血管内皮生长因子有望成为加速骨折愈合的全新治疗手段

Vascular endothelial growth factor intervention: a new approach for accelerating fracture healing

背景:血管内皮生长因子是一种多功能的细胞因子,具有促进血管生成、提高血管通透性、维持血管稳定性等功能,对骨折愈合及骨再生过程有积极意义,基于血管内皮生长因子的治疗方法有望成为加速骨折愈合的全新治疗手段。目的:探讨血管内皮生长因子对骨折愈合的影响,并对其影响因素及临床应用进行综述。方法:检索CNKI,PubMed数据库2014年1月至2019年3月文献,以“血管内皮生长因子,骨折愈合”为中文检索词,“vascular endothelial growth factor,fracture healing”为英文检索词,检索有关血管内皮生长因子对骨折愈合影响作用的文章。共检索到167篇文献,通过阅读文题、摘要进行初筛,排除无关的或内容重复的文献,最后纳入符合标准的85篇文献作进一步分析。结果与结论:①血管内皮生长因子存在于骨折断端不同细胞内,且不同细胞内表达具有显著的周期性;②血管内皮生长因子具有促进血管生成、提高血管通透性、维持血管正常形态及完整性的作用,并由此促进骨折愈合及骨再生过程;③一些理化因素及细胞因子均能影响血管内皮生长因子表达,从而影响骨折愈合过程;④基于血管内皮生长因子的组织工程疗法有显著优势,主要的方法包括:运用组织工程材料向患处递送血管内皮生长因子;利用基因转染技术维持并提高血管内皮生长因子表达;将血管内皮生长因子与其他细胞因子及外源性干细胞联合应用;基于提高血管内皮生长因子的生物涂层应用;⑤随着医学研究的重点向“交叉学科”发展,相信未来基于血管内皮生长因子的组织工程学治疗会是医学研究的热点。

BACKGROUND:Vascular endothelial growth factor(VEGF)is a multifunctional cytokine that promotes angiogenesis,improves vascular permeability,maintains vascular stability,and has positive effects on fracture healing and bone regeneration.VEGF-based treatment is expected to become an emerging means for accelerating fracture healing.OBJECTIVE:To explore the effects of VEGF on fracture healing and to review its influencing factors and clinical applications.METHODS:The CNKI and PubMed databases were searched for articles related to VEGF effect on fracture healing published from January 2014 to March 2019 with the key words of“vascular endothelial growth factor,fracture healing”in Chinese and English,respectively.Initially 167 articles were retrieved,and only 85 eligible articles were included in result analysis after removal of unrelated or duplicate literature.RESULTS AND CONCLUSION:VEGF exists in different cells of the fracture end,and the expression in different cells has significant periodicity.VEGF promotes angiogenesis,enhances vascular permeability,and maintains the normal morphology and integrity of blood vessels,thereby promoting fracture healing and bone regeneration.Several physicochemical factors and cytokines can change the expression of VEGF,thus influencing the fracture healing process.VEGF-based tissue engineering therapies have significant advantages,and the main methods include:delivering VEGF into the affected area using tissue engineering materials;maintaining and improving VEGF expression using gene transfection technology;combining VEGF with other cytokines and exogenous stem cells;and applying bio-coatings based on the upregulation of VEGF.With the interdisciplinary development,VEGF-based tissue engineering treatment is expected to be a hot topic in medical research.