Matsayin platelets a cikin buri na kasusuwa ya tattara hankali
Ana amfani da PRP da kasusuwa na kasusuwa mai mahimmanci (BMAC) don jerin jiyya na asibiti a cikin ofisoshin ofisoshin da kuma tiyata saboda amfanin su na farfadowa a cikin MSK da cututtuka na kashin baya, kula da ciwo mai tsanani da kuma alamun nama mai laushi.PRP ba wai kawai yana daidaita ƙaurawar tantanin halitta da haɓakar tantanin halitta ba, amma kuma yana ba da gudummawa ga angiogenesis da gyare-gyaren ECM don ƙirƙirar microenvironment mai kyau da haɓaka gyaran nama da haɓakawa.
Tsarin gyaran BMAC
BMACs nau'ikan tantanin halitta iri-iri ne masu ɗauke da BMMSCs, suna mai da su tushen tantanin halitta don farfadowar gyaran magunguna.Suna taka rawa ta hanyar rage apoptosis cell, fibrosis da kumburi;Kuma kunna aikin cascade wanda ke haifar da yaduwar kwayar halitta.Bugu da ƙari, BMMSCs suna da damar da za su bambanta cikin nau'o'in layi na tantanin halitta, ciki har da osteoblasts, adipocytes, myoblasts, epithelial cell da neurons.Hakanan suna haɓaka angiogenesis ta hanyar paracrine da hanyoyin autocrine.Hakanan yana da mahimmanci cewa BMMSC shine mai ba da gudummawa ga tsarin rigakafi mai zaman kansa ba tare da takamaiman ƙwayoyin rigakafi ba, waɗanda ke shiga cikin matakin kumburi na gyaran rauni.Bugu da kari, BMMSCs suna tallafawa ɗaukar sel zuwa sabbin wuraren jiyya na angiogenesis don haɓaka sake gina jini na gida.Jin et al.An tabbatar da cewa idan babu isassun ɓangarorin, ƙimar rayuwa na BMMSC da gyare-gyare da bambance-bambancen ikon inganta warkarwa sun lalace.Kodayake tarin nama, shirye-shiryen samfurori da tsarin aikin PRP da BMAC sun bambanta, nazarin ya nuna cewa za su iya haɗawa da juna.Haƙiƙa, haɗa PRP da BMAC cikin samfuran halitta na iya samun ƙarin fa'idodi.
Haɗa PRP da BMAC
Bisa ga wasu binciken da ba a san su ba, ainihin ƙa'idar haɗa PRP da BMAC ta dogara ne akan wurare da yawa.Na farko, PRP na iya samar da microenvironment mai dacewa wanda BMSC zai iya inganta yaduwar kwayar halitta da bambance-bambance da kuma ƙara angiogenesis.Na biyu, an yi amfani da PRP azaman abin zamba ga waɗannan sel tare da BMAC.Akasin haka, haɗin PRP da BMAC na iya zama kayan aikin ilimin halitta mai ƙarfi don jawo hankalin yawan BMMSC.An yi amfani da fili na PRP-BMAC don magance tendinosis, raunuka, raunin kashin baya, fayafai na intervertebral degenerative da lahani na osteochondral tare da babban ƙarfin farfadowa.Abin baƙin ciki, ko da yake nau'o'in ƙwayoyin jijiyoyi daban-daban sun haɗa da platelets, rahotanni kaɗan sun ambaci yawan adadin platelets a cikin ƙwayar kasusuwa da aka cire da kuma bayan maganin BMAC, amma ana iya fitar da su ta hanyoyin da suka dace.Ana buƙatar ƙarin bincike don fahimtar ko ana buƙatar ƙarin abubuwan tattarawar platelet da ake buƙatar amfani da su tare da BMAC.A halin yanzu, babu bayanai game da mafi kyawun rabo na platelets zuwa MSC (ko wasu kwayoyin kasusuwan kasusuwa), wanda ke da tasiri mai kyau akan tsarin abinci mai gina jiki na MSC a gyaran nama.Mahimmanci, ana iya inganta kayan aikin tattara barawon kasusuwa da fasaha don fitar da isassun platelets.
