Indima yama-platelet ku-bone marrow aspiration concentrate
I-PRP kanye ne-bone marrow aspiration concentrate (BMAC) isetshenziselwa uchungechunge lwezokwelapha endaweni yehhovisi nokuhlinzwa ngenxa yezinzuzo zabo zokuvuselela ku-MSK kanye nezifo zomgogodla, ukuphathwa kobuhlungu obungapheli kanye nezinkomba zezicubu ezithambile.I-PRP ayigcini nje ngokulawula ukufuduka kwamangqamuzana nokwanda kwamangqamuzana, kodwa futhi inomthelela ekulungisweni kwe-angiogenesis kanye ne-ECM ukuze kwakhiwe i-microenvironment evumayo futhi kukhuthaze ukulungiswa kwezicubu nokuvuselelwa kabusha.
Inqubo yokulungisa i-BMAC
Ama-BMAC angama-heterogeneous cell compositions aqukethe ama-BMMSC, awenza abe umthombo weseli ongapheli wokwelapha ukulungisa imithi evuselelayo.Badlala indima ngokunciphisa i-apoptosis yeseli, i-fibrosis nokuvuvukala;Futhi wenze kusebenze ukusabela kwe-cascade okuholela ekwandeni kwamaseli.Ukwengeza, ama-BMMSC anamandla okuhlukanisa abe izinhlobo ezihlukahlukene zomugqa wamaseli, okuhlanganisa ama-osteoblasts, ama-adipocytes, ama-myoblasts, amaseli e-epithelial nama-neurons.Baphinde bakhuthaze i-angiogenesis ngokusebenzisa i-paracrine kanye ne-autocrine pathways.Kubalulekile futhi ukuthi i-BMMSC ibe negalelo ekulawulweni kwamasosha omzimba ngaphandle kwamaseli athile omzimba, abamba iqhaza esigabeni sokuvuvukala sokulungiswa kwesilonda.Ukwengeza, ama-BMMSC asekela ukubuthwa kwamaseli ezindaweni ezintsha zokwelapha i-angiogenesis ukuze kusheshiswe ukwakhiwa kabusha kokugeleza kwegazi kwendawo.Jin et al.Kwafakazelwa ukuthi ngenxa yokungabikho kwezikafula ezanele, izinga lokusinda kwe-BMMSC kanye nekhono layo lokulungisa nokuhlukanisa ukuze kuthuthukiswe ukuphulukiswa konakele.Nakuba ukuqoqwa kwezicubu, ukulungiswa kwe-specimen kanye nendlela yokusebenza ye-PRP ne-BMAC kuhlukile, izifundo zibonisa ukuthi zingakwazi ukuphelelisana.Eqinisweni, ukuhlanganisa i-PRP ne-BMAC ibe umkhiqizo webhayoloji kungase kube nezinzuzo ezengeziwe.
Ukuhlanganisa i-PRP ne-BMAC
Ngokocwaningo oluthile olwaziwa kancane, umgomo oyisisekelo wokuhlanganisa i-PRP ne-BMAC usekelwe ezakhiweni ezimbalwa.Okokuqala, i-PRP inganikeza i-microenvironment efanelekile lapho i-BMSC ingathuthukisa ukwanda kwamaseli nokuhlukaniswa futhi ikhulise i-angiogenesis.Okwesibili, i-PRP isetshenziswe njengesikafula kulawa maseli kanye ne-BMAC.Ngokuphambene, inhlanganisela ye-PRP ne-BMAC ingaba ithuluzi elinamandla lebhayoloji ukuheha abantu be-BMMSC.Inhlanganisela ye-PRP-BMAC isetshenziselwe ukwelapha i-tendinosis, amanxeba, ukulimala komgogodla, ama-disc intervertebral degenerative kanye nokukhubazeka kwe-osteochondral enamandla amakhulu okuvuselela.Ngeshwa, nakuba izingxenye zengqamuzana zomnkantsha wethambo ezihlukene zihlanganisa ama-platelet, imibiko embalwa isho ukugcwala kwama-platelet kumnkantsha wethambo okhishiwe nangemva kokwelashwa kwe-BMAC, kodwa angakhishwa ngezindlela ezifanele zokulangazelela.Ucwaningo olwengeziwe luyadingeka ukuze kuqondwe ukuthi ukugxila kweplatelet eyengeziwe kuyadingeka yini ukusetshenziswa kuhlanganiswe ne-BMAC.Njengamanje, ayikho idatha ngesilinganiso esifanele samaplatelet kuya ku-MSC (noma amanye amaseli omnkantsha), okunomthelela omuhle endleleni yokudla okunomsoco ye-MSC ekulungiseni izicubu.Ngokufanelekile, izinto zokuqoqa umnkantsha kanye nobuchwepheshe zingathuthukiswa ukuze kukhishwe ama-platelet omnkantsha anele.
