The Lancet:鼻子或许可以治愈膝关节损伤
2016/10/23
近日,一项发表在The Lancet杂志上的研究表明,来源于鼻中隔的软骨细胞可以移植到受损的膝盖中,治疗膝盖关节软骨损伤。


关节软骨损伤后很难修复,往往导致进行性关节损伤。不论是传统的治疗方法还是以植入关节软骨细胞为基础的先进疗法都无法可预见性地修复这种损伤。近日,一项发表在The Lancet杂志上的研究表明,对于那些膝关节损伤的患者来说,最有希望治愈他们的软骨可能来源于他们的鼻子。

来自瑞士的医生们首次将软骨从鼻内移植到患者严重损伤的膝盖结缔组织中,这种结缔组织的撕裂将导致疼痛和关节炎。

目前临床上修复软骨的方法比较有限,医生们将来自于尸体或者患者关节中健康部分的软骨细胞注射或者移植到损伤部位。

在过去的十年中,研究人员已经意识到来源于鼻子的软骨细胞比较容易形成可耐受膝关节机械压力的新组织。比起他人膝盖中的软骨细胞修复损伤,使用患者自身鼻子里的软骨细胞生物相容性更好,损伤也更小。

在这项研究中,研究人员从患者鼻中隔切出一个小扁块,利用酶将组织破碎,然后在一个多孔膜上培养细胞。当这些细胞被移植到膝关节时,它们将产生明显的膝关节软骨特性,可通过关键结构分子比如胶原蛋白和葡萄糖胺聚糖的浓度加以评估。

研究人员表示,与其他移植方法相比,该方法可以使患者经历更少的疼痛,并且日常功能得到了更大的改善。

不过,作者也承认,这可能一部分是由于安慰剂效应或者是一些与移植过程无关的改善,但是这些结果带来了足够的希望使他们能在4个不同的临床中心的108名患者中进行II期临床试验。

备注:本文编译自Science网站,原标题:“Tear your knee? Maybe your nose can help it heal

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  • Nasal chondrocyte-based engineered autologous cartilage tissue for repair of articular cartilage defects: an observational first-in-human trial

    Background Articular cartilage injuries have poor repair capacity, leading to progressive joint damage, and cannot be restored predictably by either conventional treatments or advanced therapies based on implantation of articular chondrocytes. Compared with articular chondrocytes, chondrocytes derived from the nasal septum have superior and more reproducible capacity to generate hyaline-like cartilage tissues, with the plasticity to adapt to a joint environment. We aimed to assess whether engineered autologous nasal chondrocyte-based cartilage grafts allow safe and functional restoration of knee cartilage defects. Methods In a first-in-human trial, ten patients with symptomatic, post-traumatic, full-thickness cartilage lesions (2–6 cm2) on the femoral condyle or trochlea were treated at University Hospital Basel in Switzerland. Chondrocytes isolated from a 6 mm nasal septum biopsy specimen were expanded and cultured onto collagen membranes to engineer cartilage grafts (30 × 40 × 2 mm). The engineered tissues were implanted into the femoral defects via mini-arthrotomy and assessed up to 24 months after surgery. Primary outcomes were feasibility and safety of the procedure. Secondary outcomes included self-assessed clinical scores and MRI-based estimation of morphological and compositional quality of the repair tissue. This study is registered with ClinicalTrials.gov, number NCT01605201. The study is ongoing, with an approved extension to 25 patients. Findings For every patient, it was feasible to manufacture cartilaginous grafts with nasal chondrocytes embedded in an extracellular matrix rich in glycosaminoglycan and type II collagen. Engineered tissues were stable through handling with forceps and could be secured in the injured joints. No adverse reactions were recorded and self-assessed clinical scores for pain, knee function, and quality of life were improved significantly from before surgery to 24 months after surgery. Radiological assessments indicated variable degrees of defect filling and development of repair tissue approaching the composition of native cartilage. Interpretation Hyaline-like cartilage tissues, engineered from autologous nasal chondrocytes, can be used clinically for repair of articular cartilage defects in the knee. Future studies are warranted to assess efficacy in large controlled trials and to investigate an extension of indications to early degenerative states or to other joints. Funding Deutsche Arthrose-Hilfe.

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