Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy.
Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Bologna, Italy.
J Cell Physiol. 2018 Apr;233(4):2723-2732. doi: 10.1002/jcp.26065. Epub 2017 Jul 24.
One of the methods employed to improve healing of damaged tissues is the use of cellular based therapies. A number of regenerative medicine based strategies, from in vitro expanded mesenchymal stem cells (MSCs) to "one-step" procedures using bone marrow (BM) in toto (BM aspirate; BMA) or BM concentrate (BMC), have been developed. Recently, orthopedic researchers focused their attention on the clinical therapeutic potential of BMC and BMA for musculoskeletal regeneration. BMA is reported as an excellent source of cells and growth factors. However, the quality of BM harvest and aspirate is extremely technique-dependent and, due to the presence of megakaryocytes and platelets, BMA is prone to clot. BMA clot formation is usually considered a complication hampering the procedures on both BMC preparation and MSC expansion. Therefore, different protocols have been developed to avoid and/or degrade clots. However, from a biological point of view there is a strong rationale for the use of BMA clot for tissue engineering strategies. This descriptive systematic literature review summarizes preclinical and clinical studies dealing the use of BMA clot for orthopedic procedures and provided some evidence supporting its use as a cell based therapy for cartilage and bone regeneration. Despite these results, there are still few preclinical and clinical studies that carefully evaluate the safety and efficacy of BMA clot in orthopedic procedures. Thus, implementing biological knowledge and both preclinical and clinical studies could help researchers and clinicians to understand if BMA clots can really be considered a possible therapeutic tool.
一种促进受损组织愈合的方法是使用细胞疗法。许多基于再生医学的策略已经被开发出来，从体外扩增间充质干细胞（MSCs）到使用骨髓（BM）的“一步法”程序，包括全骨髓（BM 抽吸物；BMA）或骨髓浓缩物（BMC）。最近，骨科研究人员将注意力集中在 BMC 和 BMA 用于肌肉骨骼再生的临床治疗潜力上。BMA 被报道为细胞和生长因子的极好来源。然而，BM 采集和抽吸的质量非常依赖技术，并且由于巨核细胞和血小板的存在，BMA 容易形成凝块。BMA 凝块的形成通常被认为是阻碍 BMC 制备和 MSC 扩增过程的并发症。因此，已经开发了不同的方案来避免和/或降解凝块。然而，从生物学的角度来看，使用 BMA 凝块进行组织工程策略有很强的理论依据。本描述性系统文献综述总结了涉及 BMA 凝块在骨科手术中应用的临床前和临床研究，并提供了一些证据支持其作为软骨和骨再生的细胞治疗方法的使用。尽管有这些结果，但仍有少数临床前和临床研究仔细评估了 BMA 凝块在骨科手术中的安全性和疗效。因此，实施生物学知识以及临床前和临床研究可以帮助研究人员和临床医生了解 BMA 凝块是否真的可以被视为一种潜在的治疗工具。
