PRP na zamani: "PRP na asibiti"
A cikin shekaru 10 da suka gabata, tsarin kulawa na PRP ya sami manyan canje-canje.Ta hanyar gwaje-gwaje da bincike na asibiti, yanzu muna da kyakkyawar fahimta game da platelet da sauran ilimin halittar jiki.Bugu da ƙari, ƙima mai yawa na tsarin ƙima, ƙididdigar meta-bincike da gwaje-gwajen da bazuwar bazuwar sun nuna tasirin ilimin kimiyyar halittu na PRP a fannonin kiwon lafiya da yawa, gami da dermatology, tiyata na zuciya, tiyata filastik, tiyata orthopedic, kula da ciwo, cututtuka na kashin baya, da kuma maganin wasanni. .
Halin halin yanzu na PRP shine cikakken ƙaddamarwar platelet, wanda ya canza daga ma'anar farko na PRP (ciki har da ƙaddamarwar platelet sama da ƙimar tushe) zuwa fiye da 1 × 10 6/µ L ko kusan sau 5 mafi ƙarancin ƙwayar platelet a cikin platelet daga tushe.A cikin babban bita na Fadadu et al.An kimanta tsarin PRP 33 da ka'idoji.Ƙididdigar platelet na shirye-shiryen PRP na ƙarshe da wasu daga cikin waɗannan tsarin suka samar ya kasance ƙasa da na dukan jini.Sun bayar da rahoton cewa adadin platelet na PRP ya karu da ƙasa kamar 0.52 tare da kayan juzu'i guda ɗaya (Selphyl®).Sabanin haka, juyawa biyu EmCyte Farawa PurePRPII ® Tsarin platelet da na'urar ke samarwa shine mafi girma (1.6 × 10 6 /µL).
Babu shakka, in vitro da hanyoyin dabba ba su ne kyakkyawan yanayin bincike don samun nasarar canji zuwa aikin asibiti ba.Hakazalika, binciken kwatancen na'urar baya goyan bayan shawarar, saboda sun nuna cewa ƙaddamarwar platelet tsakanin na'urorin PRP ya bambanta sosai.Abin farin ciki, ta hanyar fasaha da bincike na tushen proteomics, za mu iya ƙara fahimtar ayyukan tantanin halitta a cikin PRP wanda ke shafar sakamakon jiyya.Kafin a cimma matsaya kan daidaitattun shirye-shiryen PRP da gyare-gyare, PRP ya kamata ya bi ka'idodin PRP na asibiti don haɓaka ingantattun hanyoyin gyaran nama da ci gaba da sakamakon asibiti.
Tsarin PRP na asibiti
A halin yanzu, ingantaccen PRP na asibiti (C-PRP) an siffanta shi azaman hadadden abun da ke tattare da abubuwa masu yawa na autologous a cikin ƙaramin ƙaramar plasma da aka samu daga wani ɓangaren jini na gefe bayan centrifugation.Bayan centrifugation, za a iya dawo da PRP da abubuwan da ba na platelet ba daga na'urar tattarawa bisa ga nau'in sel daban-daban (wanda yawancin platelet shine mafi ƙanƙanta).
Yi amfani da PurePRP-SP ® Kayan aikin rabuwar ƙwayar salula (EmCyte Corporation, Fort Myers, FL, Amurka) an yi amfani da shi don cikakken jini bayan hanyoyi biyu na centrifugation.Bayan tsari na farko na centrifugation, an raba dukkan sassan jini zuwa nau'i biyu na asali, platelet (lean) suspension plasma da kuma jajayen kwayoyin jini.A cikin A, an kammala mataki na centrifugation na biyu.Ana iya fitar da ainihin ƙarar PRP don aikace-aikacen haƙuri.Girman da ke cikin B yana nuna cewa an tsara nau'in nau'in nau'in nau'in erythrocyte sedimentation launin ruwan kasa (wanda ke wakiltar layin blue) a kasan kayan aiki, wanda ya ƙunshi babban adadin platelets, monocytes da lymphocytes, bisa ga girman girman.A cikin wannan misali, bisa ga ka'idar shirye-shiryen C-PRP tare da ƙananan neutrophils, za a fitar da mafi ƙarancin adadin neutrophils (<0.3%) da erythrocytes (<0.1%).
Platelet granule
A cikin aikace-aikacen PRP na farko na asibiti, α- Granules sune tsarin da aka fi sani da platelet na ciki, saboda sun ƙunshi abubuwan haɗin gwiwa, babban adadin PDGF da masu kula da angiogenic, amma suna da ƙananan aikin thrombogenic.Sauran abubuwan sun haɗa da abubuwan da ba a sani ba na chemokine da cytokine, irin su platelet factor 4 (PF4), furotin pre-platelet, P-selectin (mai kunnawa na integrin) da chemokine RANTES (wanda aka tsara ta kunnawa, yana bayyana ƙwayoyin T na al'ada da mai yiwuwa. sirri).Gabaɗayan aikin waɗannan ƙayyadaddun abubuwan ɓangarorin platelet shine ɗaukar aiki da kunna wasu ƙwayoyin rigakafi ko haifar da kumburin sel na endothelial.
Abubuwan ɓangarorin granular masu yawa kamar ADP, serotonin, polyphosphate, histamine da adrenaline an fi amfani da su a fakaice azaman masu kula da kunna platelet da thrombosis.Mafi mahimmanci, yawancin waɗannan abubuwan suna da aikin gyara ƙwayoyin rigakafi.Platelet ADP an gane shi ta hanyar P2Y12ADP mai karɓa akan sel dendritic (DC), don haka yana haɓaka endocytosis na antigen.DC (kwayoyin gabatarwa na antigen) yana da matukar mahimmanci don farawa da amsawar rigakafi na T cell da kuma sarrafa amsawar rigakafi, wanda ke danganta tsarin rigakafi na asali da tsarin rigakafi na daidaitawa.Bugu da ƙari, platelet adenosine triphosphate (ATP) yana aika sigina ta hanyar T cell receptor P2X7, wanda ya haifar da ƙara yawan bambance-bambancen CD4 T a cikin kwayoyin proinflammatory T helper 17 (Th17).Sauran abubuwan ɓangarorin ɓangarorin platelet masu yawa (kamar glutamate da serotonin) suna haifar da ƙaurawar tantanin halitta T kuma suna haɓaka bambancin monocyte zuwa DC, bi da bi.A cikin PRP, waɗannan immunomodulators waɗanda aka samo daga ɓangarorin ɗimbin yawa suna da wadatuwa sosai kuma suna da ayyukan rigakafi masu yawa.
Adadin yuwuwar hulɗar kai tsaye da kaikaice tsakanin platelets da sauran sel (mai karɓa) yana da yawa.Sabili da haka, aikace-aikacen PRP a cikin yanayin ƙwayar ƙwayar cuta na gida na iya haifar da nau'i-nau'i iri-iri.
Matsalolin platelet
C-PRP ya kamata ya ƙunshi allurai na asibiti na platelet mai da hankali don samar da tasirin warkewa mai fa'ida.Platelets a cikin C-PRP ya kamata su haɓaka haɓakar ƙwayoyin cuta, haɓakar abubuwan mesenchymal da neurotrophic, haɓaka ƙaura na ƙwayoyin chemotactic da haɓaka ayyukan rigakafi, kamar yadda aka nuna a cikin adadi.
Kunna platelets, sakin PGF da kwayoyin adhesion suna daidaita ma'amala iri-iri: chemotaxis, adhesion cell, ƙaura, da bambance-bambancen tantanin halitta, da daidaita ayyukan tsarin rigakafi.Wadannan hulɗar sel-kwayoyin platelet suna ba da gudummawa ga angiogenesis da ayyukan kumburi, kuma a ƙarshe suna ƙarfafa tsarin gyaran nama.Abbreviations: BMA: kasusuwan kasusuwa aspirate, EPC: endothelial progenitor cells, EC: endothelial cell, 5-HT: 5-hydroxytryptamine, RANTES: tsarin da aka kunna na al'ada T cell magana da ɓoyewar ɓoyewa, JAM: nau'in nau'in kwayoyin adhesion, CD40L: cluster. 40 ligand, SDF-1 α: Stromal cell-derived factor-1 α, CXCL: chemokine (CXC motif) ligand, PF4: platelet factor 4. An daidaita shi daga Everts et al.
