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Zellbasierte und zukünftige Therapieansätze der Femurkopfnekrose

Cell-based and future therapeutic strategies for femoral head necrosis

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Zusammenfassung

Hintergrund

Die Verwendung zell- und wachstumsfaktorbasierter Verfahren im Rahmen herkömmlicher chirurgischer Strategien zur Behandlung der aseptischen Femurkopfnekrose (FKN) birgt ein großes therapeutisches Potenzial.

Ziel der Arbeit

Es wird ein Überblick über neue Strategien mit dem Fokus auf zell- und wachstumsfaktorbasierte Verfahren zur Therapie der FKN gegeben.

Material und Methoden

Die Ergebnisse einer Literaturrecherche werden zusammengefasst, die wesentlichen Arbeiten dargestellt und unter dem Einfluss der Expertise der Autoren diskutiert.

Ergebnisse

Im Mittelpunkt der Entwicklung neuer Strategien für die Therapie der FKN stehen Zellkonzentrate aus aspiriertem Knochenmark und ex vivo expandierte mesenchymale Stammzellen. Neben der lokalen Anwendung im Rahmen einer Entlastungsbohrung stellt die systemische Gabe der Zellen über Hüftkopf versorgende Gefäße einen interessanten Ansatz dar. Der Einsatz von osteogenen und angiogenen Wachstumsfaktoren gekoppelt an Biomaterialien wurde ebenfalls klinisch getestet. Erste Ergebnisse randomisierter klinischer Studien mit zell- und wachstumsfaktorbasierten Therapien untermauern das Potenzial dieser innovativen Therapiestrategien. Die zellbasierten Verfahren unterliegen in der EU häufig dem Gewebegesetz und bedürfen i. d. R. einer Herstellungserlaubnis.

Diskussion

Bis dato liegen nur wenige randomisierte, kontrollierte klinische Studien vor, die zusätzlich eine große Heterogenität bezüglich der Zellparameter, der Zellaufbereitung, der adjuvanten chirurgischen Therapie und der Qualität der Ergebniskontrolle aufweisen. Daher ist eine abschließende Aussage über die Wirksamkeit neuer zell- und wachstumsfaktorbasierter Therapieverfahren zum jetzigen Zeitpunkt nicht möglich.

Abstract

Background

The application of cell- and growth factor-based techniques in conjunction with conventional surgical approaches has great therapeutic potential for the treatment of avascular necrosis of the femoral head (AVNFH).

Objectives

This review provides an overview of new strategies for the treatment of AVNFH, with emphasis on cell and growth factor-based approaches.

Materials and methods

The results of a literature search are summarised, the most relevant publications are presented and discussed by the authors.

Results

In the focus of new strategies for treatment of AVNFH are bone marrow-derived cell concentrates and ex vivo-expanded mesenchymal stem cells. Besides local application during core decompression, the systemic administration of cells via blood vessels supplying the femoral head is an interesting approach. The application of osteogenic and angiogenic growth factor-laden scaffold materials has also been clinically tested. Initial results of randomised clinical trials using cell- and growth factor-based approaches underline the potential of these innovative therapeutic strategies. Cell-based therapies are governed by EU law and generally require a manufacturing authorization.

Conclusion

To date, only few randomized controlled clinical trials are available which additionally display a considerable diversity concerning cell parameters, cell processing, adjuvant surgical techniques and the quality outcome parameters. Therefore, a final statement about the effectiveness of new cell and growth factor-based strategies is currently not possible.

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Abb. 1

Abbreviations

ARCO:

Association Research Circulation Osseous

BMP:

„Bone morphogenetic protein“

CD:

„Core decompression“

FKN:

Femurkopfnekrose

HHS:

Harris-Hip-Score

HTEP:

Hüfttotalendoprothese

IGF:

„Insulin-like growth factor“

JOA:

Japanese Orthopaedic Association

KM:

Knochenmark

MSZ:

Mesenchymale Stammzelle

PDGF:

„Platelet-derived growth factor“

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße 555, 13589, Berlin, Deutschland

    L. Rackwitz, J. C. Reichert & U. Nöth

  2. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland

    M. Haversath & M. Jäger

Authors
  1. L. Rackwitz
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  2. J. C. Reichert
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  3. M. Haversath
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  4. U. Nöth
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  5. M. Jäger
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Correspondence to L. Rackwitz.

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Interessenkonflikt

L. Rackwitz, J. C. Reichert, M. Haversath, U. Nöth und M. Jäger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rackwitz, L., Reichert, J.C., Haversath, M. et al. Zellbasierte und zukünftige Therapieansätze der Femurkopfnekrose. Orthopäde 47, 770–776 (2018). https://doi.org/10.1007/s00132-018-3619-3

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