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细胞疗法可用于治疗股骨头缺血性坏死

作者:Piuzzi NS等 翻译:北医三院张警丰 来源:中国风湿病公众论坛 日期:2017-11-28
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         细胞疗法可用于治疗股骨头缺血性坏死

        背景:股骨头坏死(ONFH)与局部骨细胞缺失有关,常导致疼痛和机械性股骨头塌陷。本研究的目的是分析临床研究中细胞治疗用于ONFH的如下因素:(1)细胞来源(2)采集方法(3)细胞处理(4)细胞质量和数量特点(5)输注方法。

        方法:对目前文献中报道的应用细胞疗法治疗ONFH的文献进行系统回顾。纳入的研究均为证据等级III级及以上的。共搜索1483篇文章,11篇研究符合本研究标准并纳入本研究。

        结果:10例研究以骨髓为细胞来源,1例研究以血液为细胞来源。9例研究应用自骨髓分离的新鲜组织来源有核细胞混合骨髓来源的有核细胞,1例研究应用混合血液来源的有核细胞,1例研究应用骨髓穿刺获得的细胞进行培养扩增后的细胞。细胞数量自200万至300万不等。5项研究评估细胞质量应用细胞表面标记物CD34.2项研究分析细胞数量应用集落形成单位测定。

        结论:目前缺乏保证细胞质量和数量的标准化收集方法。细胞治疗可以作为一个因各种损伤或疾病导致局部细胞减少的方法。但是仍需证据级别更高的双盲随机对照研究结果以证实此种疗法确可获益,并建立标准化流程。

        附原文:

        Abstract:BACKGROUND:Osteonecrosis of thefemoral head(ONFH) is associated with regional loss of cells within bone, often resulting in pain and mechanical collapse. Our purpose was to analyze the cell-therapies used in clinical trials for thetreatmentof ONFH with regard to (1) cell-sources, (2) collection techniques, (3)cell-processing, (4) qualitative and quantitative characterizations, and (5) delivery methods.METHODS:A systematicreviewof the current literature on the use of cell therapies for thetreatmentof ONFH was performed. Studies with a level-of-evidence III or higher were evaluated. A total of 1483 articles were screened. Eleven studies met the criteria to be included in thisreview.RESULTS:Ten studies used bone-marrow, and 1 study used blood as the cell-source. Nine studies used freshly isolated tissue-derived nucleated cells from bone-marrow, mixed bone marrow-derived nucleated cells, 1 study used mixed blood-derived nucleated cells, and 1 study used culture-expanded cells derived from bone marrow aspirate. Cell dose varied from 2-million to 3-billion cells. Qualitative cell characterization of injected cells using surface markers was done by 5 studies using CD34. Two studies assayed the cell-population using a colony-forming-unit assay.CONCLUSION:There is a lack of standardization with respect to the quantitative and qualitative characterization of methods for cell-harvest, cell-processing, and cell-transplantation/delivery. Cell-therapyholds promise as a means of restoring local cell populations that are made deficient because of injury or disease. However, the orthopedic community and patients will benefit greatly by a greater investment in blinded, randomized, controlled trials and clinical effectiveness trials that embrace rigorous standards.

        引自:Piuzzi NS,Chahla J,Jiandong H,Chughtai M, et al.Analysis of Cell Therapies Used in Clinical Trials for theTreatmentof Osteonecrosis of the Femoral Head: A SystematicReviewof the Literature.J Arthroplasty.2017 Aug;32(8):2612-2618.

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