间充质干细胞修复骨关节炎软骨损伤的临床应用意义

Mesenchymal stem cells for cartilage repair in osteoarthritis

背景:关节软骨退变是临床和基础水平研究的持续挑战。由于受损部位软骨细胞再生能力有限,因而干细胞为基础治疗方案已成为关节软骨修复的新型治疗方法。间充质干细胞因具有多潜能性及免疫抑制等特性而成为组织工程研究的首选资源。目的:总结近年来不同组织来源间充质干细胞在软骨损伤修复方面的应用效果。方法:以"间充质干细胞,软骨损伤修复,骨关节炎"为中文检索词,"mesenchymal stem cells,cartilage repair,osteoarthritis"为英文检索词,在PubMed、WebofScience及中国知网数据库中检索建库至2018年关于间充质干细胞用于软骨损伤治疗的文献。初步共检索到168篇文献,阅读全文后,按照入选标准进行评估,最终选取59篇文献,其中英文文献57篇,中文文献2篇。结果与结论:(1)间充质干细胞具有自我更新能力并可分化为多种中胚层谱系细胞,如成骨细胞、软骨细胞、脂肪细胞,心肌细胞和血管细胞等;(2)间充质干细胞的免疫调节作用和再生能力能够调节骨关节炎中关节合成代谢和分解代谢过程的失衡;(3)当前,虽然已有大量间充质干细胞用于软骨损伤修复的临床研究,但其修复机制仍不明确,有待进一步探究;(4)间充质干细胞治疗效果受细胞来源、移植细胞数量及注射方式影响。

BACKGROUND:The degeneration of articular cartilage represents an ongoing challenge at the clinical and basic levels.Considering the restricted intrinsic capacity of resident chondrocytes to regenerate post injury,stem cell-based therapies have been proposed as a novel therapeutic approach for cartilage repair.Mesenchymal stem cells are pluripotent and immunosuppressive,which have become the first choice for tissue engineering research.OBJECTIVE:To summarize the application of mesenchymal stem cells derived from different tissues in cartilage repair in recent years.METHODS:With“mesenchymal stem cells,cartilage damage repair,osteoarthritis”as retrieval words,we searched relevant articles regarding mesenchymal stem cells for cartilage repair in PubMed,Web of Science and CNKI.Initially 168 articles were retrieved,and 59 eligible articles(57 in English and 2 in Chinese)were included in final analysis.RESULTS AND CONCLUSION:Mesenchymal stem cells with self-renewal ability can differentiate into a variety of mesodermal lineage cells,such as osteoblasts,chondrocytes,adipocytes,cardiomyocytes and vascular cells.The immunomodulatory and regenerative capacity of mesenchymal stem cells can regulate the imbalance of anabolism and catabolism in the osteoarthritic joint.Although a large number of mesenchymal stem cells have been used for cartilage repair in clinical practice,the mechanism underlying cartilage repair with mesenchymal stem cells is still unclear.Moreover,the therapeutic effect of mesenchymal stem cells is determined by cell sources,the number of transplanted cells and the way of injection.All of these problems need further explorations.