Lana José Fábio Santos Duarte, da Fonseca Lucas Furtado, Macedo Rafael da Rocha, Mosaner Tomas, Murrell William, Kumar Ashok, Purita Joseph, de Andrade Marco Antonio Percope
Department of Orthopedics, The Bone and Cartilage Institute, Indaiatuba 13334-170, SP, Brazil.
Department of Orthopedics, The Federal University of São Paulo, São Paulo 04023-062, SP, Brazil.
World J Stem Cells. 2021 Feb 26;13(2):155-167. doi: 10.4252/wjsc.v13.i2.155.
The use of orthobiologics as a novel therapy for the treatment of numerous musculoskeletal disorders has increased considerably over the past decade. Currently, there are multiple alternatives available as suitable treatments; however, the use of autologous blood-derived products such as platelet-rich plasma (PRP), bone marrow aspirate (BMA) and BMA concentrate (BMAC), specifically, is expanding. Although many investigations attempted to demonstrate the effectiveness of these therapies, even with positive results, the literature lacks standardized protocols and overall accuracy in study designs, which leads to variance and difficulty in reproducibility of protocols. The efficacy of PRP for the treatment of cartilage, bone and muscle tissues is well known. Although BMAC has generated optimistic results for the same purposes, its applicability in clinical trials is still relatively recent when compared to PRP. Both products demonstrate the potential to set forth reparative processes, each in their own distinct mechanism. The combination of these biological products has been previously proposed, yet little is known about their synergism. Evidence indicates that growth factor, cytokine, and chemokine profiles seen in both PRP and BMAC vary but are likely to work synergistically to enhance musculoskeletal healing. BMAC products seem to work well without PRP; however, the addition of PRP to BMAC has been shown to act as a rich and natural source of culture medium for stem cells located either peripherally or in the bone marrow itself. Nevertheless, additional variables associated with the use of BMAC and PRP in orthopedics must be further evaluated in order to consolidate the efficacy of this therapeutic strategy.
在过去十年中，使用矫形生物制品作为治疗多种肌肉骨骼疾病的新型疗法的情况显著增加。目前，有多种替代方法可作为合适的治疗手段；然而，自体血源产品的使用，如富血小板血浆（PRP）、骨髓抽吸物（BMA）和骨髓抽吸物浓缩物（BMAC），尤其在不断扩大。尽管许多研究试图证明这些疗法的有效性，即使取得了积极成果，但文献中缺乏标准化方案以及研究设计的整体准确性，这导致方案的变异性和可重复性存在困难。PRP用于治疗软骨、骨骼和肌肉组织的疗效是众所周知的。尽管BMAC出于同样目的也产生了令人乐观的结果，但与PRP相比，其在临床试验中的应用仍相对较新。这两种产品都显示出引发修复过程的潜力，各自有着独特的机制。此前曾有人提出将这些生物制品联合使用，但对它们的协同作用了解甚少。有证据表明，PRP和BMAC中所见的生长因子、细胞因子和趋化因子谱各不相同，但可能协同作用以促进肌肉骨骼愈合。BMAC产品在没有PRP的情况下似乎也能很好地发挥作用；然而，已证明在BMAC中添加PRP可作为外周或骨髓本身干细胞丰富且天然的培养基来源。尽管如此，与在骨科中使用BMAC和PRP相关的其他变量仍必须进一步评估，以巩固这种治疗策略的疗效。