Marx shine mutum na farko da ya tabbatar da cewa an inganta warkar da kashi da taushi, kuma mafi ƙarancin adadin platelet shine 1 × 10 6 / µL. An tabbatar da waɗannan sakamakon a cikin binciken haɗin gwiwa na lumbar ta hanyar intervertebral foramen, lokacin da adadin platelet ya fi girma. 1.3 × A 106 platelets/µ L, wannan binciken ya nuna ƙarin haɗuwa.Bugu da kari, Giusti et al.Bayyana 1.5 × Tsarin gyaran nama a kashi na 109 yana buƙatar platelets / mL don haifar da angiogenesis na aiki ta hanyar aikin sel na endothelial.A cikin binciken na ƙarshe, babban taro ya rage yuwuwar angiogenesis na platelet a ciki da kewayen follicles.Bugu da kari, bayanan da suka gabata sun nuna cewa adadin PRP shima zai shafi sakamakon jiyya.Sabili da haka, don haɓaka haɓakar angiogenesis da haɓaka haɓakar ƙwayoyin cuta da ƙaurawar tantanin halitta, C-PRP yakamata ya ƙunshi aƙalla 7.5 a cikin kwalban magani na 5-mL PRP × 10 9 na iya sadar da platelet.
Baya ga dogaro da kashi, tasirin PRP akan ayyukan tantanin halitta da alama yana dogaro da lokaci sosai.Sophie et al.Wadannan sakamakon sun nuna cewa bayyanar ɗan gajeren lokaci ga lysates na platelet na ɗan adam na iya ƙarfafa haɓakar ƙwayoyin kashi da chemotaxis.Sabanin haka, dogon lokaci mai tsawo ga PRP zai haifar da ƙananan matakan alkaline phosphatase da samuwar ma'adinai.
Jan jinin jini
Kwayoyin jajayen jini suna da alhakin jigilar iskar oxygen zuwa kyallen takarda da kuma jigilar carbon dioxide daga kyallen zuwa huhu.Ba su da tsakiya kuma sun ƙunshi ƙwayoyin heme waɗanda ke ɗaure da sunadarai.Abubuwan baƙin ƙarfe da heme a cikin ƙwayoyin jajayen jini suna haɓaka haɗin oxygen da carbon dioxide.Gabaɗaya, zagayowar rayuwar jajayen ƙwayoyin jini kusan kwanaki 120 ne.Ana cire su daga wurare dabam dabam ta hanyar macrophages ta hanyar tsarin da ake kira RBC tsufa.Kwayoyin jinin ja a cikin samfurori na PRP na iya lalacewa a ƙarƙashin yanayin shear (misali, aikin zubar da jini gaba ɗaya, tsari mai tsaka-tsaki, damuwa na oxidative ko rashin isasshen tsarin tattarawar PRP).Saboda haka, membrane cell na RBC yana bazuwa kuma yana sakin haemoglobin mai guba (Hb), wanda aka auna ta haemoglobin kyauta (PFH), heme da baƙin ƙarfe.PFH da samfuran lalacewa (heme da baƙin ƙarfe) tare suna haifar da cutarwa da tasirin cytotoxic akan kyallen takarda, wanda ke haifar da damuwa na oxidative, asarar nitric oxide, kunna hanyoyin kumburi da rigakafi.Wadannan tasirin za su haifar da rashin aiki na microcirculation, vasoconstriction na gida da rauni na jijiyoyin jini, da kuma mummunan lalacewar nama.
Abu mafi mahimmanci shine lokacin da aka ba da RBC dauke da C-PRP zuwa nama, zai haifar da wani abu na gida wanda ake kira eryptosis, wanda zai haifar da sakin cytokine mai tasiri da kuma macrophage mai hana ƙaura.Wannan cytokine yana hana ƙaura na monocytes da macrophages.Yana aiwatar da sigina masu ƙarfi masu ƙarfi ga kyallen da ke kewaye da su, yana hana ƙaurawar ƙwayar ƙwayar cuta da haɓakar fibroblast, kuma yana haifar da rashin aikin sel na gida mai mahimmanci.Sabili da haka, yana da mahimmanci don iyakance ƙarancin RBC a cikin shirye-shiryen PRP.Bugu da kari, ba a taba tantance matsayin jajayen kwayoyin halittar jini a cikin farfadowar nama ba.Cikakken C-PRP centrifugation da tsarin shirye-shirye yawanci zai rage ko ma kawar da kasancewar jajayen ƙwayoyin jini, don haka guje wa mummunan sakamako na hemolysis da polycythemia.
Leukocytes a cikin C-PRP
Kasancewar fararen jini a cikin shirye-shiryen PRP ya dogara da kayan aikin jiyya da tsarin shiri.A cikin kayan aikin PRP na tushen plasma, an kawar da fararen jini gaba ɗaya;Duk da haka, fararen jini sun fi mayar da hankali sosai a cikin shirye-shiryen PRP na erythrocyte sedimentation launin ruwan kasa.Saboda tsarin garkuwar jiki da rundunar tsaro, ƙwayoyin farin jini suna tasiri sosai ga ilimin halitta na ciki na yanayi mai tsanani da na kullum.Za a tattauna waɗannan fasalulluka a ƙasa.Sabili da haka, kasancewar takamaiman leukocytes a cikin C-PRP na iya haifar da tasiri mai mahimmanci na salon salula da nama.More musamman, daban-daban PRP erythrocyte sedimentation launin ruwan kasa-rawaya Layer tsarin yi amfani da daban-daban shirye-shirye makircinsu, don haka samar da daban-daban rabo na neutrophils, lymphocytes da monocytes a cikin PRP.Eosinophils da basophils ba za a iya auna su ba a cikin shirye-shiryen PRP saboda membranes na sel suna da rauni sosai don jure wa sojojin sarrafa centrifugal.
Neutrophils
Neutrophils sune mahimman leukocytes a cikin hanyoyin warkarwa da yawa.Waɗannan hanyoyin suna haɗuwa da sunadaran ƙwayoyin cuta waɗanda ke cikin platelet don samar da shinge mai yawa daga ƙwayoyin cuta masu haɗari.An ƙaddara kasancewar neutrophils bisa ga manufar magani na C-PRP.Ana iya buƙatar ƙarin matakan kumburin nama a cikin kulawar rauni na yau da kullun PRP biotherapy ko a aikace-aikacen da ke nufin haɓakar kashi ko waraka.Mahimmanci, an sami ƙarin ayyuka na neutrophil a cikin nau'i-nau'i da yawa, suna jaddada matsayin su a cikin angiogenesis da gyaran nama.Duk da haka, neutrophils kuma na iya haifar da illa masu illa, don haka ba su dace da wasu aikace-aikace ba.Zhou da Wang sun tabbatar da cewa yin amfani da PRP mai arzikin neutrophils na iya haifar da karuwar nau'in collagen na nau'in III zuwa nau'in collagen na I, don haka yana kara tsananta fibrosis da rage karfin tsoka.Sauran halaye masu cutarwa da aka yi sulhu ta hanyar neutrophils sune sakin cytokines masu kumburi da matrix metalloproteinases (MMPs), wanda zai iya inganta kumburi da catabolism lokacin amfani da kyallen takarda.
Leukomonocyte
A cikin C-PRP, mononuclear T da B lymphocytes sun fi mayar da hankali fiye da kowane farin jini.Suna da alaƙa ta kut-da-kut da rigakafi na daidaitawa na cytotoxic mai shiga tsakani.Lymphocytes na iya haifar da halayen sel don yaƙar kamuwa da cuta da daidaitawa ga maharan.Bugu da kari, T-lymphocyte samu cytokines (interferon-γ [IFN-γ] da interleukin-4 (IL-4) inganta polarization na macrophages. ƙirar linzamin kwamfuta ta hanyar daidaita bambance-bambancen monocytes da macrophages.
