Oreffo R O, Triffitt J T
University Orthopaedics, Southampton University, Southampton General Hospital, UK.
Bone. 1999 Aug;25(2 Suppl):5S-9S. doi: 10.1016/s8756-3282(99)00124-6.
Ideal skeletal reconstruction depends on regeneration of normal tissues that result from initiation of progenitor cell activity. However, knowledge of the origins and phenotypic characteristics of these progenitors and the controlling factors that govern bone formation and remodeling to give a functional skeleton adequate for physiological needs is limited. Practical methods are currently being investigated to amplify in in vitro culture the appropriate autologous cells to aid skeletal healing and reconstruction. Recent advances in the fields of biomaterials, biomimetics, and tissue engineering have focused attention on the potentials for clinical application. Current cell therapy procedures include the use of tissue-cultured skin cells for treatment of burns and ulcers, and in orthopedics, the use of cultured cartilage cells for articular defects. As mimicry of natural tissues is the goal, a fuller understanding of the development, structures, and functions of normal tissues is necessary. Practically all tissues are capable of being repaired by tissue engineering principles. Basic requirements include a scaffold conducive to cell attachment and maintenance of cell function, together with a rich source of progenitor cells. In the latter respect, bone is a special case and there is a vast potential for regeneration from cells with stem cell characteristics. The development of osteoblasts, chondroblasts, adipoblasts, myoblasts, and fibroblasts results from colonies derived from such single cells. They may thus, theoretically, be useful for regeneration of all tissues that this variety of cells comprise: bone, cartilage, fat, muscle, tendons, and ligaments. Also relevant to tissue reconstruction is the field of genetic engineering, which as a principal step in gene therapy would be the introduction of a functional specific human DNA into cells of a patient with a genetic disease that affects mainly a particular tissue or organ. Such a situation is pertinent to osteogenesis imperfecta, for example, where in more severely affected individuals any improvements in long bone quality would be beneficial to the patient. In conclusion, the potentials for using osteogenic stem cells and biomaterials in orthopedics for skeletal healing is immense, and work in this area is likely to expand significantly in the future.
理想的骨骼重建依赖于祖细胞活性启动后正常组织的再生。然而，关于这些祖细胞的起源、表型特征以及控制骨形成和重塑以产生适合生理需求的功能性骨骼的因素的知识仍然有限。目前正在研究实用方法，以在体外培养中扩增合适的自体细胞，以促进骨骼愈合和重建。生物材料、生物模拟和组织工程领域的最新进展已将注意力集中在临床应用的潜力上。当前的细胞治疗程序包括使用组织培养的皮肤细胞治疗烧伤和溃疡，在骨科领域，则使用培养的软骨细胞治疗关节缺损。由于模仿天然组织是目标，因此有必要更全面地了解正常组织的发育、结构和功能。实际上，所有组织都能够根据组织工程原理进行修复。基本要求包括有利于细胞附着和维持细胞功能的支架，以及丰富的祖细胞来源。在这方面，骨骼是一个特殊情况，具有干细胞特征的细胞具有巨大的再生潜力。成骨细胞、成软骨细胞、成脂肪细胞、成肌细胞和成纤维细胞的发育源于此类单细胞衍生的集落。因此，从理论上讲，它们可能对由这些不同细胞组成的所有组织的再生有用：骨骼、软骨、脂肪、肌肉、肌腱和韧带。与组织重建相关的还有基因工程领域，作为基因治疗的主要步骤，它将功能性特定人类DNA引入主要影响特定组织或器官的遗传病患者的细胞中。例如，这种情况与成骨不全症相关，在病情更严重的个体中，长骨质量的任何改善都将对患者有益。总之，在骨科中使用成骨干细胞和生物材料促进骨骼愈合的潜力巨大，并且该领域的工作在未来可能会显著扩展。
