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Kumvetsetsa Kwatsopano kwa Platelet Rich Plasma Therapy (PRP) - Gawo III

Udindo wa mapulateleti mu m`mafupa aspiration kuganizira

PRP ndi bone marrow aspiration concentrate (BMAC) akugwiritsidwa ntchito pazithandizo zingapo zachipatala m'malo a ofesi ndi opaleshoni chifukwa cha ubwino wawo wotsitsimutsa mu MSK ndi matenda a msana, kupweteka kosalekeza ndi zizindikiro za minofu yofewa.PRP sikuti imangoyendetsa kusamuka kwa maselo ndi kuchuluka kwa maselo, komanso imathandizira ku angiogenesis ndi ECM kukonzanso kuti apange microenvironment yabwino ndikulimbikitsa kukonzanso minofu ndi kusinthika.

 

BMAC kukonza ndondomeko

Ma BMAC ndi ma cell amitundu yosiyanasiyana omwe amakhala ndi ma BMMSC, kuwapanga kukhala gwero la cell lamankhwala okonzanso mankhwala.Amagwira ntchito pochepetsa apoptosis ya cell, fibrosis ndi kutupa;Ndipo yambitsani zomwe zimachititsa kuti ma cell achuluke.Kuphatikiza apo, ma BMMSC amatha kusiyanitsa mitundu yosiyanasiyana yama cell, kuphatikiza ma osteoblasts, adipocytes, myoblasts, maselo a epithelial ndi ma neurons.Amalimbikitsanso angiogenesis kudzera munjira za paracrine ndi autocrine.Ndikofunikiranso kuti BMMSC ikhale yothandizira kuti chitetezo cha mthupi chitetezeke popanda maselo enieni a chitetezo cha mthupi, omwe amatenga nawo mbali mu gawo lotupa la kukonza mabala.Kuphatikiza apo, ma BMMSC amathandizira kulembera maselo kumalo atsopano ochizira angiogenesis kuti apititse patsogolo kukonzanso kwa magazi.Jin et al.Zinatsimikiziridwa kuti pakalibe ma scaffolds okwanira, kuchuluka kwa moyo wa BMMSC ndi kukonzanso kwake ndi kusiyanitsa kulimbikitsa machiritso kunawonongeka.Ngakhale kusonkhanitsa minofu, kukonzekera kwa zitsanzo ndi machitidwe a PRP ndi BMAC ndizosiyana, kafukufuku amasonyeza kuti amatha kuthandizirana.M'malo mwake, kuphatikiza PRP ndi BMAC kukhala chinthu chachilengedwe kungakhale ndi zabwino zina.

 

Kuphatikiza PRP ndi BMAC

Malinga ndi kafukufuku wina wosadziwika bwino, mfundo yoyambira yophatikizira PRP ndi BMAC idakhazikitsidwa ndi malo angapo.Choyamba, PRP ikhoza kupereka chilengedwe choyenera chomwe BMSC ikhoza kupititsa patsogolo kukula kwa maselo ndi kusiyanitsa ndikuwonjezera angiogenesis.Kachiwiri, PRP yakhala ikugwiritsidwa ntchito ngati scaffold yama cell awa pamodzi ndi BMAC.M'malo mwake, kuphatikiza kwa PRP ndi BMAC kumatha kukhala chida champhamvu chachilengedwe chokopa anthu a BMMSC.Pulogalamu ya PRP-BMAC yakhala ikugwiritsidwa ntchito pochiza tendinosis, mabala, kuvulala kwa msana, ma discs osokonekera a intervertebral discs ndi osteochondral osteochondral omwe amatha kubadwanso.Tsoka ilo, ngakhale kuti zigawo za maselo a m'mafupa amtundu wambiri zimaphatikizapo mapulateleti, malipoti ochepa amatchula kuchuluka kwa mapulateleti m'mafupa ochotsedwa komanso pambuyo pa chithandizo cha BMAC, koma akhoza kuchotsedwa ndi njira zoyenera zokhumba.Kafukufuku wowonjezera akufunika kuti amvetsetse ngati zowonjezera zamagulu a m'magazi ziyenera kugwiritsidwa ntchito limodzi ndi BMAC.Pakalipano, palibe deta yokhudzana ndi chiŵerengero choyenera cha mapulateleti ku MSC (kapena maselo ena a m'mafupa), zomwe zimakhudza kwambiri kayendedwe ka kadyedwe ka MSC pakukonza minofu.Moyenera, zida zosonkhanitsira mafupa ndi ukadaulo zitha kukonzedwa kuti zitheke kutulutsa mapulateleti okwanira m'mafupa.