Monocyte – Kwayoyin gyara masu ƙarfi da yawa
Bisa ga na'urar shirye-shiryen PRP da aka yi amfani da ita, monocytes na iya fitowa ko a'a a cikin kwalban magani na PRP.Abin takaici, aikinsu da ƙarfin sake farfadowa ba a cika yin magana a cikin wallafe-wallafe ba.Sabili da haka, an ba da hankali kadan ga monocytes a cikin hanyar shirye-shiryen ko tsari na ƙarshe.Ƙungiyar Monocyte iri-iri ce, wadda ta samo asali daga sel masu tasowa a cikin kasusuwa, kuma ana jigilar su zuwa kyallen takarda ta hanyar hanyar kwayar halitta ta hematopoietic bisa ga ƙarfafawar microenvironment.A lokacin homeostasis da kumburi, monocytes masu yawo suna barin magudanar jini kuma ana ɗaukarsu zuwa ga waɗanda suka ji rauni ko ƙasƙanci.Za su iya aiki azaman macrophages (M Φ) Kwayoyin Effector ko sel masu tasowa.Monocytes, macrophages da dendritic Kwayoyin suna wakiltar tsarin phagocytic mononuclear (MPS) .. Siffar dabi'a ta MPS ita ce filastik na tsarin bayyanarsa da kuma aikin aiki tsakanin waɗannan nau'in tantanin halitta.A cikin kyallen da aka lalata, macrophages mazauna, abubuwan haɓaka haɓakar gida, cytokines masu kumburi, ƙwayoyin apoptotic ko necrotic da samfuran ƙwayoyin cuta suna fara monocytes don bambanta cikin ƙungiyoyin tantanin halitta MPS.Yi tsammanin cewa lokacin da C-PRP dauke da monocytes mai girma ya shiga cikin ƙananan ƙwayoyin cuta na gida, monocytes zasu iya bambanta zuwa M Φ Don haifar da manyan canje-canjen tantanin halitta.
Daga monocyte zuwa M % A cikin tsarin canji, takamaiman M Φ Phenotype.A cikin shekaru goma da suka gabata, an ƙirƙiri samfurin, wanda ya haɗa M Φ An kwatanta hadadden tsarin kunnawa azaman polarization na jihohi biyu masu adawa da juna: M Φ Phenotype 1 (M Φ 1, Classic activation) da M Φ Phenotype 2 (M Φ). 2, madadin kunnawa).M Φ 1 yana da alaƙa da ɓoyewar cytokine mai kumburi (IFN-γ) Da kuma nitric oxide don samar da ingantaccen tsarin kashe ƙwayoyin cuta.M Φ Har ila yau, nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'in nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i nau'i)).M Φ phenotype ya ƙunshi ƙwayoyin anti-mai kumburi tare da babban phagocytosis.M Φ 2 Samar da abubuwan haɗin matrix na waje, angiogenesis da chemokines, da interleukin 10 (IL-10).Bugu da ƙari ga kariyar ƙwayoyin cuta, M Φ Hakanan zai iya rage kumburi da inganta gyaran nama.Yana da kyau a lura cewa an raba M Φ 2 zuwa M in vitro Φ 2a, M Φ 2b da M Φ 2. Ya dogara da abin ƙarfafawa.A cikin vivo fassarar waɗannan ƙananan nau'ikan yana da wahala saboda nama na iya ƙunsar gauraye M % Ƙungiyoyi.Abin sha'awa, dangane da siginar muhalli na gida da matakan IL-4, proinflammatory M Φ 1 za a iya canzawa don inganta gyaran M Φ 2. Daga waɗannan bayanan, yana da kyau a ɗauka cewa akwai babban adadin monocytes da M Φ C-PRP shirye-shirye. na iya ba da gudummawa ga ingantacciyar gyaran nama saboda suna da gyaran gyare-gyaren nama mai hana kumburi da iyawar siginar tantanin halitta.
Ma'anar ruɗani na juzu'in farin jinin jini a cikin PRP
Kasancewar fararen jini a cikin kwalabe na magani na PRP ya dogara da na'urar shirya PRP kuma yana iya samun bambance-bambance masu mahimmanci.Akwai sabani da yawa game da wanzuwar leukocytes da gudummawar su ga samfuran sub-PRP daban-daban (kamar PRGF, P-PRP, LP-PRP, LR-PRP, P-PRF da L-PRF) A cikin bita na baya-bayan nan, shida bazuwar. Gwaje-gwajen da aka sarrafa (matakin shaida 1) da kuma nazarin kwatancen kwatance guda uku (matakin shaida 2) sun haɗa da marasa lafiya 1055, yana nuna cewa LR-PRP da LP-PRP suna da irin wannan aminci.Marubucin ya ƙarasa da cewa mummunan sakamako na PRP bazai kasance da alaƙa kai tsaye da haɗuwa da fararen jini ba.A cikin wani binciken, LR-PRP bai canza interleukin mai kumburi ba (IL-1) a cikin OA gwiwa β, IL-6, IL-8 da IL-17).Wadannan sakamakon suna goyan bayan ra'ayi cewa rawar da leukocytes a cikin ayyukan nazarin halittu na PRP a cikin vivo na iya fitowa daga tsaka-tsakin tsaka-tsakin tsakanin platelets da leukocytes.Wannan hulɗar na iya inganta biosynthesis na wasu dalilai (irin su lipoxygen), wanda zai iya daidaitawa ko inganta haɓakar kumburi.Bayan fitowar farko na ƙwayoyin kumburi masu kumburi (arachidonic acid, leukotriene da prostaglandin), ana fitar da lipoxygen A4 daga platelets da aka kunna don hana kunnawa neutrophil.A cikin wannan yanayi ne M Φ Phenotype daga M Φ 1 Canja zuwa M Φ 2. Bugu da ƙari, akwai ƙara shaida cewa zazzagewar ƙwayoyin mononuclear na iya bambanta zuwa nau'ikan tantanin halitta marasa phagocytic saboda yawan ƙarfinsu.
Nau'in PRP zai shafi al'adun MSC.Idan aka kwatanta da samfurori na PRP ko PPP masu tsabta, LR-PRP na iya haifar da haɓakar ƙwayar kasusuwa da aka samo MSCs (BMMSCs), tare da saurin saki da kuma mafi kyawun aikin nazarin halittu na PGF.Duk waɗannan halaye suna da amfani don ƙara monocytes a cikin kwalban magani na PRP da kuma fahimtar iyawar su na rigakafi da iya bambanta.
Tsarin rigakafi na haihuwa da daidaitacce na PRP
Shahararriyar aikin physiological na platelet shine sarrafa zubar jini.Suna taruwa a wurin lalacewar nama da kuma lalacewar tasoshin jini.Wadannan abubuwan da suka faru suna faruwa ta hanyar bayyanar da integrins da zaɓaɓɓun abubuwan da ke motsa platelet adhesion da tarawa.Lalacewar endothelium yana kara tsananta wannan tsari, kuma fallasa collagen da sauran sunadaran matrix subendothelial suna haɓaka zurfin kunna platelet.A cikin waɗannan lokuta, an tabbatar da muhimmiyar rawar hulɗar tsakanin von Willebrand factor (vWF) da glycoprotein (GP), musamman GP-Ib,.Bayan kunna platelet, platelet α-, Dense, lysosome da T-granules suna daidaita exocytosis kuma suna sakin abubuwan da ke cikin su cikin yanayin waje.
Kwayoyin adhesion na platelet
Don ƙarin fahimtar rawar PRP a cikin kyallen takarda masu kumburi da platelets a cikin amsawar rigakafi, ya kamata mu fahimci yadda daban-daban masu karɓa na saman platelet (integrins) da ƙwayoyin adhesion kwayoyin (JAM) da hulɗar tantanin halitta na iya fara aiwatar da matakai masu mahimmanci a cikin haɓakar rigakafi da daidaitawa.
