Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
Nat Rev Rheumatol. 2013 May;9(5):277-90. doi: 10.1038/nrrheum.2013.29. Epub 2013 Mar 19.
In this Review we describe three approaches for cartilage tissue repair at the rheumatology-orthopaedics interface: disease-modifying osteoarthritis (OA) drug (DMOAD) treatment; cell-based therapies, and intrinsic cartilage repair by joint distraction. DMOADs can slow the progression of joint damage. Cell-based therapies have evolved to do the same, through selection of the most potent cell types (and combinations thereof), as well as identification of permissive boundary conditions for indications. Joint distraction techniques, meanwhile, have now demonstrated the capacity to stimulate actual intrinsic tissue repair. Although this progress is promising, true biological joint reconstruction remains distant on the developmental pathway of 'regenerative medicine'. Prolonged functional repair--that is, cure of diseases such as OA--remains an unmet medical need and scientific challenge, for which comparative and constructive interaction between these physical, chemical and cellular approaches will be required. Careful selections of patients and combinations of approaches will need to be made and tested to demonstrate their cost-effectiveness. Only with such rational and integrated assessment of outcomes will the promising results of these approaches be consolidated in clinical practice.
在这篇综述中，我们描述了在风湿病学-骨科领域中三种软骨组织修复方法：疾病修饰性骨关节炎（OA）药物（DMOAD）治疗；基于细胞的治疗方法，以及关节牵伸的内在软骨修复。DMOAD 可以减缓关节损伤的进展。细胞疗法也通过选择最有效的细胞类型（及其组合）以及确定适应证的许可边界条件来发展到这一步。与此同时，关节牵伸技术现已证明有能力刺激真正的内在组织修复。尽管这一进展很有希望，但真正的生物关节重建在“再生医学”的发展途径上仍遥遥无期。长期的功能修复——即 OA 等疾病的治愈——仍然是一个未满足的医疗需求和科学挑战，为此需要这些物理、化学和细胞方法之间进行比较和建设性的相互作用。需要仔细选择患者和治疗方法的组合，并进行测试以证明其成本效益。只有通过对这些方法的结果进行理性和综合的评估，才能将这些方法的有希望的结果在临床实践中巩固下来。
