Umqondo owaziwa namuhla njenge-PRP waqala ukuvela emkhakheni we-hematology ngawo-1970.Izazi ze-Hematologists zakha igama elithi PRP emashumini eminyaka adlule emzamweni wokuchaza i-plasma etholakala ekubalweni kweplatelet ngaphezu kwamanani ayisisekelo egazini le-peripheral.Ngaphezu kweminyaka eyishumi kamuva, i-PRP yasetshenziswa ekuhlinzeni i-maxillofacial njengendlela ye-platelet-rich fibrin (PRF).Okuqukethwe kwe-fibrin kulokhu okuphuma ku-PRP kunenani elikhulu ngenxa yezakhiwo zayo zokunamathela kanye ne-homeostatic, kuyilapho i-PRP inezici eziphikisana nokuvuvukala eziqhubekayo futhi ivuselela ukwanda kwamaseli.Ekugcineni, ngawo-1990, i-PRP yaduma, futhi ekugcineni, ubuchwepheshe badluliselwa kwezinye izinkambu zezokwelapha.Kusukela ngaleso sikhathi, le biology enhle iye yafundwa kabanzi futhi yasetshenziswa ekwelapheni ukulimala okuhlukahlukene kwe-musculoskeletal kubasubathi abangochwepheshe, okuqhubeka kube nomthelela ekunakeni kwayo kwabezindaba.Ngaphezu kokuphumelela kwemithi yamathambo nezemidlalo, i-PRP isetshenziswa ku-ophthalmology, gynecology, urology kanye ne-cardiology, izingane kanye nokuhlinzwa kwepulasitiki.Eminyakeni yamuva nje, i-PRP iye yadunyiswa odokotela besikhumba ngenxa yamandla ayo okwelapha izilonda zesikhumba, ukubuyekezwa kwesibazi, ukuvuselelwa kwezicubu, ukuvuselela isikhumba ngisho nokulahlekelwa izinwele.
Uma kucatshangelwa iqiniso lokuthi i-PRP iyaziwa ngokulawula ngokuqondile izinqubo zokuphulukisa nokuvuvukala, i-cascade yokuphulukisa kufanele yethulwe njengereferensi.Inqubo yokuphulukisa ihlukaniswe ngezigaba ezine ezilandelayo: i-hemostasis;ukuvuvukala;ukwanda kwamaselula kanye ne-matrix, futhi ekugcineni ukulungiswa kabusha kwesilonda.
1. Ukuphulukiswa Kwezicubu
I-cascade ephulukisa izicubu iyasebenza, inqubo eholela ekuhlanganisweni kweplatelet, ukwakheka kwehlule, nokuthuthukiswa kwe-matrix yesikhashana yangaphandle (ECM. Ama-Platelets abe esenamathela kumaprotheni e-collagen kanye ne-ECM edaluliwe, okubangela ukuba khona kwama-α-granules ekukhishweni Amamolekyuli e-Bioactive. Ama-Platelet aqukethe izinhlobonhlobo zamamolekyuli e-bioactive, okuhlanganisa izici zokukhula, ama-chemokines, nama-cytokines, kanye nabaxhumanisi abanokuvuvukala njenge-prostaglandin, i-prostatic cyclin, i-histamine, i-thromboxane, i-serotonin, ne-bradykinin.
Isigaba sokugcina senqubo yokuphola sincike ekulungisweni kabusha kwesilonda.Ukulungiswa kabusha kwezicubu kulawulwa ngokuqinile ukuze kusungulwe ibhalansi phakathi kwe-anabolic kanye nezimpendulo ze-catabolic.Phakathi nalesi sigaba, i-platelet-derived growth factor (PDGF), ukuguqula isici sokukhula (TGF-β) kanye ne-fibronectin ivuselela ukwanda nokufuduka kwe-fibroblasts, kanye nokuhlanganiswa kwezingxenye ze-ECM.Kodwa-ke, isikhathi sokuvuthwa kwesilonda sincike kakhulu ekuqineni kwesilonda, izici zomuntu ngamunye, kanye namandla athile okuphulukisa kwezicubu ezilimele, futhi izici ezithile ze-pathophysiological kanye ne-metabolic zingathinta inqubo yokuphulukisa, njenge-tischemia, i-hypoxia, ukutheleleka. , Ukungalingani kwe-Growth factor, kanye nezifo ezihlobene ne-metabolic syndrome.