Integrin su ne kwayoyin mannewar jikin tantanin halitta da ake samu a cikin nau'ikan tantanin halitta daban-daban kuma an bayyana su da yawa akan platelets.Integrins sun haɗa da a5b1, a6b1, a2b1 LFA-2, (GPIa/IIa) da aIIbb3 (GPIIb/IIIa).Yawancin lokaci, suna wanzuwa a cikin a tsaye da ƙarancin kusanci.Bayan kunnawa, suna canzawa zuwa yanayin haɗin haɗin haɗin haɗin gwiwa.Integrins suna da ayyuka daban-daban akan platelet kuma suna shiga cikin hulɗar platelet tare da nau'ikan farin jini iri-iri, sel endothelial da matrix extracellular.Bugu da ƙari, GP-Ib-V-IX hadaddun an bayyana akan ƙwayar platelet kuma shine babban mai karɓa don ɗaure tare da von vWF.Wannan hulɗar tana daidaita hulɗar farko tsakanin platelets da fallasa tsarin subendothelial.Platelet integrin da hadaddun GP suna da alaƙa da matakai daban-daban na kumburi kuma suna taka muhimmiyar rawa wajen samuwar hadaddun platelet-leucocyte.Musamman, integrin aIIbb3 ya zama dole don samar da tsayayyen hadaddun ta hanyar haɗa fibrinogen tare da mai karɓar macrophage 1 antigen (Mac-1) akan neutrophils.
Platelets, neutrophils da jijiyoyi endothelial sel suna bayyana takamaiman kwayoyin mannewar tantanin halitta, wanda ake kira selectin.A ƙarƙashin yanayin kumburi, platelets suna bayyana P-selectin da neutrophil L-selectin.Bayan kunna platelet, P-selectin na iya ɗaure zuwa ligand PSGL-1 wanda ke kan neutrophils da monocytes.Bugu da ƙari, ɗaurin PSGL-1 yana fara amsawar siginar siginar intracellular, wanda ke kunna neutrophils ta hanyar neutrophil integrin Mac-1 da antigen 1 (LFA-1) da ke da alaƙa da aikin lymphocyte.Mac-1 mai kunnawa yana ɗaure zuwa GPIb ko GPIIb/IIIa akan platelet ta hanyar fibrinogen, don haka yana daidaita hulɗar tsakanin neutrophils da platelets.Bugu da ƙari, LFA-1 da aka kunna zai iya haɗawa tare da ƙwayar ƙwayar ƙwayar cuta ta intercellular adhesion 2 don ƙara daidaitawa neutrophil-platelet hadaddun don inganta manne na dogon lokaci tare da sel.
Platelets da leukocytes suna taka muhimmiyar rawa a cikin abubuwan da suka dace da na rigakafi
Jiki na iya gane jikin kasashen waje da kyallen jikin da suka ji rauni a cikin cututtuka masu tsanani ko na yau da kullun don fara maganin raunin rauni da kuma hanyar kumburi.Tsarin rigakafi na asali da daidaitacce yana kare mai gida daga kamuwa da cuta, kuma fararen jini suna taka muhimmiyar rawa wajen haɗuwa tsakanin tsarin biyu.Musamman, monocytes, macrophages, neutrophils da kwayoyin kisa na halitta suna taka muhimmiyar rawa a cikin tsarin halitta, yayin da lymphocytes da sassan su suna taka rawa iri ɗaya a cikin tsarin rigakafi na daidaitawa.
Ma'amalar platelet da leukocyte a cikin hulɗar ƙwayoyin rigakafi na asali.Platelet yana hulɗa tare da neutrophils da monocytes, kuma a ƙarshe tare da M Φ Interact, daidaitawa da haɓaka ayyukan masu tasiri.Wadannan hulɗar platelet-leukocyte suna haifar da kumburi ta hanyoyi daban-daban, ciki har da NETosis.Takaitawa: MPO: myeloperoxidase, ROS: nau'in oxygen mai amsawa, TF: factor factor, NET: neutrophil extracellular trap, NF-κ B: Nuclear factor kappa B, M Φ: Macrophages.
Tsarin rigakafi na asali
Matsayin tsarin rigakafi na asali shine rashin takamaiman gano ƙwayoyin cuta masu ɓarna ko gutsuttsuran nama da kuma motsa sharewarsu.Lokacin da wasu sifofin kwayoyin halitta da ake kira masu karɓar ra'ayi na yanayin magana (PRRs) sun haɗu tare da tsarin ƙwayoyin cuta masu alaƙa da lalacewar ƙwayoyin cuta, tsarin rigakafi na asali zai kunna.Akwai nau'ikan PRRs da yawa, gami da Toll-like receptor (TLR) da RIG-1 kamar mai karɓa (RLR).Waɗannan masu karɓa za su iya kunna babban ma'aunin rubutun kappa B (NF-κ B) Hakanan yana daidaita bangarori da yawa na amsawar rigakafi da haɓakawa.Abin sha'awa shine, platelets kuma suna bayyana nau'ikan kwayoyin masu karɓa na immunoregulatory akan saman su da cytoplasm, irin su P-selectin, furotin CD40 ligand (CD40L), cytokines (irin su IL-1 β, TGF- β) da TLR-takamaiman platelet. Saboda haka, platelets na iya yin hulɗa tare da ƙwayoyin rigakafi daban-daban.
Ma'amalar tantanin halitta-fararen fata a cikin rigakafi na asali
Lokacin da platelets suka shiga ko mamaye kwararar jini ko nama, platelets ɗaya ne daga cikin sel waɗanda ke gano raunin endothelial da ƙwayoyin cuta na ƙwayoyin cuta da farko.Ƙaddamarwar Platelet da kuma inganta sakin agonists na platelet ADP, thrombin da vWF, wanda ya haifar da kunna farantin karfe da kuma bayyanar da masu karɓar platelet chemokine C, CC, CXC da CX3C, don haka haifar da platelet a cikin wurin da ya kamu da cutar ko rauni.
Tsarin garkuwar jiki na asali an ƙaddara ta hanyar gado don gano maharan, kamar ƙwayoyin cuta, ƙwayoyin cuta, parasites da gubobi, ko raunukan nama da raunuka.Yana da tsarin da ba na musamman ba, saboda duk wani ƙwayar cuta za a gano shi a matsayin na waje ko wanda ba shi da kansa kuma yana da sauri.Tsarin rigakafi na asali yana dogara ne akan saitin sunadaran da phagocytes, wanda ke gane halayen da aka adana da kyau na ƙwayoyin cuta kuma da sauri kunna amsawar rigakafi don taimakawa wajen kawar da masu shiga, koda kuwa mai watsa shiri bai taɓa fuskantar takamaiman ƙwayoyin cuta ba.
Neutrophils, monocytes da sel dendritic sune mafi yawan ƙwayoyin rigakafi na halitta a cikin jini.Daukar su ya zama dole don isasshiyar amsawar rigakafi da wuri.Lokacin da ake amfani da PRP a cikin maganin farfadowa, hulɗar kwayar halitta-fararen fata yana daidaita kumburi, raunin rauni da gyaran nama.TLR-4 akan platelets yana ƙarfafa hulɗar platelet-neutrophil, wanda ke daidaita abin da ake kira leukocyte oxidative fashe ta hanyar daidaita sakin nau'in oxygen mai amsawa (ROS) da myeloperoxidase (MPO) daga neutrophils.Bugu da ƙari, hulɗar tsakanin platelet-neutrophil da neutrophil degenranulation yana haifar da samuwar tarkon neutrophil-extracellular (NETs).NETs sun ƙunshi neutrophil nucleus da sauran abubuwan ciki na ciki neutrophil, wanda zai iya kama kwayoyin cuta kuma ya kashe su ta hanyar NETosis.Samuwar NETs shine muhimmin tsarin kashe neutrophils.
Bayan kunna platelet, monocytes na iya yin ƙaura zuwa ƙwayoyin cuta da masu lalacewa, inda suke gudanar da ayyukan mannewa da ɓoye ƙwayoyin kumburi waɗanda zasu iya canza halayen chemotaxis da abubuwan proteolytic.Bugu da ƙari, platelets na iya haifar da monocyte NF-κ B kunnawa don daidaita aikin tasiri na monocytes, wanda shine mahimmin matsakanci na amsawar kumburi da kunnawa da kuma bambanta ƙwayoyin rigakafi.Platelets suna ƙara haɓaka fashewar oxidative na monocytes don haɓaka lalata ƙwayoyin cuta na phagocytic.Sakin MPO yana yin sulhu ta hanyar hulɗar kai tsaye tsakanin platelet-monocyte CD40L-MAC-1.Abin sha'awa shine, lokacin da P-selectin ke kunna platelet a ƙarƙashin yanayi mai tsanani da na kullum, chemokines da aka samu platelet PF4, RANTES, IL-1 β da CXCL-12 na iya hana apoptosis na monocytes ba tare da bata lokaci ba, amma inganta bambancin su zuwa macrophages.