Isici sokukhula se-PRP kanye nomphumela wokudla okunomsoco we-BMAC
I-PRP platelet growth factor iyiphrotheni ebalulekile ehilelekile ekulungiseni i-BMAC.Ukuhlukahluka kwe-PGF namanye ama-cytokines ahilelekile ohlelweni lokudla okunempilo kwe-BMAC kungaqala ukulungiswa kwezicubu ngokunciphisa i-cell apoptosis, i-anabolism kanye nemiphumela ephikisana nokuvuvukala, kanye nokwenza kusebenze ukwanda kwamaseli, ukuhlukaniswa kanye ne-angiogenesis ngokusebenzisa i-paracrine kanye ne-autocrine pathways.
Isici sokukhula esisuselwa ku-Platelet kanye nezingxenye ze-granule eziminyene ngokusobala zibandakanyeka enqubweni yokudla okunomsoco ye-BMAC futhi zisekela ukulungiswa nokuvuselelwa kwezicubu okubangelwa yi-MSC.Izifinyezo: MSC: mesenchymal stem cells, HSC: hematopoietic stem cells.
Ngokusobala, ekwelapheni i-OA, i-PDGF idlala indima ethile ekuvuselelweni kwe-cartilage nokugcinwa kwe-homeostasis ngokusebenzisa ukwanda kwe-MSC kanye nokuvinjelwa kwe-IL-1-induced chondrocyte apoptosis nokuvuvukala.Ukwengeza, ezintathu ze-TGF- β I-subtypes zisebenza ekukhuthazeni ukwakheka kwe-cartilage nokuvimbela ukuvuvukala, futhi zibonisa ikhono lokukhuthaza ukuphulukiswa kwezicubu ezihlobene ne-MSC ngokusebenzisa ukusebenzisana kwe-intermolecular.Umphumela wokudla okunomsoco we-MSC uhlobene nomsebenzi we-PGF kanye nokugcinwa kwama-cytokines okulungisa.Ngokufanelekile, wonke lawa ma-cytokines kufanele abe khona ebhodleleni lokwelapha le-BMAC futhi ahanjiswe endaweni yokulimala kwezicubu ukuze akhuthaze ukuphulukiswa kwezicubu zokwelapha okuhlobene ne-MSC okungcono kakhulu.
Ocwaningweni oluhlanganyelwe lwe-OA, u-Mui ñ os-L ó pez et al.Kubonisa ukuthi i-MSC etholakala kuzicubu ze-synovial ishintshe ukusebenza, okuholele ekulahlekeni kwekhono layo lokululama.Kuyathakazelisa ukuthi ukujova okuqondile kwe-PRP ku-subchondral bone ye-osteoarthritis kuholele ekunciphiseni kwe-MSC ku-synovial fluid, okubonisa ukuthuthukiswa komtholampilo.Umphumela wokwelapha uqondiswa ngokunciphisa inqubo yokuvuvukala ku-synovial fluid yeziguli ze-OA.
Kunolwazi oluncane olutholakalayo mayelana nokuba khona noma ukugxila kwe-PGF ku-BMAC noma isilinganiso esifanele esidingekayo ukuze kusekelwe umsebenzi wokudla okunomsoco we-BMMSC.Abanye odokotela bahlanganisa ukugxila okuphezulu kwe-PRP ne-BMAC ukuze bathole ukuxhunyelelwa okusebenzayo kwebhayoloji, okulindeleke ukuthi kuthuthukise imiphumela yokwelapha yomuthi ovuselelayo.Kodwa-ke, kukhona idatha etholakalayo yokuphepha nokusebenza kahle, ebonisa ukuthi ukuhlanganisa ukugxila kwe-PRP ephezulu ne-BMAC kuyindlela yokwelapha ephumelela kakhulu.Ngakho-ke, sikholelwa ukuthi kungase kungafaneleki ukukhohlisa i-BMMSC ngokuyivula ngokugxilisa kweplatelet ephezulu kulesi sigaba.
