokuqonda okubanzi ngakumbi kokusebenza kwe-PRP.
Kolu hlaziyo, siyavuma ukuba kusekho ukunqongophala komgangatho kunye nokuhlelwa kweteknoloji yokulungiselela;Ngoko ke, akukho mvumelwano kwi-PRP ye-biological agents okwangoku, nangona uncwadi oluninzi lufikelele kwisivumelwano malunga ne-concentration ye-platelet dose esebenzayo efunekayo ukukhuthaza (entsha) i-angiogenesis.Apha, sazisa ngokufutshane umsebenzi wee-PGFs, kodwa ngokubanzi sibonisa indlela ethile yeplatelet kunye nesiphumo seeseli ezimhlophe zegazi kunye nee-MSCs, kunye nokusebenzisana kweseli kweeseli.Ngokukodwa, ubukho beeseli ezimhlophe zegazi kumalungiselelo e-PRP kunika ukuqonda okunzulu kwimiphumo eyingozi okanye enenzuzo.Indima ecacileyo yeeplatelet kunye nokusebenzisana kwabo kunye ne-innate and adaptive immune systems kuxoxiwe.Ukongezelela, izifundo zeklinikhi ezaneleyo kwaye zibhalwe kakuhle zifunekayo ukuze kuqinisekiswe amandla apheleleyo kunye nonyango lwe-PRP kwizibonakaliso ezahlukeneyo.
(Imixholo yeli nqaku ishicilelwe, kwaye asiboneleli nasiphi na isiqinisekiso esicacileyo okanye esichaziweyo sokuchaneka, ukuthembeka okanye ukugqibelela kokuqulathwe kweli nqaku, kwaye abanaxanduva ngezimvo zeli nqaku, nceda uqonde.)
Ixesha lokuposa: Mar-01-2023