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Zelltherapie bei Knochenheilungsstörungen

Cell therapy in bone-healing disorders

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Zusammenfassung

Neben stabilisierenden Osteosynthesetechniken und der autologen Knochentransplantation spielen Orthobiologika bei der Behandlung von Knochenheilungsstörungen eine zunehmende Rolle. Derzeit kommen hierbei v. a. Wachstumsfaktoren zum Einsatz. Zudem mehren sich Berichte, dass Zelltherapeutika die lokale Knochenregeneration fördern. Aus ethischen und biologischen Gründen ist die klinische Anwendung von Progenitorzellen am Bewegungsapparat zurzeit auf autologe, postpartale Stammzellen beschränkt. Dabei zeigte v. a. die intraoperative einzeitige Zelltherapie mit autologen Progenitorzellen in ersten klinischen Studien positive Ergebnisse. Anhand einer Literaturrecherche sowie eigenen Erfahrungen an 75 Patienten mit Knochendefekten oder -heilungsstörungen wird eine aktuelle Übersicht über die biologischen Hintergründe und die Besonderheiten der klinischen Anwendung einer Zelltherapie zur Behandlung ossärer Substanzdefekte gegeben. Die meisten klinischen Studien berichteten über eine erfolgreiche Knochenregeneration nach Applikation von Mischzellpopulationen aus Knochenmark.

Abstract

In addition to stabilizing osteosynthesis and autologous bone transplantation, so-called orthobiologics are playing an increasing role in the treatment of bone-healing disorders. Besides the application of different growth factors, new data in the literature suggest that cell therapeutic agents promote local bone regeneration. Due to ethical and biological considerations, clinical application of progenitor cells for the musculoskeletal system is limited to autologous postpartum stem cells. Here in particular, cell therapy with autologous progenitor cells in one surgical session has delivered first promising results. Based on a review of the literature and on our own experience with 75 patients, this article reviews the rationale and characteristics of the clinical application of cell therapy for the treatment of bony substance defects. Most clinical trials report successful bone regeneration after the application of mixed cell populations from bone marrow.

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  1. Orthopädische Klinik, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    M. Jäger, C. Zilkens, M. Herten & R. Krauspe

  2. Service de Chirurgie Orthopédique, Hôpital Henri Mondor, Creteil, Frankreich

    P. Hernigou

  3. Institut für Transplantationsdiagnostik und Zelltherapie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    J. Fischer

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  1. M. Jäger
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  2. P. Hernigou
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  3. C. Zilkens
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  4. M. Herten
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  5. J. Fischer
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Jäger, M., Hernigou, P., Zilkens, C. et al. Zelltherapie bei Knochenheilungsstörungen. Orthopäde 39, 449–464 (2010). https://doi.org/10.1007/s00132-009-1583-7

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