Abubuwan haɓaka PRP da tasirin sinadirai na BMAC
Abubuwan haɓakar platelet PRP shine mabuɗin sunadaran da ke cikin aikin gyaran BMAC.Bambance-bambancen PGF da sauran cytokines da ke cikin tsarin abinci mai gina jiki na BMAC na iya fara gyaran nama ta hanyar rage apoptosis cell, anabolism da anti-inflammatory effects, da kuma kunna yaduwar kwayar halitta, bambance-bambance da angiogenesis ta hanyar paracrine da autocrine hanyoyi.
Abubuwan ci gaban da aka samu ta Platelet da ɗigon ɓangarorin ɓangarorin a fili suna da hannu a cikin tsarin sinadirai na BMAC kuma suna tallafawa gyaran nama da sabuntawar da MSC ke jawo.Gajartawa: MSC: Kwayoyin tushe na mesenchymal, HSC: Kwayoyin hematopoietic.
Babu shakka, a cikin maganin OA, PDGF yana taka muhimmiyar rawa a cikin farfadowa na guringuntsi da kuma kula da homeostasis ta hanyar yaduwar MSC da kuma hana IL-1-induced chondrocyte apoptosis da kumburi.Bugu da kari, nau'ikan nau'ikan nau'ikan TGF-β guda uku suna aiki a cikin haɓaka haɓakar guringuntsi da hana kumburi, kuma suna nuna ikon haɓaka warkar da nama mai alaƙa da MSC ta hanyar hulɗar intermolecular.Sakamakon abinci mai gina jiki na MSC yana da alaƙa da ayyukan PGF da ɓoyewar cytokines na gyarawa.Da kyau, duk waɗannan cytokines yakamata su kasance a cikin kwalabe na magani na BMAC kuma a kai su zuwa wurin rauni na nama don haɓaka mafi kyawun warkaswar nama mai alaƙa da MSC.
A cikin binciken OA na haɗin gwiwa, Mui ñ os-L ó pez et al.Ya nuna cewa MSC da aka samu daga nama na synovial ya canza aiki, wanda ya haifar da asarar ikon dawowa.Abin sha'awa shine, allurar kai tsaye na PRP a cikin ƙashin ƙananan ƙwayar cuta na osteoarthritis ya haifar da raguwar MSC a cikin ruwan synovial, yana nuna haɓakar asibiti.Ana yin amfani da maganin warkewa ta hanyar rage tsarin kumburi a cikin ruwan synovial na marasa lafiya na OA.
Akwai ƙaramin bayani game da kasancewar ko tattarawar PGF a cikin BMAC ko madaidaicin rabon da ake buƙata don tallafawa aikin sinadirai na BMMSC.Wasu likitocin sun haɗa babban maida hankali na PRP tare da BMAC don samun ƙarin kayan aikin ilimin halitta, wanda ake tsammanin zai inganta sakamakon jiyya na maganin farfadowa.Duk da haka, akwai ƴan samuwa aminci da inganci bayanai, yana nuna cewa haɗa babban taro na PRP tare da BMAC shine zaɓin magani mafi inganci.Saboda haka, mun yi imanin cewa ba zai dace ba don sarrafa BMMSC ta hanyar kunna su tare da babban adadin platelet a wannan matakin.
Yin hulɗa da platelets tare da magungunan antiplatelet da NSAIDs
PRP yana ƙunshe da ɓangarorin ɓangarori na ɓangarori na sirri kuma sun ƙunshi yawancin kafofin watsa labarai na halitta.Ana danganta tasirin magani na PRP ga waɗannan masu shiga tsakani.Kodayake masu shiga tsakani na warkewa a cikin platelet suna da masaniya, mafi kyawun tsari da motsin waɗannan magungunan anabolic da catabolic ba su da cikakkiyar fahimta.Ɗaya daga cikin ƙayyadaddun ƙayyadaddun abubuwan da ake amfani da su na maganin warkewa shine a shawo kan sauye-sauyen waɗannan masu shiga tsakani na nazarin halittu don auna tasirin da aka tsara da kyau a ƙasa wanda ko da yaushe yana da maimaitawa kuma yana da fa'ida a asibiti.Saboda wannan dalili, kwayoyi (irin su magungunan anti-inflammatory marasa steroidal (NSAIDs)) na iya shafar sakin ƙungiyoyin masu ɓoye platelet.A cikin binciken ƙayyadaddun ƙayyadaddun lakabi na kwanan nan, cin abinci na yau da kullun na 81 MG na aspirin (ASA) ya rage maganganun maɓalli masu mahimmanci, kamar TGF- β 1. PDGF da VEGF.
