Elgaz S, Bonig H, Bader P
Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Institute of Transfusion Medicine and Immunohematology, and German Red Cross Blood Center Baden-Württemberg-Hessen, Goethe University, Frankfurt am Main, Germany.
J Transl Med. 2020 Oct 20;18(1):399. doi: 10.1186/s12967-020-02565-9.
Osteonecrosis (ON) is an acquired debilitating skeletal disorder, which is caused by a multitude of traumatic and non-traumatic etiological factors. Vascular damage, mechanical stress and increased intraosseous pressure have been discussed as contributors to ON. The optimal treatment of ON remains to be determined, since the current gold standard, core decompression, is insufficiently effective. Specific properties of mesenchymal stromal cells (MSCs) provide the rationale for their assessment in advanced stages of ON: Osteoinductive potential has been demonstrated and MSC preparations of suitable quality for use as medicinal products have been developed. Here we review the scant information on the use of allogeneic or autologous MSCs in advanced ON as well as potentially supportive data from pre-clinical studies with autologous bone marrow mononuclear cells (auto BM-MNCs), which have been studied quite extensively and the presumed therapeutic effect of which was attributed to the rare MSCs contained in these cell products. Outcomes in clinical trials with MSCs and auto-BM-MNCs remain preliminary and non-definitive, at best promising, with respect to their pharmacological effect. Clearly, though, the application of any of these cell therapies was technically feasible and safe in that it was associated with low complication rates. The heterogeneity of cell type and source, study protocols, cell manufacturing, cell properties, cell doses and surgical techniques might contribute to inconsistent results.
骨坏死（ON）是一种后天性致残性骨骼疾病，由多种创伤性和非创伤性病因引起。血管损伤、机械应力和骨内压升高被认为是导致骨坏死的因素。由于目前的金标准——髓芯减压术效果不够理想，骨坏死的最佳治疗方法仍有待确定。间充质基质细胞（MSCs）的特殊性质为其在骨坏死晚期的评估提供了理论依据：已证实其具有骨诱导潜能，并且已开发出质量适合用作药品的间充质基质细胞制剂。在此，我们回顾了关于在晚期骨坏死中使用异体或自体间充质基质细胞的稀少信息，以及来自自体骨髓单个核细胞（自体BM - MNCs）临床前研究的潜在支持性数据，自体骨髓单个核细胞已得到广泛研究，其假定的治疗效果归因于这些细胞产品中所含的稀少间充质基质细胞。就其药理作用而言，间充质基质细胞和自体骨髓单个核细胞临床试验的结果充其量只是初步的、不确定的，不过很有前景。显然，这些细胞疗法中的任何一种在技术上都是可行且安全的，因为其并发症发生率较低。细胞类型和来源的异质性、研究方案、细胞制备、细胞特性、细胞剂量和手术技术可能导致结果不一致。
