PDF herunterladen
OP-Journal 2022; 38(02): 122-130
DOI: 10.1055/a-1694-0111
Fachwissen

Regenerative Plasma- und Zelltherapien in der Orthopädie und Unfallchirurgie

Plasma- and Cell-based Regenerative Therapies in Orthopaedics and Traumatology
Tazio Maleitzke
,
Marcel Niemann
,
Sijia Zhou
,
Luis Lauterbach
,
Sven Geissler
,
Melanie Ort
,
Georg N. Duda
,
Carsten Perka
,
Ulrich Stöckle
,
Tobias Winkler
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Regenerative Therapien in der Orthopädie und Unfallchirurgie (O&U) werden zur Behandlung akuter Verletzungen oder degenerativer Gewebeschäden eingesetzt. Insbesondere die Therapie verschiedener Arthroseformen und Tendinopathien mittels Platelet-rich Plasma (PRP) nimmt mittlerweile einen zentralen Platz in der ambulanten Versorgung ein. Es fehlt bis dato allerdings an robusten Daten zur Wirksamkeit und Produktcharakterisierung. Mesenchymale Zelltherapien werden ebenfalls zur Geweberegeneration durch parakrine Immunmodulation eingesetzt und befinden sich aktuell noch in präklinischen und klinischen Forschungsstadien. In den kommenden Jahren wird neben der Sicherheit insbesondere die langfristige Wirksamkeit von Plasma- und Zelltherapien im Fokus der Wissenschaft stehen, um regenerative Therapien klinisch und evidenzbasiert in der O&U zu verankern.

Abstract

Advanced regenerative therapies aim to restore acute and degenerative tissue defects. Platelet-rich plasma (PRP) has emerged as a widely applied treatment approach for various forms of osteoarthritis and tendinopathies. To date, robust data on efficacy and product characteristics are however still scarce. While currently still being researched, mesenchymal cell-based therapies may also facilitate tissue regeneration through paracrine immunomodulation. Regenerative medicine in orthopaedics and trauma surgery will have to focus on safety and long-term-efficacy evidence, to advance into clinical practice in the years to come.