Tsarin rigakafi mai daidaitawa
Bayan tsarin rigakafi mara ƙayyadaddun ƙayyadaddun tsarin rigakafi ya gane ƙananan ƙwayoyin cuta ko lalacewar nama, ƙayyadaddun tsarin rigakafi na daidaitawa zai ɗauka.Tsarukan daidaitawa sun haɗa da antigen-daure B lymphocytes (kwayoyin B) da na al'ada T lymphocytes (Treg) waɗanda ke daidaita kawar da ƙwayoyin cuta.Kwayoyin T za a iya raba su da yawa zuwa sel T masu taimako (Th cells) da sel cytotoxic T (kwayoyin Tc, wanda kuma aka sani da ƙwayoyin T killer).An ƙara rarraba ƙwayoyin Th1, Th2 da Th17, waɗanda ke da ayyuka masu mahimmanci a cikin kumburi.Kwayoyin th na iya ɓoye cytokines proinflammatory (misali IFN-γ, TNF-β) da kuma interleukins da yawa (misali, IL-17). Kwayoyin Tc sune sel masu tasiri, waɗanda zasu iya kawar da ƙwayoyin cuta na cikin ciki da na waje da aka yi niyya.
Abin sha'awa, ƙwayoyin Th2 suna samar da IL-4 kuma suna shafar M Φ Polarization, M Φ Jagorar farfadowa M Φ 2 Phenotype, yayin da IFN-γ M Φ Canji zuwa mai kumburi M Φ 1 Phenotype, wanda ya dogara da kashi da lokacin cytokines.Bayan an kunna IL-4, M % 2 yana haifar da ƙwayoyin Treg don bambanta cikin sel Th2, sa'an nan kuma ya samar da ƙarin IL-4 (madaidaicin ra'ayi).Th sel suna juyar da M % Halin phenotype yana kaiwa ga phenotype mai sabuntawa don mayar da martani ga kwayoyin halitta na asalin nama.Wannan tsarin yana dogara ne akan shaidar cewa ƙwayoyin Th suna taka muhimmiyar rawa wajen sarrafa kumburi da gyaran nama.
Ma'amalar tantanin halitta-fararen fata a cikin rigakafin daidaitawa
Tsarin rigakafi na daidaitawa yana amfani da takamaiman masu karɓa na antigen kuma yana tunawa da ƙwayoyin cuta a baya, kuma yana lalata su lokacin da ya sadu da mai gida.Duk da haka, waɗannan martanin rigakafi masu dacewa sun haɓaka sannu a hankali.Konias et al.Ya nuna cewa sashin platelet yana ba da gudummawa ga haɗarin hasashe da gyara nama, da kuma hulɗar tsakanin platelets da leukocytes suna inganta kunna amsawar rigakafi mai dacewa.
A lokacin amsawar rigakafi na daidaitawa, platelets suna inganta amsawar monocyte da macrophage ta hanyar DC da NK cell maturation, wanda ke haifar da takamaiman T cell da B cell martani.Don haka, abubuwan da ke tattare da granular platelet suna shafar rigakafi kai tsaye ta hanyar bayyana CD40L, kwayar halitta wacce ke da mahimmanci don daidaita amsawar rigakafi.Platelets ta hanyar CD40L ba wai kawai suna taka rawa wajen gabatar da antigen ba, har ma suna shafar halayen T cell.Liu et al.An gano cewa platelets suna daidaita amsawar tantanin halitta CD4 T ta hanya mai rikitarwa.Wannan bambance-bambancen ka'ida na CD4 T cell subsets yana nufin cewa platelets suna inganta ƙwayoyin CD4 T don amsawa ga abubuwan da ke haifar da kumburi, don haka suna samar da martani mai karfi da kuma maganin kumburi.
Platelets kuma suna daidaita martanin daidaitawar tantanin halitta B ga ƙwayoyin cuta.An san cewa CD40L akan ƙwayoyin CD4 T da aka kunna za su haifar da CD40 na ƙwayoyin B, suna samar da sigina na biyu da ake buƙata don kunnawa B lymphocyte mai dogara da T-cell, fassarar allotype na gaba, da bambancin kwayoyin B da haɓakawa.Gabaɗaya, sakamakon yana nuna a sarari ayyuka daban-daban na platelets a cikin rigakafi na daidaitawa, yana nuna cewa platelets suna haɗa hulɗar tsakanin ƙwayoyin T da ƙwayoyin B ta CD40-CD40L, don haka haɓaka amsawar kwayar halitta ta T-cell.Bugu da ƙari, platelets suna da wadata a cikin masu karɓa na sel, wanda zai iya inganta kunnawar platelet kuma ya saki adadi mai yawa na ƙwayoyin cuta masu kumburi da kwayoyin halitta da aka adana a cikin nau'i-nau'i daban-daban na platelet, don haka yana rinjayar amsawar rigakafi da kuma daidaitawa.
Ƙaddamar da rawar da aka samu na platelet a cikin PRP
Serotonin (5-hydroxytryptamine, 5-HT) yana da muhimmiyar rawa mai mahimmanci a cikin tsarin kulawa na tsakiya (CNS), ciki har da jin zafi.An kiyasta cewa yawancin 5-HT na ɗan adam ana samar da su a cikin gastrointestinal tract sannan kuma ta hanyar zagayawa na jini, inda platelets ke shayar da shi ta hanyar jigilar serotonin reuptake da kuma adana shi a cikin ƙananan ƙwayoyin cuta a babban taro (65 mmol/L).5-HT sanannen neurotransmitter da hormone wanda ke taimakawa daidaita tsarin tafiyar da neuropsychological daban-daban a cikin CNS (tsakiyar 5-HT).Duk da haka, yawancin 5-HT yana wanzuwa a waje da CNS (na gefe 5-HT), kuma yana da hannu wajen daidaita tsarin tsarin kwayoyin halitta da kuma salon salula na tsarin gabobin jiki da yawa, ciki har da cututtukan zuciya, huhu, gastrointestinal, urogenital da tsarin aikin platelet.5-HT yana da metabolism-dogara metabolism akan nau'ikan tantanin halitta iri-iri, gami da adipocytes, sel epithelial da fararen jini.Peripheral 5-HT kuma shine mai sarrafa rigakafi mai ƙarfi, wanda zai iya tadawa ko hana kumburi kuma yana shafar ƙwayoyin rigakafi daban-daban ta takamaiman mai karɓar 5-HT (5HTR).
Paracrine da autocrine inji na HT
Ayyukan 5-HT yana shiga tsakani ta hanyar hulɗa da 5HTRs, wanda shine babban iyali tare da mambobi bakwai (5-HT 1 - 7) kuma aƙalla nau'ikan nau'ikan masu karɓa daban-daban na 14, gami da memba 5-HT 7 da aka gano kwanan nan, na gefe da kuma aiki a cikin kula da ciwo.A cikin aiwatar da raguwar platelet, platelets da aka kunna suna ɓoye babban adadin 5-HT da aka samu ta platelet, wanda zai iya haɓaka ƙanƙancewar jijiyoyin jini kuma yana haɓaka kunna platelet da lymphocytes kusa da ta hanyar bayyanar 5-HTR akan sel endothelial, ƙwayoyin tsoka mai santsi kwayoyin rigakafi.Pacala et al.An yi nazarin tasirin mitotic na 5-HT akan sel endothelial na jijiyoyin jini, kuma an ƙaddara yiwuwar haɓaka haɓakar tasoshin jini da aka lalace ta hanyar ƙarfafa angiogenesis.Yadda ake tsara waɗannan hanyoyin ba a bayyane yake ba, amma yana iya haɗawa da bambance-bambancen hanyoyin sigina guda biyu a cikin microcircuit nama don daidaita ayyukan ƙwayoyin jijiyoyi na jijiyoyi da ƙwayoyin tsoka mai santsi, fibroblasts da ƙwayoyin rigakafi ta hanyar takamaiman masu karɓar 5-HT akan waɗannan sel. .Ayyukan autocrine na platelet 5-HT bayan an kunna aikin platelet [REF].Sakin 5-HT yana haɓaka kunnawar platelet da ɗaukar ɗaukar platelet masu yawo, wanda ke haifar da kunna halayen cascade na sigina da masu tasiri na sama masu goyan bayan sake kunnawar platelet.
