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关节软骨再生的当前概念与观点

Current concepts and perspectives for articular cartilage regeneration.

作者信息

Roseti Livia, Grigolo Brunella

机构信息

IRCCS Istituto Ortopedico Rizzoli Bologna, Bologna, Italy.

出版信息

J Exp Orthop. 2022 Jul 1;9(1):61. doi: 10.1186/s40634-022-00498-4.

Abstract

Articular cartilage injuries are common in the population. The increment in the elderly people and active life results in an increasing demand for new technologies and good outcomes to satisfy longer and healthier life expectancies. However, because of cartilage's low regenerative capacity, finding an efficacious treatment is still challenging for orthopedics.Since the pioneering studies based on autologous cell transplantation, regenerative medicine has opened new approaches for cartilage lesion treatment.Tissue engineering combines cells, biomaterials, and biological factors to regenerate damaged tissues, overcoming conventional therapeutic strategies. Cells synthesize matrix structural components, maintain tissue homeostasis by modulating metabolic, inflammatory, and immunologic pathways. Scaffolds are well acknowledged by clinicians in regenerative applications since they provide the appropriate environment for cells, can be easily implanted, reduce surgical morbidity, allow enhanced cell proliferation, maturation, and an efficient and complete integration with surrounding articular cartilage. Growth factors are molecules that facilitate tissue healing and regeneration by stimulating cell signal pathways.To date, different cell sources and a wide range of natural and synthetic scaffolds have been used both in pre-clinical and clinical studies with the aim to find the suitable solution for recapitulating cartilage microenvironment and inducing the formation of a new tissue with the biochemical and mechanical properties of the native one. Here, we describe the current concepts for articular cartilage regeneration, highlighting the key actors of this process trying to identify the best perspectives.

摘要

关节软骨损伤在人群中很常见。老年人数量的增加以及积极的生活方式导致对新技术和良好治疗效果的需求不断增长,以满足更长且更健康的预期寿命。然而,由于软骨的再生能力较低,找到一种有效的治疗方法对骨科来说仍然具有挑战性。自从基于自体细胞移植的开创性研究以来,再生医学为软骨损伤治疗开辟了新途径。组织工程将细胞、生物材料和生物因子结合起来以再生受损组织,克服了传统治疗策略。细胞合成基质结构成分,通过调节代谢、炎症和免疫途径维持组织稳态。支架在再生应用中得到临床医生的广泛认可,因为它们为细胞提供了合适的环境,易于植入,降低手术发病率,促进细胞增殖、成熟,并能与周围关节软骨高效且完全地整合。生长因子是通过刺激细胞信号通路促进组织愈合和再生的分子。迄今为止,在临床前和临床研究中已经使用了不同的细胞来源以及各种各样的天然和合成支架,目的是找到重现软骨微环境并诱导形成具有天然软骨生化和力学特性的新组织的合适解决方案。在此,我们描述了关节软骨再生的当前概念,强调了这一过程的关键因素,试图确定最佳前景。

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