以水凝胶为载体的生长因子及药物修复椎间盘退变:问题及应用前景

Hydrogel-based growth factors and drugs in the treatment of intervertebral disc degeneration: problems and prospects

背景:因椎间盘退变而产生下腰痛的患者逐年增多,但手术及保守治疗均存在其局限性,近年来新型的以水凝胶为载体的再生治疗方法为治疗椎间盘退变带来了新的思路。目的:综述各类生长因子及药物搭载于不同种类水凝胶对于椎间盘早期退变的修复作用。方法:使用计算机检索PubMed、中国知网和万方数据库发表的关于椎间盘退变再生治疗及分子生物学的相关文献。文献发表时间为1999年1月至2021年5月。中文检索词:"椎间盘、椎间盘退变、水凝胶、生长因子、趋化因子、药物、再生、修复",英文检索词:"Intervertebral disc,intervertebral disc degeneration,hydrogels,growth factors,chemokines,drugs,regeneration,repair",共筛选出87篇文献后再进一步归纳总结。结果与结论:(1)天然水凝胶可在椎间盘组织中逐渐被降解,成为椎间盘组织的基质或者被直接吸收,体现了其优越的生物相容性,其在椎间盘退变治疗早期亦能恢复间盘高度,起到支撑作用,从而恢复脊柱生物力学。(2)以水凝胶为载体的生长因子及药物等活性分子治疗椎间盘退变的研究目前仍存在诸多难题亟待解决,主要包括:大多数研究成果来自于动物实验,如何安全有效地递送水凝胶复合物进入椎间盘,以及在治疗早期能否立即解决患者腰痛的问题等。(3)复合水凝胶因其优越的生物力学性能和良好的生物相容性成为未来治疗椎间盘退变的重要方向,富血小板血浆因富含多种生长因子亦是未来治疗椎间盘退变的热点。(4)水凝胶因其材料和聚合方式的多样性将为组织工程和医学提供更广阔的应用前景,各类生长因子及药物搭载于不同种类水凝胶可为椎间盘退变的修复和再生治疗提供新思路。

BACKGROUND:The number of patients with low back pain due to intervertebral disc degeneration is increasing year by year.However,both surgical and conservative treatments have their limitations.In recent years,new regenerative therapy using hydrogel as carrier has brought new ideas for the treatment of intervertebral disc degeneration.OBJECTIVE:To summarize the repair effects of various growth factors and drugs loaded on different types of hydrogels on the early degeneration of intervertebral discs.METHODS:The articles about intervertebral disc degeneration and regeneration therapy and molecular biology published on PubMed,CNKI,and Wanfang databases were searched by computer.The period was set from January 1999 to May 2021.The search terms were"intervertebral disc,intervertebral disc degeneration,hydrogels,growth factors,chemokines,drugs,regeneration,repair"in Chinese and English.Summary was further conducted after screening out 87 articles.RESULTS AND CONCLUSION:(1)Natural hydrogel can be gradually degraded in the intervertebral disc tissue to become the matrix of the intervertebral disc tissue or be directly absorbed,which reflects its superior biocompatibility,but it also needs to restore the height of the intervertebral disc in the early stage of the treatment of intervertebral disc degeneration to play a supporting role,thereby restoring the biomechanics of the spine.(2)Currently,there are still many problems that need to be solved urgently in the research of active molecules such as growth factors and drugs using hydrogels as carriers to treat intervertebral disc degeneration,including most of the current research results from animal experiments,how to safely and effectively deliver hydrogel composites into the intervertebral disc,and whether the problem of low back pain in patients can be solved immediately in the early stage of treatment.(3)Composite hydrogels have become an important direction for the future development of the treatment of intervertebral disc degeneration due to their superior biomechanical properties and good biocompatibility.Platelet-rich plasma is also a hotspot for the future treatment of intervertebral disc degeneration due to its rich content of various growth factors.(4)Due to the diversity of its materials and polymerization methods,hydrogels can provide a broader application prospect for tissue engineering and medicine,and various growth factors and drugs carried in different types of hydrogels can provide a new idea of great significance in the repair and regeneration treatment of intervertebral disc degeneration.