Turajane Thana, Chaweewannakorn Ukrit, Larbpaiboonpong Viroj, Aojanepong Jongjate, Thitiset Thakoon, Honsawek Sittisak, Fongsarun Juthatip, Papadopoulos Konstantinos I
Stem Cell Research and Technology Center Department of Orthopedic Surgery, Police General Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2013 May;96(5):580-8.
Trauma or osteoarthritis (OA) create articular cartilage defects that cannot efficiently heal, thus leading to significant long-term disability. Failed conservative treatment in cartilage diseases is a known condition that necessitates repair attempts but current methods are inadequate. Recent studies in OA animal models and humans, showed articular cartilage regeneration following combinations of drilling, adult stem cells, and intra-articular hyaluronic acid.
In the present series, the authors evaluated the combination of repeated intra-articular (IA) autologous activated peripheral blood stem cells (AAPBSC) with growth factor addition/preservation (GFAP) along with hyaluronic acid (HA) in conjunction with arthroscopic microdrilling mesenchymal cell stimulation (MCS) in early osteoarthritic knee disease that failed conservative treatment.
Four women and one man (median age 56, range 52-59 years) that failed conservative treatment were enrolled. Arthroscopic MCS was performed once in all patients with subsequent IA injection of AAPBSC with GFAP along with IA-HA intra-operatively, repeated at days 7 and 14. The patients were evaluated by WOMAC and KOO scores at baseline, one, and six months. Cancellous bone biopsies were performed to investigate cell attachment, proliferation, and differentiation by electron microscopy and histological staining.
All patients improved significantly in WOMAC and KOO scores at one and six months compared to baseline. No adverse effects were seen during the AAPBSC harvesting, arthroscopy and/or IA injections. One month post-surgery, all pain medications could be withdrawn. Electron microscopy scanning revealed cell attachment and proliferation while histological analysis demonstrated that the cell layer on the cancellous scaffold showed increased proteoglycan and glycosaminoglycan content indicating hyaline cartilage presence.
The combination of intra-articular (IA) autologous activated peripheral blood stem cells (AAPBSC) with growth factor addition/preservation (GFAP) along with hyaluronic acid (HA) in conjunction with arthroscopic microdrilling mesenchymal cell stimulation (MCS) resulted in Quality of Life improvements measured by WOMAC and KOO scores and succeeded in regenerating articular cartilage in early osteoarthritic knee disease that failed conservative treatment. Further controlled studies are warranted to confirm the above results in larger groups.
创伤或骨关节炎（OA）会导致关节软骨缺损，且无法有效愈合，从而导致严重的长期残疾。软骨疾病保守治疗失败是一种已知情况，需要进行修复尝试，但目前的方法并不充分。最近在OA动物模型和人类中的研究表明，钻孔、成体干细胞和关节内透明质酸联合使用后可实现关节软骨再生。
在本系列研究中，作者评估了在保守治疗失败的早期骨关节炎性膝关节疾病中，重复关节内（IA）注射自体活化外周血干细胞（AAPBSC）并添加/保留生长因子（GFAP），同时联合透明质酸（HA）以及关节镜下微钻孔间充质细胞刺激（MCS）的效果。
纳入5例保守治疗失败的患者，其中4名女性，1名男性（中位年龄56岁，范围52 - 59岁）。所有患者均接受一次关节镜下MCS，术中随后IA注射AAPBSC并添加GFAP以及IA - HA，在第7天和第14天重复注射。在基线、1个月和6个月时通过WOMAC和KOO评分对患者进行评估。进行松质骨活检，通过电子显微镜和组织学染色研究细胞附着、增殖和分化情况。
与基线相比，所有患者在1个月和6个月时WOMAC和KOO评分均显著改善。在采集AAPBSC、关节镜检查和/或IA注射过程中未观察到不良反应。术后1个月，所有止痛药物均可停用。电子显微镜扫描显示细胞附着和增殖，而组织学分析表明松质骨支架上的细胞层蛋白聚糖和糖胺聚糖含量增加，表明存在透明软骨。
关节内（IA）注射自体活化外周血干细胞（AAPBSC）并添加/保留生长因子（GFAP），同时联合透明质酸（HA）以及关节镜下微钻孔间充质细胞刺激（MCS），可使通过WOMAC和KOO评分衡量的生活质量得到改善，并成功在保守治疗失败的早期骨关节炎性膝关节疾病中实现关节软骨再生。需要进一步的对照研究以在更大的群体中证实上述结果。