Immunomodulatory 5-HT sakamako
Shaidu da yawa sun nuna cewa serotonin na iya taka rawa a cikin 5HTR daban-daban a matsayin mai daidaitawa na rigakafi.Dangane da 5HTR da aka bayyana a cikin nau'ikan leukocytes daban-daban waɗanda ke da hannu cikin haɓakar kumburi, 5-HT da aka samu platelet yana aiki azaman mai sarrafa rigakafi a cikin tsarin rigakafi na asali da na daidaitawa.5-HT na iya haɓaka haɓakar Treg da daidaita ayyukan ƙwayoyin B, ƙwayoyin kisa na halitta da neutrophils ta hanyar ɗaukar DC da monocytes zuwa wurin kumburi.Nazarin kwanan nan ya nuna cewa 5-HT da aka samu platelet zai iya daidaita aikin ƙwayoyin rigakafi a ƙarƙashin takamaiman yanayi.Sabili da haka, ta yin amfani da C-PRP, ƙaddamarwar platelet ya fi 1 × 10 6/µ L zai iya taimakawa wajen ɗaukar nauyin 5-HT da aka samu daga manyan platelets zuwa nama.A cikin microenvironment da aka kwatanta da sassa masu kumburi, PRP na iya yin hulɗa tare da ƙwayoyin rigakafi da yawa waɗanda ke taka muhimmiyar rawa a cikin waɗannan cututtuka, wanda zai iya rinjayar sakamakon asibiti.
Hoto yana nuna amsawar 5-HT mai yawa bayan kunna faranti na PRP mai kumburi.Bayan kunna platelets, platelets suna sakin granules, ciki har da 5-HT a cikin ƙananan granules, wanda ke da nau'o'in nau'i na daban-daban na ƙwayoyin cuta, ƙwayoyin endothelial da ƙwayoyin tsoka mai santsi.Abbreviations: SMC: m tsoka Kwayoyin, EC: endothelial Kwayoyin, Treg: al'ada T lymphocytes, M Φ: Macrophages, DC: dendritic Kwayoyin, IL: interleukin, IFN-γ: Interferon γ. Modified da kuma daidaita daga Everts et al.da Hull et al.
Analgesic sakamako na PRP
Ƙwayoyin da aka kunna za su saki yawancin masu shiga tsakani masu tasowa da masu kumburi, wanda ba zai iya haifar da ciwo kawai ba, amma kuma ya rage kumburi da zafi.Da zarar an yi amfani da shi, nau'in nau'in platelet na PRP yana canza yanayin microenvironment kafin gyaran nama da sake farfadowa ta hanyar hanyoyi daban-daban masu rikitarwa da suka shafi anabolism da catabolism, yaduwar kwayar halitta, bambance-bambance da tsarin tsarin kwayar halitta.Wadannan halaye na PRP suna haifar da aikace-aikacen PRP a cikin yanayi daban-daban na cututtuka na asibiti yawanci suna hade da ciwo mai tsanani (kamar raunin wasanni, cututtuka na orthopedic, cututtuka na kashin baya da kuma hadaddun rauni na yau da kullum), ko da yake ba a ƙayyade ainihin tsarin ba.
A cikin 2008, Evertz et al.Shine gwajin gwaji na farko da aka bazu don bayar da rahoton sakamako na analgesic na shirye-shiryen PRP, wanda aka shirya daga launin ruwan kasa na erythrocyte sedimentation na autologous kuma an kunna shi tare da thrombin autologous bayan tiyatar kafada.Sun lura da raguwar ma'aunin ma'auni na gani na gani, amfani da maganin analgesics na tushen opioid, da kuma samun nasarar gyarawa bayan tiyata.Abin lura ne cewa suna nuna tasirin analgesic na platelet da aka kunna kuma suna yin hasashe akan tsarin platelet ɗin da ke sakin 5-HT.A takaice, platelets suna barci a cikin sabon shiri na PRP.Bayan kunna platelet kai tsaye ko a kaikaice (fasali na nama), platelets suna canza siffa kuma suna samar da isasshen karya don haɓaka haɓakar platelet.Sa'an nan, sun saki intracellular α- Kuma mai yawa barbashi.PGF, cytokines da sauran platelet lysosomes za su mamaye nama da aka yi tare da PRP da aka kunna.Musamman ma, lokacin da ƙananan ƙwayoyin cuta suka saki abubuwan da ke ciki, za su saki babban adadin 5-HT wanda ke daidaita ciwo.A cikin C-PRP, ƙaddamarwar platelet ya ninka sau 5 zuwa 7 fiye da na cikin jini na gefe.Saboda haka, sakin 5-HT daga platelet shine astronomical.Abin sha'awa, Sprott et al.Rahoton ya lura cewa an rage jin zafi sosai bayan acupuncture da moxibustion, ƙaddamar da ƙwayar platelet da aka samu 5-HT ya ragu sosai, sannan kuma matakin plasma na 5-HT ya karu.
A cikin gefe, platelets, ƙwayoyin mast da sel na endothelial za su saki 5-HT na ƙarshe yayin raunin nama ko rauni na tiyata.Abin sha'awa, an gano nau'ikan masu karɓa na 5-HT na ƙananan ƙwayoyin cuta a cikin yanki na gefe, wanda ya tabbatar da cewa 5-HT na iya tsoma baki tare da watsawar nociceptive a cikin yanki na gefe.Wadannan nazarin sun nuna cewa 5-HT na iya rinjayar watsawar nociceptive na kyallen takarda ta hanyar 5-HT1, 5-HT2, 5-HT3, 5-HT4 da 5-HT7 masu karɓa.
Tsarin 5-HT yana wakiltar tsarin mai ƙarfi wanda zai iya ragewa da ƙara yawan jin zafi bayan haɓakawa mai cutarwa.Tsarin tsakiya da na gefe na siginar nociceptive da canje-canje a cikin tsarin 5-HT an ruwaito a cikin marasa lafiya da ciwo mai tsanani.A cikin 'yan shekarun nan, yawancin karatu sun mayar da hankali kan rawar 5-HT da masu karɓa a cikin aiki da kuma daidaita bayanan cutarwa, wanda ya haifar da kwayoyi irin su masu hana masu satar maganin serotonin (SSRI).Wannan miyagun ƙwayoyi yana hana sake dawo da serotonin a cikin ƙwayoyin presynaptic bayan sakin serotonin.Yana rinjayar tsawon lokaci da ƙarfin sadarwar serotonin kuma shine madadin magani don ciwo mai tsanani.Ana buƙatar ƙarin bincike na asibiti don fahimtar tsarin kwayoyin halitta na PRP-derived 5-HT raɗaɗin raɗaɗi a cikin cututtuka na yau da kullum da cututtuka.
Sauran bayanai don warware yiwuwar tasirin analgesic na PRP za a iya samu bayan gwajin samfurin dabba mai analgesic.Ƙirar ƙididdiga ta kwatanta a cikin waɗannan samfuran suna da ƙalubale saboda waɗannan binciken sun ƙunshi masu canji da yawa.Duk da haka, wasu nazarin asibiti sun magance matsalolin nociceptive da analgesic na PRP.Yawancin karatu sun nuna cewa marasa lafiya da ke karbar magani don tendinosis ko rotator cuff hawaye suna da ƙananan jin zafi.Sabanin haka, wasu binciken da yawa sun nuna cewa PRP na iya rage ko ma kawar da ciwo na marasa lafiya tare da lalatawar tendon, OA, plantar fasciitis da sauran cututtuka na ƙafa da idon kafa.An gano ƙaddamarwar platelet na ƙarshe da tsarin kwayoyin halitta a matsayin mahimman halaye na PRP, waɗanda ke taimakawa wajen lura da daidaitaccen tasirin analgesic bayan aikace-aikacen PRP.Sauran masu canji sun haɗa da hanyar isarwa ta PRP, fasahar aikace-aikacen, ka'idar kunna platelet, matakin ayyukan nazarin halittu na PGF da cytokines da aka saki, nau'in nama na aikace-aikacen PRP da nau'in rauni.