Publikationsverlauf

Artikel online veröffentlicht:
09. März 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 U.S. Food and Drug Administration (FDA). Part 640 – Additional Standards for Human Blood and Blood Products. In: Code of Federal Regulations (CFR), Title 21, Volume 7 Im Internet (Stand: 01.11.2021): https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=640.34
  • 2 Degen RM, Bernard JA, Oliver KS. et al. Commercial Separation Systems Designed for Preparation of Platelet-Rich Plasma Yield Differences in Cellular Composition. HSS J 2017; 13: 75-80
    CrossrefPubMedSuche in Google Scholar
  • 3 Mazzocca AD, McCarthy MB, Chowaniec DM. et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg Am 2012; 94: 308-316
    CrossrefPubMedSuche in Google Scholar
  • 4 Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med 2011; 39: 2135-2140
    CrossrefPubMedSuche in Google Scholar
  • 5 McCarrel TM, Minas T, Fortier LA. Optimization of leukocyte concentration in platelet-rich plasma for the treatment of tendinopathy. J Bone Joint Surg Am 2012; 94: e143(1-8)
    CrossrefPubMedSuche in Google Scholar
  • 6 Dragoo JL, Braun HJ, Durham JL. et al. Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med 2012; 40: 1274-1281
    CrossrefPubMedSuche in Google Scholar
  • 7 Scott A, LaPrade RF, Harmon KG. et al. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Am J Sports Med 2019; 47: 1654-1661
    CrossrefPubMedSuche in Google Scholar
  • 8 Le ADK, Enweze L, DeBaun MR. et al. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med 2018; 11: 624-634
    CrossrefPubMedSuche in Google Scholar
  • 9 Everts P, Onishi K, Jayaram P. et al. Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci 2020; 21: 7794
    CrossrefPubMedSuche in Google Scholar
  • 10 DeLong JM, Russell RP, Mazzocca AD. Platelet-rich plasma: the PAW classification system. Arthroscopy 2012; 28: 998-1009
    CrossrefPubMedSuche in Google Scholar
  • 11 Banerjee M, Doepfer AK, Glanzmann M. et al. Leitlinie der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie. S2 k-Leitlinie – Epicondylopathia radialis humeri. AWMF Registernummer: 033-019. Im Internet (Stand: 01.11.2021): https://www.awmf.org/uploads/tx_szleitlinien/033-019l_S2k_Epicondylopathia_radialis_humeri_2019-09.pdf
    PubMed
  • 12 Stöve J. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). S2 k-Leitlinie – Gonarthrose. AWMF Registernummer: 033-004. Im Internet (Stand: 01.11.2021): https://www.awmf.org/uploads/tx_szleitlinien/033-004l_S2k_Gonarthrose_2018-01_1-verlaengert.pdf
    PubMed
  • 13 Fitzpatrick J, Bulsara M, Zheng MH. The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Clinical Trials. Am J Sports Med 2017; 45: 226-233
    CrossrefPubMedSuche in Google Scholar
  • 14 Dean BJ, Lostis E, Oakley T. et al. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum 2014; 43: 570-576
    CrossrefPubMedSuche in Google Scholar
  • 15 Laudy AB, Bakker EW, Rekers M. et al. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 2015; 49: 657-672
    CrossrefPubMedSuche in Google Scholar
  • 16 Nie LY, Zhao K, Ruan J. et al. Effectiveness of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Clinical Trials. Orthop J Sports Med 2021; 9: 2325967120973284
    Suche in Google Scholar
  • 17 Sundman EA, Cole BJ, Karas V. et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014; 42: 35-41
    CrossrefPubMedSuche in Google Scholar
  • 18 Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol 2011; 23: 471-478
    CrossrefPubMedSuche in Google Scholar
  • 19 Han Y, Huang H, Pan J. et al. Meta-analysis Comparing Platelet-Rich Plasma vs. Hyaluronic Acid Injection in Patients with Knee Osteoarthritis. Pain Med 2019; 20: 1418-1429
    CrossrefPubMedSuche in Google Scholar
  • 20 Bannuru RR, Osani MC, Vaysbrot EE. et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage 2019; 27: 1578-1589
    Suche in Google Scholar
  • 21 Bruyere O, Honvo G, Veronese N. et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum 2019; 49: 337-350
    CrossrefPubMedSuche in Google Scholar
  • 22 Schnabel LV, Mohammed HO, Miller BJ. et al. Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res 2007; 25: 230-240
    CrossrefPubMedSuche in Google Scholar