I-pro-inflammatory microenvironment ephazamisa inqubo yokuphulukisa.Ukwenza izinto zibe nzima, kukhona nomsebenzi ophezulu we-protease ovimbela isenzo semvelo se-growth factor (GF).Ngaphezu kokuba nezakhiwo ze-mitogenic, angiogenic, kanye ne-chemotactic, i-PRP iphinde ibe umthombo ocebile wezici eziningi zokukhula, ama-biomolecules angase amelane nemiphumela elimazayo ezicutshini ezivuthayo ngokulawula ukuvuvukala okuthuthukile nokusungula izisusa ze-anabolic.Njengoba kunikezwe lezi zakhiwo, Abacwaningi bangathola amandla amakhulu ekwelapheni izinhlobonhlobo zokulimala okuyinkimbinkimbi.
2. I-Cytokine
Ama-Cytokines ku-PRP adlala indima ebalulekile ekuphatheni izinqubo zokulungisa izicubu kanye nokulawula umonakalo ovuthayo.Ama-cytokines alwa nokuvuvukala awuchungechunge olubanzi lwama-molecule e-biochemical axhumanisa izimpendulo ze-cytokine ezinokuvuvukala, ikakhulukazi ezibangelwa ama-macrophage acushiwe.Ama-cytokines aphikisana nokuvuvukala asebenzisana nama-cytokine inhibitors athile kanye nama-soluble cytokine receptors ukuze alungise ukuvuvukala.I-Interleukin (IL) -1 receptor antagonists, IL-4, IL-10, IL-11 kanye ne-IL-13 zihlukaniswa njengama-cytokines aphikisana nokuvuvukala.Kuye ngohlobo lwesilonda, amanye ama-cytokines, njenge-interferon, i-leukemia inhibitory factor, i-TGF-β ne-IL-6, ingabonisa imiphumela ephikisanayo noma ephikisana nokuvuvukala.I-TNF-α, i-IL1 ne-IL-18 ine-receptors ethile ye-cytokine engavimbela imiphumela yokuvuvukala kwamanye amaprotheni [37].I-IL-10 ingenye yama-cytokines e-anti-inflammatory anamandla kakhulu, ingakwazi ukulawula ama-cytokines ane-pro-inflammatory njenge-IL-1, IL-6 ne-TNF-α, futhi ilawule ama-cytokines aphikisana nokuvuvukala.Lezi zindlela eziphikisayo zokulawula zidlala indima ebalulekile ekukhiqizeni nasekusebenzeni kwama-cytokines ane-pro-inflammatory.Ngaphezu kwalokho, ama-cytokines athile angase aqalise izimpendulo ezithile zokubonisa ezivuselela ama-fibroblasts, abalulekile ekulungiseni izicubu.I-cytokines evuthayo TGFβ1, IL-1β, IL-6, IL-13, ne-IL-33 ivuselela ama-fibroblasts ukuze ahlukanise abe yi-myofibroblasts futhi athuthukise i-ECM [38].Ngokulandelayo, ama-fibroblasts akhiqiza ama-cytokines TGF-β, IL-1β, IL-33, CXC, kanye ne-CC chemokines, ekhuthaza izimpendulo eziphikisana nokuvuvukala ngokuvula nokuqasha amaseli omzimba afana nama-macrophages.Lawa mangqamuzana avuthayo anezindima eziningi endaweni yenxeba, ngokuyinhloko ngokugqugquzela ukuchithwa kwezilonda - kanye ne-biosynthesis yama-chemokines, ama-metabolites kanye nezici zokukhula, ezibalulekile ekulungiseni kabusha izicubu ezintsha.Ngakho-ke, ama-cytokines akhona ku-PRP adlala indima ebalulekile ekukhuthazeni izimpendulo ze-immune zohlobo lweseli, ukushayela ukuxazululwa kwesigaba sokuvuvukala.Eqinisweni, abanye abacwaningi baye babiza le nqubo ngokuthi "ukuvuvukala okuvuselelayo," okusikisela ukuthi isigaba sokuvuvukala, naphezu kokukhathazeka kwesiguli, isinyathelo esibalulekile esidingekayo ukuze inqubo yokulungisa izicubu ifinyelele esiphethweni esiphumelelayo, kunikezwe izindlela ze-epigenetic lapho izimpawu zokuvuvukala zikhuthaza amaselula. ipulasitiki.
