Kapasa Elizabeth R, Giannoudis Peter V, Jia Xiaodong, Hatton Paul V, Yang Xuebin B
Doctoral Training Centre-Regenerative Medicine, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK.
Biomaterials and Tissue Engineering Group, School of Dentistry, University of Leeds, Leeds LS2 9JT, UK.
J Funct Biomater. 2017 Sep 22;8(4):42. doi: 10.3390/jfb8040042.
Despite the phenomenal success of implants particularly in the realms of dentistry and orthopaedics, there are still challenges to overcome. The failure of implants resulting from infection, prosthetic loosening, and non-union continue to be the most notorious examples. The cascade of fracture healing and bone repair, especially with the presence of an implant, is complex because it involves a multifaceted immune response alongside the intricate process of bone formation and remodelling. Bone loss is a serious clinical problem that is frequently accompanied by chronic inflammation, illustrating that there is a convoluted relationship between inflammation and bone erosion. The effects of pro-inflammatory factors play a significant role in initiating and maintaining osteoclastogenesis that results in bone resorption by osteoclasts. This is because there is a disruption of the relative ratio between Receptor Activator of Nuclear Factor κB-Ligand (RANKL) and osteoprotegerin (OPG), which is central to modulating bone repair and remodelling. This review aims to provide a background to the bone remodelling process, the bone repair cascade post-implantation, and the associated complications. Furthermore, current clinical solutions that can influence bone formation via either internal or extrinsic mechanisms will be described. These efficacious treatments for osteolysis via targeting the RANKL/OPG ratio may be crucial to reducing the incidence of related implant failures in the future.
尽管植入物取得了显著成功，尤其是在牙科和骨科领域，但仍有挑战需要克服。由感染、假体松动和骨不连导致的植入物失败仍然是最臭名昭著的例子。骨折愈合和骨修复的过程，尤其是在有植入物的情况下，是复杂的，因为它涉及多方面的免疫反应以及骨形成和重塑的复杂过程。骨质流失是一个严重的临床问题，经常伴有慢性炎症，这表明炎症与骨侵蚀之间存在复杂的关系。促炎因子的作用在启动和维持破骨细胞生成中起重要作用，破骨细胞生成会导致破骨细胞对骨的吸收。这是因为核因子κB受体活化因子配体（RANKL）与骨保护素（OPG）之间的相对比例受到破坏，而这一比例对于调节骨修复和重塑至关重要。本综述旨在提供骨重塑过程、植入后骨修复级联反应以及相关并发症的背景知识。此外，还将描述目前可通过内部或外部机制影响骨形成的临床解决方案。这些通过靶向RANKL/OPG比例有效治疗骨溶解的方法可能对未来降低相关植入物失败的发生率至关重要。
