Platelets in wound healing and regenerative medicine
Platelets in wound healing and regenerative medicine
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DOI：
10.1080/09537104.2018.1430357
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发表时间：
2018-01-01
期刊：
影响因子：
3.3
通讯作者：
Etulain, Julia
中科院分区：
文献类型：
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作者：
Etulain, Julia
尽管血小板被广泛认为在原发性止血和血栓形成中具有关键作用，但越来越多的实验和临床证据将这些去核细胞鉴定为包括炎症和组织再生在内的其他生理病理过程的相关调节剂。这些现象是通过释放生长因子、细胞因子和细胞外基质调节剂介导的，它们依次促进（i）通过诱导内皮细胞在新血管中的迁移、增殖、分化和稳定来使受损组织再血管化;（ii）通过成纤维细胞的迁移、增殖和活化来使受损结缔组织恢复;和（iii）间充质干细胞增殖和分化为组织特异性细胞类型。由于这些原因，富血小板血浆（PRP）衍生物被用于再生医学中，用于治疗几种临床病症，包括溃疡、烧伤、肌肉修复、骨疾病和手术后的组织恢复。考虑到PRP管理不需要复杂的设备或培训来执行，PRP管理的益处与经济优势相关。此外，由于它们的主要自体来源，可以忽略疾病传播或免疫原性反应的问题。因此，血小板富集材料在过去十年中变得高度相关，并且在伤口愈合和组织再生的背景下构成实验和临床研究的日益关注的焦点。然而，尽管有各种各样的应用，使用PRP的再生治疗的功效受到质疑，因为缺乏大型对照临床试验和缺乏关于PRP制备技术的共识。本文综述了PRP的再生作用的生物学机制，这些生物材料的不同制备方法和应用，以及与PRP在再生医学中的应用有关的争议和未来前景。
Although platelets are widely recognized as having a critical role in primary hemostasis and thrombosis, increasing experimental and clinical evidence identifies these enucleated cells as relevant modulators of other physiopathological processes including inflammation and tissue regeneration. These phenomena are mediated through the release of growth factors, cytokines, and extracellular matrix modulators that sequentially promote (i) revascularization of damaged tissue through the induction of migration, proliferation, differentiation, and stabilization of endothelial cells in new blood vessels; (ii) restoration of damaged connective tissue through migration, proliferation, and activation of fibroblasts; and (iii) proliferation and differentiation of mesenchymal stem cells into tissue-specific cell types. For these reasons, platelet-rich plasma (PRP) derivatives are used in regenerative medicine for the treatment of several clinical conditions including ulcers, burns, muscle repair, bone diseases, and tissue recovery following surgery. The benefits of PRP administration are associated with an economical advantage, taking into consideration that PRP administration does not require complex equipment or training for its execution. Moreover, due to their primary autologous origin, concerns of disease transmission or immunogenic reactions can be disregarded. Thus, platelet-enriched materials have become highly relevant in the last decade and constitute a growing focus of experimental and clinical study in the context of wound healing and tissue regeneration. However, despite the diverse applications, the efficacy of regenerative treatments using PRP is being called into question due to the lack of large controlled clinical trials and the lack of consensus regarding the PRP preparation techniques. This review describes the biological mechanisms underlying PRP's regenerative effects, the different methods of preparation and application of these biomaterials, and the controversies and future prospects related to the use of PRP in regenerative medicine.