3. I-Fibrin
Ama-platelet aphethe izinto ezimbalwa ezihlobene nohlelo lwe-fibrinolytic olungase lulawule noma lwehlise ukusabela kwe-fibrinolytic.Ubudlelwano besikhashana kanye negalelo elihlobene lezingxenye ze-hematological kanye nokusebenza kwe-platelet ekuwohlokeni kwehlule kuseyindaba efanele ukudingidwa kabanzi emphakathini.Izincwadi zinikeza izifundo eziningi ezigxile kuphela kuma-platelet, aziwa ngokukwazi kwawo ukuthonya inqubo yokuphulukisa.Naphezu kwezifundo eziningi ezivelele, ezinye izakhi ze-hematological, ezifana nezici ze-coagulation kanye nesistimu ye-fibrinolytic, nazo zitholakale zenza iminikelo ebalulekile ekulungiseni isilonda esisebenzayo.Ngokwencazelo, i-fibrinolysis iyinqubo eyinkimbinkimbi yezinto eziphilayo encike ekusebenzeni kwama-enzyme athile ukuze kube lula ukuwohloka kwe-fibrin.Impendulo ye-fibrinolytic iye yasikiselwa abanye ababhali ukuthi imikhiqizo ye-fibrin degradation (fdp) ingase ibe ama-molecule e-molecular anesibopho sokugqugquzela ukulungiswa kwezicubu, ukulandelana kwezenzakalo ezibalulekile ze-biological ngaphambi kokufakwa kwe-fibrin nokususwa ku-angiogenesis, okudingekayo ekwelapheni kwesilonda.Ukwakheka kwehlule ngemva kokulimala kusebenza njengesendlalelo esivikelayo esivikela izicubu ekulahlekelweni kwegazi, ukuhlasela ama-microbial agents, futhi futhi kunikeza i-matrix yesikhashana lapho amangqamuzana angakwazi ukufuduka ngesikhathi sokulungiswa.Ihlule libangelwa ukuqhekeka kwe-fibrinogen ngama-serine protease kanye nama-platelet aggregate kunethiwekhi ye-fibrin fibrous exhumene.Lokhu kusabela kuqala i-polymerization yama-fibrin monomers, isenzakalo esiyinhloko ekwakhekeni kwehlule legazi.Amahlule angakwazi futhi ukusebenza njengamanzi ama-cytokines nezici zokukhula, akhululwa ekuwohlokeni kwamaplatelet acushiwe.Uhlelo lwe-fibrinolytic lulawulwa ngokuqinile yi-plasmin futhi ludlala indima ebalulekile ekukhuthazeni ukufuduka kwamangqamuzana, ukukhula kwesici se-bioavailability, kanye nokulawula ezinye izinhlelo ze-protease ezihilelekile ekuvuvukeni kwezicubu kanye nokuvuselelwa kabusha.Izingxenye ezibalulekile ku-fibrinolysis, njenge-urokinase plasminogen activator receptor (uPAR) kanye ne-plasminogen activator inhibitor-1 (PAI-1) zaziwa ngokuthi zivezwe kumaseli e-mesenchymal stem (MSCs), uhlobo lweseli olukhethekile oludingekayo ukuze kupholeke isilonda ngempumelelo.