Wadannan tasirin ana danganta su ga hanawa na cyclooxygenase-1 (COX-1) da kuma hanawa na cyclooxygenase-2 (COX-2), wanda shine enzymes guda biyu da ake buƙata don lalatawar platelet.Wani bita na yau da kullun na yau da kullun ya gano cewa magungunan antiplatelet na iya rage haɓakar haɓakar haɓakar haɓakar haɓakar haɓakar haɓakar haɓakar haɓakar haɓakar haɓakar yanayin COX-1 da COX-2, kuma 8 na binciken 15 sun gano cewa abubuwan haɓaka sun ragu.
Ana amfani da kwayoyi (misali NSAIDs) don rage zafi da rage kumburi da cutar MSK ke haifarwa.Hanyar NSAIDs ita ce hana kunna faranti ta hanyar haɗawa ba tare da canzawa ba tare da COX enzyme da daidaita hanyar arachidonic acid.Sabili da haka, aikin platelet zai canza a duk tsawon rayuwar platelet, don haka hana watsa siginar PGF.NSAIDs sun hana samar da cytokine (misali, PDGF, FGF, VEGF, da IL-1 β, IL-6, da IL-8), yayin da suke haɓaka TNF-α. Duk da haka, akwai ƙananan bayanai game da tasirin kwayoyin NSAIDs akan PRP.Babu yarjejeniya akan mafi kyawun lokaci don shirye-shiryen da gudanarwa na PRP a cikin marasa lafiya da ke amfani da NSAIDs.Mannava da abokan aiki sun ƙididdige abubuwan anabolic da catabolic abubuwan halitta a cikin PRP mai wadatar leukocyte na masu sa kai masu lafiya waɗanda ke ɗaukar naproxen.Sun gano cewa bayan yin amfani da naproxen na mako guda, matakan PDGF-AA da PDGF-AB (m mitogen mai tasiri don inganta angiogenesis) sun ragu sosai.Bayan mako guda, matakin haɓakar haɓaka ya koma kusa da matakin tushe.Bayan amfani da naproxen na mako guda, matakin LR-PRP na proinflammatory da kuma catabolic factor IL-6 shima ya ragu, kuma ya koma matakin tushe bayan lokacin izinin mako guda.A halin yanzu, babu wani binciken asibiti don tabbatar da cewa marasa lafiya da naproxen bayan maganin PRP suna da sakamako mara kyau;Koyaya, ana ba da shawarar yin la'akari da lokacin wanka na mako ɗaya don maido da ƙimar PDGF-AA, PDGF-BB da IL-6 zuwa matakin tushe don haɓaka ayyukan ilimin halittar su.Ana buƙatar ƙarin bincike don cikakken fahimtar tasirin antiplatelet da NSAID akan rukunin ɓoye na PRP da maƙasudin sa na ƙasa.
Haɗa aikace-aikacen plasma mai wadatar platelet tare da gyarawa
Ko da yake bincike na kimiyya na asali ya nuna cewa farfadowa na jiki da nauyin kayan aiki suna da muhimmiyar rawa wajen dawo da tsarin tendon bayan allurar PRP, babu wata yarjejeniya akan mafi kyawun tsarin gyarawa don cutar MSK bayan maganin PRP.