Ukusebenzisana kwamaplatelet anezidakamizwa ze-antiplatelet nama-NSAID
I-PRP iqukethe i-spectrum ebanzi yezingxenye eziyimfihlo futhi yakhiwe imidiya eminingi yezinto eziphilayo.Umphumela wokwelapha we-PRP ubizwa ngokuthi kulaba balamuli.Nakuba abalamuli bezokwelapha kuma-platelet baziwa kahle, ukwakheka kanye ne-kinetics yalezi zidakamizwa ze-anabolic kanye ne-catabolic akucaci ngokuphelele.Omunye wemikhawulo eyinhloko yokuzuza ukwakheka kokwelapha ukunqoba ukuhlukahluka kwalaba balamuli bebhayoloji ukuze uqondise imiphumela elawulwa kahle yomfula ehlala iphindaphindeka futhi inenzuzo ngokomtholampilo.Ngenxa yalesi sizathu, izidakamizwa (njengezidakamizwa ezingezona ukuvuvukala (ama-NSAID) zingathinta ukukhululwa kwamaqembu e-platelet secretory.Ocwaningweni lwakamuva lwelebula evulekile yokulandelanisa okuhleliwe, ukuthathwa kwansuku zonke kwe-81 mg ye-aspirin (ASA) kunciphise ukubonakaliswa kwabalamuli ababalulekile, njenge-TGF- β 1. PDGF ne-VEGF.
Le miphumela ibangelwa ukuvinjelwa okungenakuhlehliswa kwe-cyclooxygenase-1 (COX-1) kanye nokuvinjelwa okuguquguqukayo kwe-cyclooxygenase-2 (COX-2), okungama-enzyme amabili adingekayo ekunciphiseni kweplatelet degranulation.Ukubuyekezwa okuhlelekile kwakamuva kuthole ukuthi izidakamizwa ze-antiplatelet zinganciphisa ijika lokukhululwa kwesici sokukhula ngendlela encike ku-COX-1 kanye ne-COX-2, futhi izifundo ezingu-8 kwezingu-15 zithole ukuthi izici zokukhula zehlile.
Izidakamizwa (isb. ama-NSAID) ngokuvamile zisetshenziselwa ukukhulula ubuhlungu nokunciphisa ukuvuvukala okubangelwa yisifo se-MSK.Indlela yama-NSAID ukuvimbela ukusebenza kweplatelet ngokubopha ngendlela engenakuhlehliswa nge-COX enzyme nokulawula indlela ye-arachidonic acid.Ngakho-ke, umsebenzi wamaplatelet uzoshintsha phakathi nawo wonke umjikelezo wokuphila we-platelet, ngaleyo ndlela kuvimbele ukudluliswa kwesignali ye-PGF.Ama-NSAID avimbela ukukhiqizwa kwe-cytokine (isb, i-PDGF, i-FGF, i-VEGF, ne-IL-1 β, IL-6, ne-IL-8), kuyilapho ithuthukisa i-TNF- α. Nokho, kukhona idatha encane ngomthelela wamangqamuzana we-NSAID ku-PRP.Akukho ukuvumelana ngesikhathi esingcono kakhulu sokulungiswa nokuphathwa kwe-PRP ezigulini ezisebenzisa ama-NSAID.UMannava kanye nozakwabo balinganisele izici ze-anabolic kanye ne-catabolic biological ku-PRP ecebile nge-leucocyte yamavolontiya anempilo athatha i-naproxen.Bathole ukuthi ngemva kokusebenzisa i-naproxen isonto elilodwa, amazinga e-PDGF-AA kanye ne-PDGF-AB (i-mitogen esebenzayo yokukhuthaza i-angiogenesis) ehle kakhulu.Ngemva kweviki elilodwa, izinga lokukhula libuyele eduze neleveli yokuqala.Ngemva kokusebenzisa i-naproxen isonto elilodwa, izinga le-LR-PRP le-proinflammatory kanye ne-catabolic factor IL-6 nalo lehla, futhi labuyela ezingeni lokuqala ngemva kwesikhathi sokuvunyelwa kwesonto elilodwa.Njengamanje, asikho isifundo somtholampilo sokufakazela ukuthi iziguli ezine-naproxen ngemva kokwelashwa kwe-PRP zinemiphumela emibi;Kodwa-ke, kunconywa ukuthi ucabangele isikhathi sokugeza seviki elilodwa ukuze ubuyisele amanani e-PDGF-AA, PDGF-BB kanye ne-IL-6 ezingeni lokuqala ukuze kuthuthukiswe umsebenzi wawo webhayoloji.Ucwaningo olwengeziwe luyadingeka ukuze kuqondwe ngokugcwele imiphumela ye-antiplatelet kanye ne-NSAID kuqembu le-PRP secretion kanye nezinhloso zalo ezingezansi.
Hlanganisa ukusetshenziswa kwe-plasma ecebile ngeplatelet kanye nokuvuselelwa
Nakuba ucwaningo oluyisisekelo lwesayensi lubonisa ukuthi ukwelashwa ngokomzimba kanye nomthwalo wemishini kunendima ecacile ekubuyiseleni isakhiwo se-tendon ngemva kokujova i-PRP, akukho ukuvumelana ngohlelo olungcono kakhulu lokuvuselela isifo se-MSK ngemva kokwelashwa kwe-PRP.