4. Ukufuduka Kweseli
Ukwenza kusebenze i-plasminogen ngokusebenzisa inhlangano ye-uPA-uPAR kuyinqubo ekhuthaza ukufuduka kwamangqamuzana okuvuvukala njengoba ithuthukisa i-extracellular proteinolysis.Njengoba i-uPAR ingenazo izizinda ze-transmembrane kanye ne-intracellular, iphrotheni idinga ama-co-receptors afana nama-interins nama-vitreins ukulawula ukufuduka kwamaseli.Ngaphezu kwalokho, ukubophezela kwe-UPA-uPAR kuholele ekwandiseni ukuhlobana kwe-uPAR kuma-vitreous connexins nama-interins, okuthuthukisa ukunamathela kwamaseli.I-Plasminogen activator inhibitor-1 (PAI-1) yona ikhipha amaseli, ibhidlize i-upar-vitrein kanye ne-integrin- uma ibophezela ku-uPA ye-uPA-upar-integrin complex endaweni yeseli Ukusebenzisana kwamavokseli engilazi.
Esimweni somuthi wokuvuselela kabusha, amangqamuzana e-mesenchymal stem ahlanganiswa kusukela emnkantsheni wethambo esimweni sokulimala okukhulu kwesitho futhi ngaleyo ndlela angatholakala ekujikelezeni kweziguli ezineziphambeko eziningi.Kodwa-ke, ezimweni ezithile, njengokuhluleka kwe-renal ekupheleni, ukwehluleka kwesibindi sokuphela, noma ngesikhathi sokuqala kokulahlwa ngemva kokufakelwa kwenhliziyo, lawa maseli angase angabonakali egazini [66].Kuyathakazelisa ukuthi lawa mangqamuzana e-mesenchymal (stromal) atholakala ngomnkantsha wethambo lomuntu awakwazi ukutholwa egazini labantu abanempilo [67].Indima ye-UPAR ekuhlanganiseni iseli lomnkantsha wethambo i-mesenchymal stem cell nayo iye yahlongozwa ngaphambilini, efana nalokho okwenzeka ekuhlanganiseni i-hematopoietic stem cell (HSC).Varabaneni et al.Imiphumela yabonisa ukuthi ukusetshenziswa kwe-granulocyte colony-stimulating factor kumagundane ashoda nge-uPAR kubangele ukwehluleka kwama-MSC, kwaphinde kwaqinisa indima yokusekela yohlelo lwe-fibrinolytic ekufudukeni kweseli.Ucwaningo olwengeziwe luphinde lwabonisa ukuthi i-glycosylphosphatidylinositol-anchored uPA receptors ilawula ukunamathela, ukufuduka, ukwanda, nokuhlukanisa ngokwenza kusebenze izindlela ezithile zokusayina ze-intracellular, ngale ndlela elandelayo: i-pro-survival phosphatidylinositol 4,5-bisphosphate 3-kinase/Akt pathways1/Akt , kanye ne-adhesion kinase (FAK).
Ama-MSC akhombise ukubaluleka okwengeziwe kumongo wokuphola kwesilonda.Isibonelo, amagundane ashoda nge-plasminogen abonise ukubambezeleka okukhulu ezenzakalweni zokuphulukisa amanxeba, okuphakamisa ukuthi i-plasmin ihileleke kakhulu kule nqubo.Kubantu, ukulahleka kwe-plasmin nakho kungaholela ezinkingeni zokuphola kwesilonda.Ukuphazamiseka kokugeleza kwegazi kungavimbela kakhulu ukuvuselelwa kwezicubu, okuchaza ukuthi kungani lezi zinqubo zokuvuselela ziyinselele kakhulu ezigulini ezinesifo sikashukela.
