School of Medicine & Health Sciences, George Washington University, Washington, District of Columbia, USA.
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Am J Sports Med. 2018 Jan;46(1):234-247. doi: 10.1177/0363546517697682. Epub 2017 Apr 4.
Placenta has a long history of use for treating burns and wounds. It is a rich source of collagen and other extracellular matrix proteins, tissue reparative growth factors, and stem cells, including mesenchymal stem cells (MSCs). Recent data show its therapeutic potential for orthopaedic sports medicine indications.
To provide orthopaedic surgeons with an anatomic description of the placenta, to characterize its cellular composition, and to review the literature reporting the use of placenta-derived cells and placental tissue allografts for orthopaedic sports medicine indications in animal models and in humans.
Systematic review.
Using a total of 63 keyword combinations, the PubMed and MEDLINE databases were searched for published articles describing the use of placental cells and/or tissue for orthopaedic sports medicine indications. Information was collected on placental tissue type, indications, animal model, study design, treatment regimen, safety, and efficacy outcomes. Results were categorized by indication and subcategorized by animal model.
Outcomes for 29 animal studies and 6 human studies reporting the use of placenta-derived therapeutics were generally positive; however, the placental tissue source, clinical indication, and administration route were highly variable across these studies. Fourteen animal studies described the use of placental tissue for tendon injuries, 13 studies for osteoarthritis or articular cartilage injuries, 3 for ligament injuries, and 1 for synovitis. Both placenta-derived culture-expanded cells (epithelial cells or MSCs) and placental tissue allografts were used in animal studies. In all human studies, commercial placental allografts were used. Five of 6 human studies examined the treatment of foot and ankle pathological conditions, and 1 studied the treatment of knee osteoarthritis.
A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes of administration, and treatment regimens, which prohibits making any definitive conclusions. Currently, the clinical use of placenta is limited to only commercial placental tissue allografts, as there are no placenta-derived biological drugs approved for the treatment of orthopaedic sports medicine conditions in the United States. However, this review shows that the application of placental cells or tissue allografts appears to be safe and has potential to improve outcomes for orthopaedic sports medicine indications.
胎盘在治疗烧伤和创伤方面有着悠久的历史。它是胶原蛋白和其他细胞外基质蛋白、组织修复生长因子和间充质干细胞（MSCs）的丰富来源。最近的数据显示，它在骨科运动医学适应症方面具有治疗潜力。
为骨科医生提供胎盘的解剖描述，描述其细胞组成，并回顾文献中关于胎盘衍生细胞和胎盘组织同种异体移植物在动物模型和人类中用于骨科运动医学适应症的报告。
系统评价。
使用总共 63 个关键词组合，对 PubMed 和 MEDLINE 数据库进行了搜索，以查找描述胎盘细胞和/或组织用于骨科运动医学适应症的已发表文章。收集了有关胎盘组织类型、适应症、动物模型、研究设计、治疗方案、安全性和疗效结果的信息。结果按适应症分类，并按动物模型进一步分类。
29 项动物研究和 6 项人类研究报告了使用胎盘衍生疗法的结果通常是积极的；然而，这些研究中胎盘组织来源、临床适应症和给药途径差异很大。14 项动物研究描述了胎盘组织用于肌腱损伤，13 项研究用于骨关节炎或关节软骨损伤，3 项研究用于韧带损伤，1 项研究用于滑膜炎。动物研究中既使用了胎盘衍生的培养细胞（上皮细胞或 MSCs），也使用了胎盘组织同种异体移植物。在所有 6 项人类研究中，都使用了商业胎盘同种异体移植物。6 项人类研究中有 5 项研究了足部和踝关节病理状况的治疗，1 项研究了膝关节骨关节炎的治疗。
对少数已报道研究的回顾显示，胎盘细胞类型、胎盘组织准备、给药途径和治疗方案存在高度变异性，这使得无法得出任何明确的结论。目前，胎盘的临床应用仅限于商业胎盘组织同种异体移植物，因为在美国，没有批准用于治疗骨科运动医学疾病的胎盘衍生生物药物。然而，本综述表明，胎盘细胞或组织同种异体移植物的应用似乎是安全的，并且有可能改善骨科运动医学适应症的结果。