Abin lura ne cewa Kuffler ya warware yuwuwar PRP don rage jin zafi a cikin marasa lafiya tare da ciwo mai laushi zuwa mai tsanani na ciwon neuropathic, na biyu zuwa jijiyar da ba ta sake farfadowa ba.Manufar wannan binciken shine don bincika ko za a iya rage ciwon neuropathic ko ragewa saboda PRP inganta farfadowa na axonal da kuma ƙaddamar da jijiyoyi.Abin mamaki, a cikin marasa lafiya da ke karbar magani, ciwon neuropathic har yanzu an kawar da shi ko kuma ya rage akalla shekaru shida bayan tiyata.Bugu da ƙari, duk marasa lafiya sun fara jin zafi a cikin makonni uku bayan aikace-aikacen PRP.
Kwanan nan, an lura da irin wannan tasirin PRP na analgesic a fagen raunin rauni da kuma kula da fata.Abin sha'awa shine, marubutan sun ba da rahoton abubuwan da suka shafi ilimin lissafin jiki na ciwon rauni da ke hade da raunin jijiyoyin jini da hypoxia nama na fata.Sun kuma tattauna mahimmancin angiogenesis don inganta iskar oxygen da isar da abinci mai gina jiki.Nazarin su ya nuna cewa idan aka kwatanta da ƙungiyar kulawa, marasa lafiya da ke karbar magani na PRP ba su da zafi sosai kuma sun karu da angiogenesis.A ƙarshe, Johal da abokan aikinsa sun gudanar da nazari na yau da kullum da bincike-bincike kuma sun kammala cewa PRP na iya rage ciwo bayan yin amfani da PRP a cikin alamun orthopedic, musamman ma marasa lafiya da ke karɓar epicondylitis na waje da kuma gwiwa OA magani.Abin baƙin ciki shine, wannan binciken bai ƙayyadad da tasirin fararen jini ba, ƙaddamarwar platelet ko kuma amfani da masu kunnawa faranti na waje, saboda waɗannan masu canji zasu shafi tasirin PRP gaba ɗaya.Madaidaicin ƙaddamarwar platelet na PRP don iyakar jin zafi ba a sani ba.A cikin nau'in bera na tendinosis, ƙaddamarwar platelet ya kasance 1.0 × 10 6 / μ A L, za'a iya kawar da ciwon gaba daya, yayin da jin zafi da PRP ya haifar tare da rabin ƙwayar platelet ya ragu sosai.Sabili da haka, muna ƙarfafa ƙarin karatun asibiti don bincika tasirin analgesic na shirye-shiryen PRP daban-daban.
PRP da tasirin angiogenesis
Shirye-shiryen C-PRP a cikin madaidaicin magungunan sake haɓakawa suna ba da damar isar da ƙwayoyin halitta waɗanda aka saki ta yawan adadin platelets waɗanda aka kunna a wuraren da aka yi niyya.Sabili da haka, an ƙaddamar da nau'ikan halayen cascade iri-iri, waɗanda ke ba da gudummawa ga ka'idodin rigakafin kan layi, tsarin kumburi da angiogenesis don haɓaka warkarwa da gyaran nama.
Angiogenesis tsari ne mai tsauri da yawa wanda ya haɗa da germination da microvessels na nama daga tasoshin jini da suka rigaya.Angiogenesis ya ci gaba saboda nau'o'in nau'o'in kwayoyin halitta, ciki har da ƙaurawar sel na endothelial, yaduwa, bambance-bambance da rarrabuwa.Waɗannan matakan salon salula sune abubuwan da ake buƙata don samuwar sabbin hanyoyin jini.Suna da mahimmanci don haɓakar tasoshin jini da suka rigaya don mayar da jini da kuma tallafawa babban aikin gyaran gyare-gyaren nama da farfadowa na nama.Wadannan sabbin hanyoyin jini suna ba da damar isar da iskar oxygen da abinci mai gina jiki, da kuma kawar da abubuwan da aka samu daga kyallen da aka yi wa magani.
Ayyukan angiogenesis ana sarrafa su ta hanyar haɓaka abubuwan angiogenic VEGF da abubuwan anti-angiogenic (misali, angiostatin da thrombospondin-1 [TSP-1]).A cikin ƙananan ƙwayoyin cuta da ƙasƙanci (ciki har da ƙananan iskar oxygen, ƙananan pH da babban matakin lactic acid), abubuwan angiogenic na gida zasu mayar da aikin angiogenesis.
Yawancin kafofin watsa labaru masu narkewa, irin su FGF na asali da TGF- β Kuma VEGF na iya motsa ƙwayoyin endothelial don samar da sabbin hanyoyin jini.Landsdown da Fortier sun ba da rahoton sakamako daban-daban masu alaƙa da haɗin PRP, gami da tushen intraplatelet na yawancin masu kula da angiogenic.Bugu da ƙari, sun yanke shawarar cewa karuwar angiogenesis yana taimakawa wajen warkar da cutar MSK a cikin yankunan da ke fama da rashin lafiya, irin su tsagewar meniscus, rauni na tendon da sauran wuraren da ba su da kyau.
Haɓaka da anti-angiogenic kaddarorin platelet
A cikin 'yan shekarun da suka gabata, binciken da aka buga ya tabbatar da cewa platelets suna taka muhimmiyar rawa a cikin hemostasis na farko, samuwar jini, haɓaka girma da sakin cytokine, da tsarin angiogenesis a matsayin wani ɓangare na tsarin gyaran nama.Paradoxically, PRP α- The granules ƙunshi arsenal na pro-angiogenic girma dalilai, anti-angiogenic sunadaran da cytokines (kamar PF4, plasminogen activator inhibitor-1 da TSP-1), da kuma niyya saki na musamman dalilai da taka rawa. .Matsayi a cikin angiogenesis.Sabili da haka, ana iya bayyana matsayin PRP a cikin sarrafa ka'idojin angiogenesis ta hanyar kunna takamaiman masu karɓa na sel, TGF- β Initiate pro-angiogenic da halayen anti-angiogenic.An tabbatar da ikon platelets don motsa jiki ta hanyar angiogenesis a cikin angiogenesis na pathological da ciwon daji angiogenesis.
Platelet-derived angiogenic girma factor da anti-angiogenic girma factor, samu daga α- Kuma mai yawa da kuma m kwayoyin.Mafi mahimmanci, an yarda gaba ɗaya cewa tasirin platelet akan angiogenesis shine pro-angiogenic kuma yana ƙarfafawa.Ana sa ran cewa maganin PRP zai sarrafa ƙaddamar da angiogenesis, wanda zai taimaka wajen maganin cututtuka da yawa, irin su warkar da raunuka da gyaran nama.Gudanar da PRP, musamman kulawar babban taro na PGF da sauran cytokines na platelet, na iya haifar da angiogenesis, angiogenesis da arteriogenesis, saboda 1a ta hanyar kwayar halitta ta stromal ta ɗaure ga mai karɓar CXCR4 akan sel masu tasowa na endothelial.Bill et al.An ba da shawarar cewa PRP yana haɓaka ischemic neovascularization, wanda zai iya zama saboda haɓakar angiogenesis, angiogenesis da arteriogenesis.A cikin samfurin su na in vitro, haɓakar ƙwayoyin endothelial da samuwar capillary sun haifar da adadi mai yawa na PDG daban-daban, wanda VEGF shine babban mai motsa jiki na angiogenic.Wani muhimmin abu kuma mai mahimmanci don maido da hanyar angiogenesis shine haɗin kai tsakanin PGF da yawa.Richardson et al.An tabbatar da cewa aikin haɗin gwiwa na angiogenic factor platelet-derived growth factor-bb (PDGF-BB) da VEGF ya haifar da saurin samuwar cibiyar sadarwa na jijiyoyin jini idan aka kwatanta da ayyukan haɓakar haɓakar mutum.Haɗin tasirin waɗannan abubuwan kwanan nan an tabbatar da su a cikin binciken kan haɓaka haɓakar ƙwayar cuta ta cerebral a cikin mice tare da hypoperfusion na dogon lokaci.