5. Ama-Monocyte kanye Nezinhlelo Zokuvuselela
Ngokusho kwezincwadi, kunezingxoxo eziningi mayelana nendima yama-monocyte ekwelapheni kwesilonda.Ama-Macrophage ngokuyinhloko atholakala kuma-monocyte egazi futhi adlala indima ebalulekile emithini yokuvuselela kabusha [81].Njengoba ama-neutrophils ekhiqiza i-IL-4, IL-1, IL-6 ne-TNF-α, lawa maseli ngokuvamile angena endaweni yenxeba cishe amahora angu-24-48 ngemva kokulimala.Ama-platelet akhulula i-thrombin ne-platelet factor 4 (PF4), ama-chemokines amabili akhuthaza ukubuthwa kwama-monocyte kanye nokuhlukaniswa kwawo abe ama-macrophage namaseli e-dendritic.Isici esimangalisayo sama-macrophage ukwakheka kwawo kwepulasitiki, okungukuthi, ikhono lawo lokushintsha ama-phenotypes futhi ahlukaniseke abe ezinye izinhlobo zamangqamuzana njengamaseli e-endothelial, kamuva abonisa imisebenzi ehlukene ekuphenduleni izisusa ezihlukene ze-biochemical endaweni ezungezile yenxeba.Amangqamuzana okuvuvukala aveza ama-phenotypes amabili amakhulu, i-M1 noma i-M2, kuye ngesignali ye-molecular yendawo engumthombo wesisusa.Ama-macrophage e-M1 abangelwa ama-microbial agents futhi ngaleyo ndlela abe nemiphumela engaphezulu yokuvuvukala.Ngokuphambene, ama-macrophage e-M2 ngokuvamile akhiqizwa uhlobo lwe-2 lokuphendula futhi anezindawo zokulwa nokuvuvukala, ezibonakala ngokunyuka kwe-IL-4, IL-5, IL-9, ne-IL-13.Iphinde ihileleke ekulungiseni izicubu ngokukhiqizwa kwezinto ezikhulayo.Ukuguqulwa kusuka ku-M1 kuya ku-M2 isoforms kuqhutshwa kakhulu izigaba zakamuva zokuphulukiswa kwesilonda, lapho ama-macrophage e-M1 eqala i-neutrophil apoptosis futhi aqalise ukucaciswa kwala maseli).I-Phagocytosis ngama-neutrophils yenza kusebenze uchungechunge lwezenzakalo lapho ukukhiqizwa kwe-cytokine kuvalwa khona, i-polarizing macrophages futhi ikhulula i-TGF-β1.Lesi sici sokukhula siyisilawuli esiyinhloko sokuhlukaniswa kwe-myofibroblast kanye nokuvinjelwa kwesilonda, okuvumela ukuxazululwa kokuvuvukala nokuqalwa kwesigaba sokwanda kwe-cascade yokuphulukisa [57].Enye iphrotheni ehlobene kakhulu ehilelekile ezinqubweni zamaselula i-serine (SG).Le granulan ene-hematopoietic cell-secreted itholwe idingeka ukuze kugcinwe amaprotheni ayimfihlo kumaseli athile omzimba omzimba, njengama-mast cells, neutrophils, nama-cytotoxic T lymphocyte.Nakuba amangqamuzana amaningi angewona awe-hematopoietic nawo ahlanganisa i-serotonin, wonke amangqamuzana okuvuvukala akhiqiza inani elikhulu lale phrotheni futhi ayigcine kuma-granules ukuze aqhubeke nokusebenzisana nabanye abaxhumanisi abavuthayo, okuhlanganisa ama-protease, ama-cytokines, ama-chemokines, kanye nesici sokukhula.Amaketango e-glycosaminoglycan (GAG) ashajiwe kabi ku-SG abonakala ebaluleke kakhulu ku-secretory granule homeostasis, njengoba akwazi ukubophezela futhi enze kube lula ukugcinwa kwezingxenye zegranule ezishajwe kakhulu ngendlela eqondene neseli-, amaprotheni-, kanye ne-GAG.Ngokuphathelene nokubandakanyeka kwabo ku-PRP, u-Woulfe kanye nozakwabo baye babonisa ngaphambilini ukuthi ukuntuleka kwe-SG kuhlotshaniswa kakhulu ne-platelet morphology eguquliwe;amaphutha ku-platelet factor 4, i-beta-thromblobulin, kanye nesitoreji se-PDGF kumaplatelet;ukuhlanganiswa okungalungile kweplatelet kanye nokukhishwa kwe-in vitro kanye ne-thrombosis ku-vivo ifomu ukukhubazeka.Ngakho-ke abacwaningi baphetha ngokuthi le proteoglycan ibonakala iyisilawuli esiyinhloko se-thrombosis.
