Blutprodukte und Stammzellen in der Arthrosetherapie

Der Grundsatz der regenerativen Medizin in der Arthrosebehandlung verfolgt eine funktionelle Wiederherstellung von Knorpelgewebe statt nur Reparatur von Knorpeldefekten. Mit dem Einsatz von Blutprodukten sollen chronische Entzündungsprozesse gehemmt und Geweberegeneration gefördert werden. Stammzelltherapien basieren in der Arthrosetherapie häufig auf mesenchymalen Stammzellen aus Fettgewebe oder Knochenmarkaspirat. Extrazelluläre Vesikel als mögliche Botenstoffe der Regeneration könnten Wirkmechanismen erklären.

Abstract

The principle of regenerative medicine in the treatment of osteoarthritis pursues a functional restoration of cartilage tissue instead of just repairing cartilage defects. The use of blood products is intended to inhibit chronic inflammatory processes and promote tissue regeneration. Intraarticular injection of autologous platelet-rich plasma (PRP) is a prominent procedure. Clinical evidence supports PRP injection over hyaluronic acid or glucocorticoid injection. Comparability of studies is difficult due to missing standardisation of production procedures, dosing and donor variability. In particular, whether presence of residual leukocytes is required or should be avoided is an open debate. In contrast, stem cell therapies in osteoarthritis therapy are often based on mesenchymal stem cells (MSC) from adipose tissue or bone marrow aspirate. Different sources of MSC might render the cells more suitable for application in a given context. Nevertheless, it became evident that their secretome rather than the cells themselves are responsible for observed regenerative processes. Research on the mechanisms of action have focused on growth factors. However, an overlooked component of blood products called extracellular vesicles (EV) came to the center of attention, which are also released by MSC as intercellular signal carriers. EV cargo molecules such as miRNAs open up new dimensions in the investigation and explanation of clinically observed anti-inflammatory and regenerative effects.

Kernaussagen

• Die Anwendung von Blutprodukten wie Platelet-rich Plasma (PRP) imitiert die Phasen der Wundheilung und soll helfen, chronische Entzündungszustände zu überwinden.

• Platelet-rich Plasma bietet Patienten in der frühen Phase einer degenerativen Knieveränderung eine bessere symptomatische Schmerzlinderung als intraartikuläre Injektion mit konventionellen Chondroprotektiva wie Hyaluronsäure und sollte bei Patienten mit Knieosteoarthrose in Betracht gezogen werden, jedoch nicht bei Patienten mit fortgeschrittener Osteoarthrose.

• MSC-basierte (MSC: mesenchymale Stamm- bzw. Stromazellen) Therapien werden zur Symptommodifikation bei Arthrose eingesetzt.

• Die klinische Evidenz ist bei vielen dieser Indikationen gering, dennoch konnte bei einigen Indikationen wie Bone Marrow Aspirate (BMAC) in Kombination mit Scaffolds bei Knorpelläsionen bereits ein moderater Body of Evidence aufgebaut werden. Die höchste Evidenz hat die Therapie mit Platelet-rich Plasma (PRP) für die Anwendung bei Gonarthrose gezeigt.

• Die Heterogenität von Produkten, Zellquellen und Prozessierungen macht die wissenschaftliche Vergleichbarkeit von Methoden oft herausfordernd.

• Extrazelluläre Vesikel können verschiedene Signalmoleküle transportieren, Entzündung hemmen und Geweberegeneration fördern.

Schlüsselwörter

Platelet-rich Plasma - mesenchymale Stammzellen - extrazelluläre Vesikel - Knorpelgewebe

Keywords

platelet-rich plasma - mesenchymal stem cells - extracellular vesicle - cartilage tissue

Publikationsverlauf

Artikel online veröffentlicht:
25. September 2024

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