 

PRP kukula factor ndi BMAC zakudya zotsatira

PRP platelet kukula factor ndi mapuloteni ofunikira omwe amakhudzidwa ndi kukonza kwa BMAC.Kusiyanasiyana kwa PGF ndi ma cytokines ena omwe amakhudzidwa ndi zakudya za BMAC akhoza kuyambitsa kukonzanso minofu mwa kuchepetsa apoptosis ya maselo, anabolism ndi zotsatira zotsutsana ndi kutupa, ndi kuyambitsa kufalikira kwa maselo, kusiyanitsa ndi angiogenesis kupyolera mu njira za paracrine ndi autocrine.

PRP-kukula-factor-ndi-BMAC-zakudya zopatsa thanzi

 

Kukula kochokera ku Platelet ndi zigawo zowirira za granule mwachiwonekere zimakhudzidwa ndi zakudya za BMAC ndikuthandizira kukonzanso minofu ndi kusinthika koyambitsidwa ndi MSC.Chidule cha MSC: maselo a mesenchymal stem cell, HSC: hematopoietic stem cell.

Mwachiwonekere, pochiza OA, PDGF imakhala ndi gawo linalake la kusinthika kwa cartilage ndi kukonza homeostasis kupyolera mu kuchuluka kwa MSC ndi kuletsa kwa IL-1-induced chondrocyte apoptosis ndi kutupa.Kuonjezera apo, atatu a TGF- β The subtypes akugwira ntchito polimbikitsa mapangidwe a cartilage ndi kulepheretsa kutupa, ndipo amasonyeza mphamvu yopititsa patsogolo machiritso a minofu yokhudzana ndi MSC kudzera mu mgwirizano wa intermolecular.Zakudya zopatsa thanzi za MSC zimagwirizana ndi ntchito ya PGF komanso kutulutsa kwa ma cytokines okonza.Momwemo, ma cytokines onsewa ayenera kukhalapo mu botolo la mankhwala a BMAC ndikupita kumalo ovulala kwa minofu kuti apititse patsogolo machiritso abwino kwambiri okhudzana ndi MSC.

Mu kafukufuku wa OA, Mui ñ os-L ó pez et al.Zikuwonetsa kuti MSC yochokera ku minofu ya synovial yasintha ntchito, zomwe zimapangitsa kuti mphamvu yake yochira iwonongeke.Chochititsa chidwi n'chakuti, jekeseni wachindunji wa PRP mu subchondral bone ya osteoarthritis inachititsa kuchepetsa MSC mu synovial fluid, kusonyeza kusintha kwachipatala.Zotsatira zochiritsira zimayendetsedwa ndi kuchepetsa njira yotupa mu synovial fluid ya OA odwala.

Pali chidziwitso chochepa chomwe chilipo chokhudza kukhalapo kapena kuchuluka kwa PGF mu BMAC kapena chiŵerengero choyenera chofunikira kuthandizira ntchito yazakudya ya BMMSC.Madokotala ena amaphatikiza kuchuluka kwa PRP ndi BMAC kuti apeze zophatikizira za biologically, zomwe zikuyembekezeka kupititsa patsogolo zotsatira za chithandizo chamankhwala obwezeretsanso.Komabe, pali zochepa zomwe zilipo zachitetezo ndi zogwira mtima, zomwe zikuwonetsa kuti kuphatikiza ndende yayikulu ya PRP ndi BMAC ndi njira yabwino yothandizira.Chifukwa chake, tikukhulupirira kuti sikungakhale koyenera kuwongolera BMMSC powayambitsa ndi kuchuluka kwa mapulateleti pakadali pano.

 

Kuyanjana kwa mapulateleti ndi antiplatelet mankhwala ndi NSAIDs

PRP ili ndi zigawo zambiri zachinsinsi ndipo imapangidwa ndi zinthu zambiri zamoyo.Zotsatira zochiritsira za PRP zimatchedwa oyimira pakati.Ngakhale oyimira achire omwe ali m'mapulateleti amadziwika bwino, kupangika koyenera komanso kusinthika kwamankhwala a anabolic ndi catabolic sikumveka bwino.Chimodzi mwazolepheretsa kwambiri kuti tipeze njira zochizira ndikuthana ndi kusiyanasiyana kwa oyimira pakati pachilengedwewa kuti athe kutsata zomwe zimayendetsedwa bwino zomwe zimabwerezedwa nthawi zonse komanso zopindulitsa pachipatala.Pachifukwa ichi, mankhwala (monga non-steroidal anti-inflammatory drugs (NSAIDs)) angakhudze kutulutsidwa kwa magulu a secretory a platelet.M'kafukufuku waposachedwa wotsegula-label yokhazikika, kudya tsiku ndi tsiku kwa 81 mg wa aspirin (ASA) kunachepetsa mawu a oyimira pakati, monga TGF- β 1. PDGF ndi VEGF.