Mafi mahimmanci, binciken in vitro ya auna tasirin tasirin jijiyar jikin mutum na endothelial na jijiyoyi da nau'ikan platelet daban-daban akan zaɓin na'urar shirye-shiryen PRP da dabarun kashi na platelet, kuma sakamakon ya nuna cewa mafi kyawun adadin platelet shine 1.5 × 10 6 platelets / μ. 50. Don inganta angiogenesis.Maɗaukakin platelet mai yawa na iya hana tsarin angiogenesis, don haka tasirin ba shi da kyau.
Tsufawar salula, tsufa da PRP
Ana iya haifar da jin daɗin tantanin halitta ta hanyoyi daban-daban.Wannan tsari ne wanda sel ke daina rarrabuwa kuma suna yin canje-canje na musamman na phenotypic don hana haɓakar ƙwayoyin da ba a iyakance ba, wanda ke taka muhimmiyar rawa wajen rigakafin cutar kansa.A cikin tsarin tsufa na ilimin lissafin jiki, tsufa na kwafi na tantanin halitta zai kuma inganta tsufa na tantanin halitta, kuma za a rage ikon sake farfadowa na MSCs.
Tasirin tsufa da tsufa na tantanin halitta
A cikin vivo, yawancin nau'in tantanin halitta za su tsufa kuma za su taru a cikin kyallen takarda daban-daban yayin tsufa, daga cikinsu akwai adadi mai yawa na ƙwayoyin tsufa.Tarin tarin ƙwayoyin tsufa yana da alama yana ƙaruwa tare da haɓakar shekaru, lalacewar tsarin rigakafi, lalacewar nama ko abubuwan da suka shafi damuwa.An gano tsarin tsufa na salon salula a matsayin abin da ke haifar da cututtuka na shekaru, irin su osteoarthritis, osteoporosis da intervertebral disc degeneration.Daban-daban abubuwan motsa jiki za su ƙara tsufa ta tantanin halitta.A cikin mayar da martani, phenotype na sirri mai alaƙa (SASP) zai ɓoye babban adadin ƙwayoyin furotin da cytokines.Wannan phenotype na musamman yana da alaƙa da ƙwayoyin tsufa, waɗanda suke ɓoye manyan matakan cytokines masu kumburi (kamar IL-1, IL-6, IL-8), abubuwan haɓaka (kamar TGF- β, HGF, VEGF, PDGF). MMP, da kuma cathepsin.Idan aka kwatanta da matasa, an tabbatar da SAPS ya karu da shekaru, saboda tsarin tsarin da aka lalata ya lalace, yana haifar da tsufa na cell da kuma rage ƙarfin sake farfadowa.Musamman, a cikin cututtuka na haɗin gwiwa da cututtuka na kwarangwal.Dangane da wannan, ana la'akari da tsufa na rigakafi a matsayin canji mai mahimmanci a cikin nau'in ɓoye na ƙwayoyin cuta, yana nuna cewa ƙaddamar da TNF-a, IL-6 da / ko Il-1b yana ƙaruwa, yana haifar da ƙananan ƙananan kumburi.Yana da kyau a lura cewa tabarbarewar kwayar halitta kuma tana da alaƙa da hanyoyin da ba na salula ba, kamar ƙwayoyin tsufa, musamman samar da abubuwan da ke haifar da kumburi da haɓakawa ta hanyar SASP.
Akasin haka, SASP kuma na iya tada filastik tantanin halitta da sake tsara sel kusa.Bugu da ƙari, SASP na iya tsara sadarwa tare da masu shiga tsakani daban-daban da kuma kunna ƙwayoyin rigakafi don inganta ƙaddamar da ƙwayoyin tsufa.Fahimtar matsayi da aiki na ƙwayoyin tsufa za su ba da gudummawa ga warkaswa da gyaran nama na tsokoki na MSK da raunuka na kullum.
Yana da mahimmanci cewa Ritcka et al.An gudanar da bincike mai zurfi, kuma an gano babban aiki mai fa'ida da SASP wajen inganta filastik tantanin halitta da farfadowar nama, kuma an gabatar da manufar isar da jiyya na wucin gadi na ƙwayoyin tsufa.A hankali sun ambata cewa tsufa galibi tsari ne mai fa'ida da sake farfadowa.
Tsufawar salula da yuwuwar PRP
Yayin da adadin sel masu tushe ya ragu, tsufa zai shafi aikin sel mai tushe.Hakazalika, a cikin mutane, halayen ƙwayoyin sel (kamar bushewa, yaduwa da bambance-bambance) suma suna raguwa da shekaru.Wang da Nirmala sun ba da rahoton cewa tsufa zai rage halayen ƙwayoyin sel na jijiyoyi da adadin masu karɓar abubuwan haɓaka.Wani binciken dabba ya nuna cewa maida hankali na PDGF a cikin matasa dawakai yana da yawa.Sun yanke shawarar cewa karuwar yawan masu karɓar GF da adadin GF a cikin matasa na iya samun mafi kyawun amsawar salula ga maganin PRP fiye da tsofaffi a cikin matasa.Wadannan binciken sun nuna dalilin da ya sa magani na PRP na iya zama ƙasa da tasiri ko ma rashin tasiri a cikin tsofaffi marasa lafiya tare da ƙananan ƙwayoyin sel da "marasa kyau".An tabbatar da cewa tsarin tsufa na guringuntsi ya koma baya kuma lokacin hutawa na chondrocytes ya karu bayan allurar PRP.Jiya et al.Ana amfani da shi don nazarin fibroblasts dermal fibroblasts in vitro photoaging, tare da kuma ba tare da magani na PRP ba, don fayyace hanyar magance PGF a cikin wannan ƙirar.Ƙungiyar PRP ta nuna tasiri kai tsaye akan matrix extracellular, ƙara nau'in I collagen da kuma rage haɗin haɗin gwiwar metalloproteinase, yana nuna cewa PRP na iya magance tsufa na cell, kuma a cikin cututtukan MSK na degenerative.
A wani binciken kuma, an yi amfani da PRP don tattara tsofaffin ƙwayoyin ɓawon kashi daga tsofaffin beraye.An ƙaddara cewa PRP na iya dawo da nau'o'in ayyuka masu mahimmanci daga tsufa, irin su yaduwar kwayar halitta da samuwar mulkin mallaka, da sake gina alamomin da suka danganci tsufa na tantanin halitta.
Kwanan nan, Oberlohr da abokan aikinsa sun yi nazari sosai game da rawar da ke tattare da tsufa na cell don raunana farfadowa na tsoka, kuma sun kimanta PRP da plasta-poor plasma (PPP) a matsayin zabin maganin ilimin halitta don gyaran ƙwanƙwasa.Sun yi la'akari da cewa PRP ko PPP magani don gyaran gyare-gyare na ƙwanƙwasa zai dogara ne akan abubuwan da suka shafi ilimin halitta da aka tsara don takamaiman alamar tantanin halitta SASP da sauran abubuwan da ke haifar da ci gaban fibrosis.
Yana da kyau a yi imani da cewa kafin aikace-aikacen PRP, tsufa tantanin halitta da aka yi niyya zai iya inganta halayen farfadowa na ingantaccen maganin ilimin halitta ta hanyar rage abubuwan SASP na gida.An ba da shawarar cewa wani zaɓi don inganta sakamakon PRP da PPP don farfadowa na ƙwanƙwasa ƙwanƙwasa shine zaɓin cire ƙwayoyin tsofaffi tare da tsofaffin tsofaffi.Babu shakka cewa sakamakon bincike na baya-bayan nan game da tasirin PRP akan tsufa da tsufa yana da ban sha'awa, amma har yanzu suna cikin matakin farko.Don haka, bai dace a ba da wata shawara ba a wannan lokacin.
(Ana sake buga abubuwan da ke cikin wannan labarin, kuma ba mu bayar da garantin bayyananne ko bayyananniyar garanti don daidaito, amintacce ko cikar abubuwan da ke cikin wannan labarin ba, kuma ba mu da alhakin ra'ayoyin wannan labarin, da fatan za a fahimta.)
Lokacin aikawa: Maris-01-2023