Intervertebral Disc Repair by Autologous Mesenchymal Bone Marrow Cells: A Pilot Study
Intervertebral Disc Repair by Autologous Mesenchymal Bone Marrow Cells: A Pilot Study
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DOI：
10.1097/tp.0b013e3182298a15
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发表时间：
2011-10-15
期刊：
影响因子：
6.2
通讯作者：
Garcia-Sancho, Javier
中科院分区：
文献类型：
--
作者：
Orozco, Lluis;Soler, Robert;Garcia-Sancho, Javier
背景退行性椎间盘疾病可能导致严重的腰痛，这是一个严重的公共卫生问题，对经济和生活质量有重大影响。慢性病例通常需要手术，这可能导致生物力学问题和相邻节段的加速退化。基于细胞的疗法可以避免这些问题，并在体外和动物研究中显示出令人鼓舞的结果。我们设计了一项试点研究，以评估可行性和安全性，并获得早期迹象的疗效与间充质干细胞（MSC）在人类。对10例慢性腰痛伴纤维环完整的腰椎间盘退变的患者，采用自体骨髓间充质干细胞髓核内注射治疗。临床进展随访1年，包括对背痛、残疾和生活质量的评价。磁共振成像测量椎间盘高度和液体含量。证实了可行性和安全性，并确定了临床疗效的强适应症。患者表现出疼痛和残疾的快速改善（3个月内达到最大值的85%），接近最佳疗效的71%。这一结果与其他手术（如脊柱融合术或全椎间盘置换术）的结果相比是有利的。虽然椎间盘高度没有恢复，但含水量在12个月时显著升高。MSC疗法可能是退行性椎间盘疾病引起的慢性背痛的有效替代治疗方法。与目前的黄金标准相比，其优势包括更简单和更保守的干预，无需手术，保留正常的生物力学，以及相同或更好的疼痛缓解。
Background. Degenerative disc disease may cause severe low-back pain, a large public health problem with significant economic and life quality impact. Chronic cases often require surgery, which may lead to biomechanical problems and accelerated degeneration of the adjacent segments. Cell-based therapies may circumvent these problems and have exhibited encouraging results in vitro and in animal studies. We designed a pilot study to assess feasibility and safety and to obtain early indications on efficacy of treatment with mesenchymal stem cells (MSC) in humans.Methods. Ten patients with chronic back pain diagnosed with lumbar disc degeneration with intact annulus fibrosus were treated with autologous expanded bone marrow MSC injected into the nucleus pulposus area. Clinical evolution was followed for 1 year and included evaluation of back pain, disability, and quality of life. Magnetic resonance imaging measurements of disc height and fluid content were also performed.Results. Feasibility and safety were confirmed and strong indications of clinical efficacy identified. Patients exhibited rapid improvement of pain and disability (85% of maximum in 3 months) that approached 71% of optimal efficacy. This outcome compares favorably with the results of other procedures such as spinal fusion or total disc replacement. Although disc height was not recovered, water content was significantly elevated at 12 months.Conclusions. MSC therapy may be a valid alternative treatment for chronic back pain caused by degenerative disc disease. Advantages over current gold standards include simpler and more conservative intervention without surgery, preservation of normal biomechanics, and same or better pain relief.