Zotsatirazi zimatheka chifukwa cha kuletsa kosasinthika kwa cyclooxygenase-1 (COX-1) komanso kuletsa kosinthika kwa cyclooxygenase-2 (COX-2), omwe ndi michere iwiri yofunikira pakutsika kwa mapulateleti.Kuwunika mwadongosolo kwaposachedwa kunapeza kuti mankhwala a antiplatelet amatha kuchepetsa curve factor kutulutsa munjira yodalira COX-1 ndi COX-2, ndipo 8 mwa maphunziro 15 adapeza kuti kukula kwachepa.

Mankhwala osokoneza bongo (monga NSAIDs) amagwiritsidwa ntchito kuthetsa ululu ndi kuchepetsa kutupa chifukwa cha matenda a MSK.Njira ya NSAIDs ndikuletsa kutsegulidwa kwa mapulateleti pomanga mosasinthika ndi COX enzyme ndikuwongolera njira ya arachidonic acid.Chifukwa chake, ntchito ya mapulateleti idzasintha nthawi yonse ya moyo wa mapulateleti, motero kupewa kufalikira kwa chizindikiro cha PGF.NSAIDs zimalepheretsa kupanga cytokine (mwachitsanzo, PDGF, FGF, VEGF, ndi IL-1 β, IL-6, ndi IL-8), pamene ikuthandizira TNF- α.Palibe mgwirizano pa nthawi yabwino yokonzekera ndi kuyendetsa PRP kwa odwala omwe amagwiritsa ntchito NSAID.Mannava ndi anzake adawerengera anabolic ndi catabolic biological factor mu leucocyte-rich PRP ya odzipereka athanzi omwe amatenga naproxen.Iwo adapeza kuti atagwiritsa ntchito naproxen kwa sabata imodzi, milingo ya PDGF-AA ndi PDGF-AB (mitogen yogwira ntchito yolimbikitsa angiogenesis) idachepetsedwa kwambiri.Pambuyo pa sabata imodzi, kuchuluka kwa kukula kunabwereranso pafupi ndi gawo loyambira.Pambuyo pogwiritsira ntchito naproxen kwa sabata imodzi, mlingo wa LR-PRP wa proinflammatory and catabolic factor IL-6 unachepanso, ndipo unabwereranso ku mlingo woyambira pambuyo pa nthawi yovomerezeka ya sabata imodzi.Pakalipano, palibe kafukufuku wachipatala wotsimikizira kuti odwala omwe ali ndi naproxen pambuyo pa chithandizo cha PRP ali ndi zotsatira zoipa;Komabe, tikulimbikitsidwa kuti tiganizire za nthawi yosamba kwa sabata imodzi kuti mubwezeretse PDGF-AA, PDGF-BB ndi IL-6 makhalidwe pamlingo woyambira kuti apititse patsogolo ntchito zawo zamoyo.Kafukufuku wochulukirapo akufunika kuti amvetse bwino zotsatira za antiplatelet ndi NSAID pa gulu lachinsinsi la PRP ndi zolinga zake zapansi.

 

Phatikizani kugwiritsa ntchito plasma wolemera ku platelet ndi kukonzanso

Ngakhale kuti kafukufuku wofunikira wa sayansi akuwonetsa kuti chithandizo chamankhwala ndi katundu wamakina ali ndi gawo lomveka bwino pakubwezeretsa kapangidwe ka tendon pambuyo pa jekeseni wa PRP, palibe mgwirizano pa ndondomeko yabwino yokonzanso matenda a MSK pambuyo pa chithandizo cha PRP.

