Comparative Orthopaedics Laboratory, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853, USA.
J Shoulder Elbow Surg. 2012 Feb;21(2):278-94. doi: 10.1016/j.jse.2011.11.015.
Repair of rotator cuff tears in experimental models has been significantly improved by the use of enhanced biologic approaches, including platelet-rich plasma, bone marrow aspirate, growth factor supplements, and cell- and gene-modified cell therapy. Despite added complexity, cell-based therapies form an important part of enhanced repair, and combinations of carrier vehicles, growth factors, and implanted cells provide the best opportunity for robust repair. Bone marrow-derived mesenchymal stem cells provide a stimulus for repair in flexor tendons, but application in rotator cuff repair has not shown universally positive results. The use of scaffolds such as platelet-rich plasma, fibrin, and synthetic vehicles and the use of gene priming for stem cell differentiation and local anabolic and anti-inflammatory impact have both provided essential components for enhanced tendon and tendon-to-bone repair in rotator cuff disruption. Application of these research techniques in human rotator cuff injury has generally been limited to autologous platelet-rich plasma, bone marrow concentrate, or bone marrow aspirates combined with scaffold materials. Cultured mesenchymal progenitor therapy and gene-enhanced function have not yet reached clinical trials in humans. Research in several animal species indicates that the concept of gene-primed stem cells, particularly embryonic stem cells, combined with effective culture conditions, transduction with long-term integrating vectors carrying anabolic growth factors, and development of cells conditioned by use of RNA interference gene therapy to resist matrix metalloproteinase degradation, may constitute potential advances in rotator cuff repair. This review summarizes cell- and gene-enhanced cell research for tendon repair and provides future directions for rotator cuff repair using biologic composites.
在实验模型中，通过使用增强的生物方法，包括富含血小板的血浆、骨髓抽吸物、生长因子补充剂以及细胞和基因修饰的细胞治疗，已经显著改善了肩袖撕裂的修复。尽管增加了复杂性，但基于细胞的治疗仍然是增强修复的重要组成部分，载体、生长因子和植入细胞的组合为强大的修复提供了最佳机会。骨髓间充质干细胞为屈肌腱修复提供了刺激，但在肩袖修复中的应用并未显示出普遍的积极结果。富含血小板的血浆、纤维蛋白和合成载体等支架的使用以及基因启动子对干细胞分化和局部合成代谢和抗炎作用的影响，都为肩袖断裂中的增强肌腱和肌腱-骨修复提供了必要的成分。这些研究技术在人类肩袖损伤中的应用一般限于自体富含血小板的血浆、骨髓浓缩物或骨髓抽吸物与支架材料的结合。培养的间充质祖细胞治疗和基因增强功能尚未在人类中进行临床试验。几种动物物种的研究表明，基因启动的干细胞，特别是胚胎干细胞，与有效的培养条件结合，用携带合成代谢生长因子的长期整合载体进行转导，以及使用 RNA 干扰基因治疗对细胞进行条件培养以抵抗基质金属蛋白酶降解，可能构成肩袖修复的潜在进展。本文综述了肌腱修复的细胞和基因增强细胞研究，并为使用生物复合材料进行肩袖修复提供了未来的方向。