Ukwelashwa kwe-PRP kuhlanganisa umjovo wamaplatelet agxilile endaweni yezicubu zendawo ukuze ulawule ubuhlungu nokukhuthaza ukulungiswa kwezicubu.Ubufakazi bomtholampilo obunamandla bukhona ku-OA yamadolo.Kodwa-ke, ukusetshenziswa kwe-PRP ekwelapheni i-tendinosis yezimpawu kuyimpikiswano, futhi imiphumela ebikiwe ihlukile.Izifundo zezilwane ngokuvamile zibonisa ukuthuthukiswa kwe-histological ye-tendinosis ngemva kokungena kwe-PRP.Lezi zifundo zibonisa ukuthi umthwalo wemishini ungavuselela ama-tendon, futhi umthwalo nomjovo we-PRP usebenza ndawonye ukukhuthaza ukuphulukiswa kwe-tendon.Umehluko wamalungiselelo e-PRP, amalungiselelo ezinto eziphilayo, amalungiselelo, izinhlelo zokujova kanye nama-subtypes okulimala kwe-tendon kungase kuholele ekuhlukeni kwemiphumela yomtholampilo.Ukwengeza, nakuba ubufakazi besayensi busekela izinzuzo zezinhlelo zokuvuselela, uphenyo olumbalwa olushicilelwe emitholampilo luzama ukuphatha nokuhlanganisa izinhlelo ezihambisanayo zokuvuselela emva kwe-PRP.
Muva nje, u-Onishi et al.Indima yomthwalo wemishini kanye ne-PRP ye-biological effect ku-Achilles tendon isifo yabuyekezwa.Bahlola izifundo zemitholampilo zesigaba I kanye nesigaba II se-Achilles tendon isifo esiphathwe nge-PRP, sigxile ohlelweni lokuvuselela ngemva kokujova kwe-PRP.Izinhlelo zokuvuselela ezigadiwe zibonakala zithuthukisa ukuthobela umsebenzi futhi zithuthukisa imiphumela kanye nekhono lokuqapha umthamo wokuzivocavoca.Izilingo eziningana eziklanywe kahle ze-Achilles tendon PRP zihlanganise ukwelashwa kwe-post-PRP nohlelo lokuvuselela umthwalo wemishini njengengxenye ebalulekile yesu lokuvuselela.
Umbono neziphetho zesikhathi esizayo
Inqubekelaphambili yezobuchwepheshe yemishini ye-PRP nezindlela zokulungiselela ibonisa imiphumela ethembisayo yesiguli, nakuba incazelo yama-agent e-PRP e-biological ahlukene kanye nezici ezifanele ze-biological zomkhiqizo wokugcina ayikacaci.Ukwengeza, amandla aphelele ezinkomba ze-PRP kanye nezicelo awakanqunywa.Kuze kube muva nje, i-PRP ithengiswe ngokwentengiso njengomkhiqizo wegazi ozenzakalelayo, onganikeza odokotela ikhono lokusebenzisa ubuchwepheshe be-autologous platelet growth factor ku-pathology ekhonjisiwe nezifo.Ekuqaleni, okuwukuphela kombandela wokusetshenziswa ngempumelelo kwe-PRP evame ukucashunwa isampula elungisiwe, okugxilwa kwayo kweplatelet kuphakeme kunelonke inani legazi.Namuhla, ngenhlanhla, odokotela banokuqonda okubanzi kokusebenza kwe-PRP.
Kulokhu kubuyekezwa, siyavuma ukuthi kusekhona ukuntuleka kokumisa nokuhlukanisa kubuchwepheshe bokulungiselela;Ngakho-ke, akukho ukuvumelana kuma-agent we-PRP wezinto eziphilayo okwamanje, nakuba izincwadi eziningi ziye zafinyelela esivumelwaneni mayelana nokugxila kwe-platelet esebenzayo edingekayo ukuze kuthuthukiswe (entsha) i-angiogenesis.Lapha, sethule kafushane umsebenzi wama-PGF, kodwa sabonisa kabanzi indlela ethile ye-platelet kanye nomthelela womphumela wamaseli amhlophe egazi nama-MSC, kanye nokusebenzisana okwalandela kwamaseli.Ikakhulukazi, ukuba khona kwamangqamuzana amhlophe egazi emalungiselelweni e-PRP kunikeza ukuqonda okujulile kwemiphumela eyingozi noma enenzuzo.Indima ecacile yamaplatelet kanye nokusebenzisana kwawo namasosha omzimba azalwa nawo futhi aguquguqukayo kuye kwaxoxwa ngakho.Ukwengeza, izifundo zomtholampilo ezanele futhi ezibhalwe kahle ziyadingeka ukuze kunqunywe amandla aphelele kanye nomphumela wokwelapha we-PRP ezinkomba ezihlukahlukene.
(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: Mar-01-2023