Chithandizo cha PRP chimaphatikizapo jekeseni wa mapulateleti okhazikika m'malo amtundu wa minofu kuti athetse ululu ndikulimbikitsa kukonza minofu.Umboni wamphamvu kwambiri wachipatala ulipo mu OA ya bondo.Komabe, kugwiritsa ntchito PRP pochiza zizindikiro za tendinosis ndizotsutsana, ndipo zotsatira zomwe zafotokozedwa ndizosiyana.Maphunziro a zinyama nthawi zambiri amasonyeza kusintha kwa histological kwa tendinosis pambuyo pa kulowa kwa PRP.Maphunzirowa akuwonetsa kuti katundu wamakina amatha kukonzanso ma tendon, ndipo katundu ndi jekeseni wa PRP amagwira ntchito limodzi kuti alimbikitse machiritso a tendon.Kusiyanasiyana kwa kukonzekera kwa PRP, kukonzekera kwachilengedwe, kukonzekera, ndondomeko za jekeseni ndi ma subtypes ovulaza tendon angayambitse kusiyana kwa zotsatira zachipatala.Kuonjezera apo, ngakhale kuti umboni wa sayansi umachirikiza ubwino wa ndondomeko zokonzanso, zofufuza zochepa zachipatala zofalitsidwa zimayesa kuyendetsa ndi kugwirizanitsa ndondomeko zokhazikika pambuyo pa PRP.

Posachedwapa, Onishi et al.Udindo wa mechanical load ndi PRP biological effect mu Achilles tendon matenda adawunikiridwa.Anayesa maphunziro a chipatala cha gawo I ndi gawo lachiwiri la matenda a Achilles tendon omwe amachitidwa ndi PRP, poyang'ana ndondomeko yokonzanso pambuyo pa jekeseni wa PRP.Mapulogalamu owongolera omwe amayang'aniridwa akuwoneka kuti amathandizira kutsata zolimbitsa thupi ndikuwongolera zotsatira komanso kuthekera koyang'anira kuchuluka kwa masewera olimbitsa thupi.Mayesero angapo opangidwa bwino a Achilles tendon PRP amaphatikiza chithandizo cha post-PRP ndi dongosolo lokonzanso katundu wamakina monga gawo lofunikira la njira yokonzanso.

 

Malingaliro amtsogolo ndi zomaliza

Kupita patsogolo kwaukadaulo kwa zida za PRP ndi njira zokonzekera zikuwonetsa zotsatira zoyembekeza za odwala, ngakhale kutanthauzira kwa ma PRP biological agents osiyanasiyana komanso mawonekedwe ofunikira achilengedwe a chomaliza akadali osatsimikizika.Kuonjezera apo, mphamvu zonse za PRP zowonetsera ndi ntchito sizinatsimikizidwe.Mpaka posachedwa, PRP yagulitsidwa malonda ngati mankhwala opangidwa ndi magazi a autologous, omwe angapereke madokotala kuti athe kugwiritsa ntchito teknoloji ya autologous platelet growth factor mu matenda ndi matenda omwe amasonyeza.Poyamba, njira yokhayo yogwiritsira ntchito bwino PRP yomwe nthawi zambiri imatchulidwa ndi chitsanzo chokonzekera, chomwe chiwerengero chake cha mapulaneti ndi apamwamba kuposa mtengo wonse wa magazi.Masiku ano, mwamwayi, madokotala ali ndi chidziwitso chokwanira cha ntchito ya PRP.

Mu ndemanga iyi, timavomereza kuti padakalibe kusowa kovomerezeka ndi kugawanika mu teknoloji yokonzekera;Choncho, palibe mgwirizano pa PRP biological agents pakali pano, ngakhale kuti zolemba zambiri zakhala zikugwirizana ndi mlingo woyenera wa mlingo wa platelet wofunikira kulimbikitsa (zatsopano) angiogenesis.Apa, tidawonetsa mwachidule zochitika za PGFs, koma zikuwonetsa momveka bwino momwe ma cell amagazi amagwirira ntchito komanso momwe maselo oyera amagazi amagwirira ntchito ndi ma MSC, komanso kulumikizana kwa ma cell.Makamaka, kukhalapo kwa maselo oyera m'makonzedwe a PRP kumapereka chidziwitso chozama cha zotsatira zovulaza kapena zopindulitsa.Udindo womveka bwino wa mapulateleti ndi kuyanjana kwawo ndi chitetezo cham'mimba komanso chosinthika chakambidwa.Kuonjezera apo, maphunziro azachipatala okwanira komanso olembedwa bwino amafunikira kuti adziwe mphamvu zonse ndi chithandizo cha PRP mu zizindikiro zosiyanasiyana.

 

 

 

(Zomwe zili m'nkhaniyi zidasindikizidwanso, ndipo sitikupereka chitsimikizo chotsimikizika kapena chotsimikizika pakulondola, kudalirika kapena kukwanira kwa zomwe zili m'nkhaniyi, ndipo sitili ndi udindo pamalingaliro ankhaniyi, chonde mvetsetsani.)


Nthawi yotumiza: Mar-01-2023