Maganin PRP ya haɗa da allurar da aka mayar da hankali kan platelets a cikin yanayin nama na gida don daidaita ciwo da inganta gyaran nama.Shaidar asibiti mafi ƙarfi tana wanzu a gwiwa OA.Duk da haka, yin amfani da PRP a cikin maganin cututtuka na tendinosis yana da rikici, kuma sakamakon da aka ruwaito ya bambanta.Nazarin dabba yawanci yana nuna haɓakar tarihi na tendinosis bayan shigar da PRP.Wadannan nazarin sun nuna cewa nauyin inji zai iya sake farfado da tendons, kuma nauyin da allurar PRP suna aiki tare don inganta warkar da tendon.Bambance-bambance a cikin shirye-shiryen PRP, shirye-shiryen nazarin halittu, shirye-shirye, shirye-shiryen allura da ƙananan raunin jijiya na iya haifar da bambance-bambance a sakamakon asibiti.Bugu da ƙari, kodayake shaidar kimiyya ta goyi bayan fa'idodin tsare-tsaren gyare-gyare, ƙananan binciken binciken asibiti da aka buga suna ƙoƙarin sarrafawa da haɗa daidaitattun tsare-tsaren gyara bayan PRP.
Kwanan nan, Onishi et al.An sake nazarin rawar da nauyin injina da tasirin ilimin halitta na PRP a cikin cututtukan jijiya na Achilles.Sun yi la'akari da kashi na I da kashi na II na nazarin asibiti na cututtukan cututtuka na Achilles da aka bi da su tare da PRP, suna mai da hankali kan tsarin gyarawa bayan allurar PRP.Shirye-shiryen gyaran gyare-gyaren da ake kulawa suna da alama suna inganta aikin motsa jiki da inganta sakamako da kuma ikon saka idanu akan adadin motsa jiki.Gwaje-gwajen PRP da aka tsara da kyau na Achilles tendon PRP sun haɗa jiyya bayan PRP tare da tsarin gyaran kayan aikin injina a matsayin wani muhimmin sashi na dabarun sabuntawa.
Ra'ayin gaba da ƙarshe
Ci gaban fasaha na kayan aikin PRP da hanyoyin shirye-shiryen yana nuna sakamako mai ban sha'awa na haƙuri, kodayake ma'anar ma'anar ma'anar kwayoyin halitta daban-daban na PRP da kuma halayen halayen halitta na samfurin ƙarshe har yanzu ba su da tabbas.Bugu da ƙari, ba a ƙayyade cikakken damar alamun PRP da aikace-aikace ba.Har zuwa kwanan nan, an sayar da PRP a matsayin samfuri na jini mai sarrafa kansa, wanda zai iya ba wa likitoci damar yin amfani da fasahar haɓakar haɓakar platelet ta atomatik a cikin takamaiman alamun cututtukan cututtuka da cututtuka.Da farko, kawai ma'auni don nasarar aikace-aikacen PRP wanda sau da yawa ana ambaton shi ne samfurin da aka shirya, wanda ƙaddamarwar platelet ya fi darajar jini duka.A yau, an yi sa'a, masu aiki suna da cikakkiyar fahimta game da aikin PRP.
A cikin wannan bita, mun yarda cewa har yanzu akwai rashin daidaituwa da rarrabuwa a cikin fasahar shirye-shiryen;Sabili da haka, babu wata yarjejeniya a kan ma'aikatan ilimin halittu na PRP a halin yanzu, kodayake ƙarin wallafe-wallafen sun cimma yarjejeniya kan tasiri mai tasiri na platelet da ake buƙata don inganta (sabon) angiogenesis.Anan, mun gabatar da ayyukan PGF a taƙaice, amma an fi nuna ƙayyadaddun ƙayyadaddun tsarin platelet da tasirin tasirin farin jini da MSCs, da kuma hulɗar tantanin halitta mai zuwa.Musamman ma, kasancewar fararen jini a cikin shirye-shiryen PRP yana ba da zurfin fahimta game da illa mai cutarwa ko amfani.An tattauna bayyanannen rawar platelets da hulɗar su tare da tsarin rigakafi na ciki da na daidaitawa.Bugu da ƙari, ana buƙatar isassun bayanai da kuma rubuce-rubuce na asibiti don ƙayyade cikakken tasiri da kuma maganin warkewa na PRP a cikin alamomi daban-daban.
(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