Imikhiqizo enothe ngamaplatelet ingatholwa ngokuqoqa futhi kugxiliswe ku-centrifuge igazi lonke lomuntu ngamunye, ihlukanise ingxube ibe izingqimba ezihlukene eziqukethe i-plasma, amaplatelet, amaleukocyte, namaleukocyte.Lapho ukugxila kweplatelet kuphakeme kunamanani ayisisekelo, ukukhula kwethambo nezicubu ezithambile kungasheshiswa ngemiphumela emibi emincane.Ukusetshenziswa kwemikhiqizo ye-PRP ezenzakalelayo kuyi-biotechnology entsha uma kuqhathaniswa eqhubeka nokubonisa imiphumela ethembisayo ekukhuthazeni nasekuphulukisweni okuthuthukisiwe kokulimala kwezicubu ezihlukahlukene.Ukusebenza kwale ndlela yokwelapha ehlukile kungase kubangelwe ekulethweni kwezihloko ezihlukahlukene zezinto ezikhulayo namaprotheni, ukulingisa nokusekela ukuphulukiswa kwesilonda somzimba kanye nezinqubo zokulungisa izicubu.Ngaphezu kwalokho, uhlelo lwe-fibrinolytic ngokusobala lunomthelela obalulekile ekulungisweni kwezicubu okuphelele.Ngaphezu kwekhono layo lokushintsha ukubuthwa kwamangqamuzana amangqamuzana avuthayo kanye namaseli e-mesenchymal stem, iguqula umsebenzi we-proteolytic ezindaweni zokuphulukisa amanxeba nangesikhathi sokuvuselelwa kwezicubu ze-mesodermal ezihlanganisa amathambo, uqwanga kanye nemisipha, ngakho-ke iyinhloko engxenyeni yemithi ye-musculoskeletal.
Ukusheshisa ukuphulukiswa kuwumgomo ofunwa kakhulu ochwepheshe abaningi emkhakheni wezokwelapha, futhi i-PRP imele ithuluzi elihle lebhayoloji eliqhubeka nokunikeza intuthuko ethembisayo ekugqugquzeleni nasekuhlanganisweni kahle kwemicimbi yokuvuselela kabusha.Kodwa-ke, njengoba leli thuluzi lokwelapha lihlala liyinkimbinkimbi, ikakhulukazi njengoba likhipha inqwaba yezici ze-bioactive kanye nezindlela zabo ezihlukahlukene zokusebenzisana kanye nemiphumela yokubonisa, izifundo ezengeziwe ziyadingeka.
(Okuqukethwe yile ndatshana kuphrintwe kabusha, futhi asinikezeli nganoma yisiphi isiqinisekiso esicacile noma esishiwoyo sokunemba, ukwethembeka noma ukuphelela kokuqukethwe okuqukethwe kulesi sihloko, futhi asinasibopho ngemibono yalesi sihloko, sicela uqonde.)
Isikhathi sokuthumela: Jul-19-2022