  • 23 Jiang G, Wu Y, Meng J. et al. Comparison of Leukocyte-Rich Platelet-Rich Plasma and Leukocyte-Poor Platelet-Rich Plasma on Achilles Tendinopathy at an Early Stage in a Rabbit Model. Am J Sports Med 2020; 48: 1189-1199
    CrossrefPubMedSuche in Google Scholar
  • 24 Miller LE, Parrish WR, Roides B. et al. Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials. BMJ Open Sport Exerc Med 2017; 3: e000237
    CrossrefPubMedSuche in Google Scholar
  • 25 Thomopoulos S, Parks WC, Rifkin DB. et al. Mechanisms of tendon injury and repair. J Orthop Res 2015; 33: 832-839
    CrossrefPubMedSuche in Google Scholar
  • 26 Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 2004; 114: 1502-1508
    CrossrefPubMedSuche in Google Scholar
  • 27 Hurley ET, Lim Fat D, Moran CJ. et al. The Efficacy of Platelet-Rich Plasma and Platelet-Rich Fibrin in Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2019; 47: 753-761
    CrossrefPubMedSuche in Google Scholar
  • 28 Yang FA, Liao CD, Wu CW. et al. Effects of applying platelet-rich plasma during arthroscopic rotator cuff repair: a systematic review and meta-analysis of randomised controlled trials. Sci Rep 2020; 10: 17171
    CrossrefPubMedSuche in Google Scholar
  • 29 Liem D, Brunner U. Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC). S2e-Leitlinie – Rotatorenmanschette. AWMF Registernummer: 033–041. Im Internet (Stand: 01.11.2021): https://www.awmf.org/uploads/tx_szleitlinien/033-041l_S2e_Rotatorenmanschette_2017-04_02.pdf
    PubMed
  • 30 Potter BK. Bench to Bedside: Platelet-rich Plasma-How Do We Adequately “Untranslate” Translational “Breakthroughs” in an After-market Setting?. Clin Orthop Relat Res 2016; 474: 2104-2107
    CrossrefPubMedSuche in Google Scholar
  • 31 Dominici M, Le Blanc K, Mueller I. et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 2006; 8: 315-317
    CrossrefPubMedSuche in Google Scholar
  • 32 Hwang JJ, Rim YA, Nam Y. et al. Recent Developments in Clinical Applications of Mesenchymal Stem Cells in the Treatment of Rheumatoid Arthritis and Osteoarthritis. Front Immunol 2021; 12: 631291
    CrossrefPubMedSuche in Google Scholar
  • 33 Bolia IK, Bougioukli S, Hill WJ. et al. Clinical Efficacy of Bone Marrow Aspirate Concentrate Versus Stromal Vascular Fraction Injection in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. Am J Sports Med 2021;
    CrossrefPubMedSuche in Google Scholar
  • 34 Moll G, Ankrum JA, Kamhieh-Milz J. et al. Intravascular Mesenchymal Stromal/Stem Cell Therapy Product Diversification: Time for New Clinical Guidelines. Trends Mol Med 2019; 25: 149-163
    CrossrefPubMedSuche in Google Scholar
  • 35 Murray IR, Chahla J, Frank RM. et al. Rogue stem cell clinics. Bone Joint J 2020; 102-B: 148-154
    CrossrefPubMedSuche in Google Scholar
  • 36 Baraniak PR, McDevitt TC. Stem cell paracrine actions and tissue regeneration. Regen Med 2010; 5: 121-143
    CrossrefPubMedSuche in Google Scholar
  • 37 Qazi TH, Mooney DJ, Duda GN. et al. Biomaterials that promote cell-cell interactions enhance the paracrine function of MSCs. Biomaterials 2017; 140: 103-114
    CrossrefPubMedSuche in Google Scholar
  • 38 Deutscher Bundestag: Wissenschaftliche Dienste. Sachstand: Behandlung von Arthrose mittels Eigenfett-Therapie; Erfordernis einer arzneimittelrechtlichen Herstellungserlaubnis für die Eigenfetttransplantation. Im Internet (Stand: 01.11.2021): https://www.bundestag.de/resource/blob/658488/67a2feb173fed068631729e5edff49a1/WD-9-049-19-pdf-data.pdf
    PubMed
  • 39 Iijima H, Isho T, Kuroki H. et al. Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: a meta-analysis toward the establishment of effective regenerative rehabilitation. NPJ Regen Med 2018; 3: 15
    CrossrefPubMedSuche in Google Scholar
  • 40 Qu H, Sun S. Efficacy of mesenchymal stromal cells for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021; 16: 11
    CrossrefPubMedSuche in Google Scholar
  • 41 Qazi TH, Duda GN, Ort MJ. et al. Cell therapy to improve regeneration of skeletal muscle injuries. J Cachexia Sarcopenia Muscle 2019; 10: 501-516
    CrossrefPubMedSuche in Google Scholar
  • 42 Winkler T, Perka C, von Roth P. et al. Immunomodulatory placental-expanded, mesenchymal stromal cells improve muscle function following hip arthroplasty. J Cachexia Sarcopenia Muscle 2018; 9: 880-897
    CrossrefPubMedSuche in Google Scholar