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干细胞在牙周再生中的疗效:临床前研究的系统评价。

Efficacy of stem cells on periodontal regeneration: Systematic review of pre-clinical studies.

机构信息

Division of Periodontics, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.

Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, TX, USA.

出版信息

J Periodontal Res. 2017 Oct;52(5):793-812. doi: 10.1111/jre.12455. Epub 2017 Apr 10.

Abstract

This systematic review aims to evaluate mesenchymal stem cells (MSC) periodontal regenerative potential in animal models. MEDLINE, EMBASE and LILACS databases were searched for quantitative pre-clinical controlled animal model studies that evaluated the effect of local administration of MSC on periodontal regeneration. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Twenty-two studies met the inclusion criteria. Periodontal defects were surgically created in all studies. In seven studies, periodontal inflammation was experimentally induced following surgical defect creation. Differences in defect morphology were identified among the studies. Autogenous, alogenous and xenogenous MSC were used to promote periodontal regeneration. These included bone marrow-derived MSC, periodontal ligament (PDL)-derived MSC, dental pulp-derived MSC, gingival margin-derived MSC, foreskin-derived induced pluripotent stem cells, adipose tissue-derived MSC, cementum-derived MSC, periapical follicular MSC and alveolar periosteal cells. Meta-analysis was not possible due to heterogeneities in study designs. In most of the studies, local MSC implantation was not associated with adverse effects. The use of bone marrow-derived MSC for periodontal regeneration yielded conflicting results. In contrast, PDL-MSC consistently promoted increased PDL and cementum regeneration. Finally, the adjunct use of MSC improved the regenerative outcomes of periodontal defects treated with membranes or bone substitutes. Despite the quality level of the existing evidence, the current data indicate that the use of MSC may provide beneficial effects on periodontal regeneration. The various degrees of success of MSC in periodontal regeneration are likely to be related to the use of heterogeneous cells. Thus, future studies need to identify phenotypic profiles of highly regenerative MSC populations.

摘要

本系统评价旨在评估间充质干细胞(MSC)在动物模型中的牙周再生潜力。检索了 MEDLINE、EMBASE 和 LILACS 数据库中评估局部给予 MSC 对牙周再生影响的定量临床前对照动物模型研究。系统评价按照系统评价和荟萃分析报告的首选条目进行。22 项研究符合纳入标准。所有研究均通过手术创建牙周缺损。在 7 项研究中,在手术缺损创建后通过实验性诱导牙周炎。研究之间存在缺损形态差异。使用自体、异体和异种 MSC 来促进牙周再生。这些 MSC 包括骨髓来源的 MSC、牙周韧带(PDL)来源的 MSC、牙髓来源的 MSC、牙龈缘来源的 MSC、包皮来源的诱导多能干细胞、脂肪组织来源的 MSC、牙骨质来源的 MSC、根尖滤泡 MSC 和牙槽骨骨膜细胞。由于研究设计存在异质性,因此无法进行荟萃分析。在大多数研究中,局部 MSC 植入与不良影响无关。使用骨髓来源的 MSC 进行牙周再生的结果存在争议。相比之下,PDL-MSC 一致促进 PDL 和牙骨质的再生。最后,MSC 的辅助使用改善了用膜或骨替代物治疗牙周缺损的再生结果。尽管现有证据的质量水平存在差异,但目前的数据表明,MSC 的使用可能对牙周再生有有益的影响。MSC 在牙周再生中的不同程度的成功可能与使用异质细胞有关。因此,未来的研究需要确定具有高度再生能力的 MSC 群体的表型特征。

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