Application of cellular technologies in the treatment of the femoral head avascular necrosis

Authors

  • I.M. Zazirnyi Clinical Hospital “Feofaniya” of the Agency of State Affairs, Kyiv, Ukraine
  • I.P. Semeniv Clinical Hospital “Feofaniya” of the Agency of State Affairs, Kyiv, Ukraine
  • V.G. Klymovytsky Scientific and Research Institute of Traumatology and Orthopedics of Donetsk National Medical University, Lyman, Ukraine
  • A. Andreev UMBAL “Santa Anna”, Sofia, Bulgaria

DOI:

https://doi.org/10.22141/1608-1706.3.21.2020.208421

Keywords:

femoral head, avascular necrosis, cell therapy, mesenchymal stem cells

Abstract

The femoral head avascular necrosis (FHAN) is a pathological condition that occurs as a result of a cellular disorder caused by decreased activity of osteoblasts and the local population of mesenchymal stem cells (MSCs). Cell therapy could help treat this condition with stem and other progenitor cells that can potentially improve the local cell environment in the affected hip joint. As a part of the treatment for FHAN, the use of cell therapy was scientifically substantiated, as well as the methods for implantation of autogenous bone marrow concentrate were described. Although the etiology of FHAN has not been fully studied, it has been hypothesized that this disease is of cellular origin. Problems that can reduce the number or change the function of osteoprogenitor cells can lead to an imbalance between osteoblast formation and necrosis, which can cause the development of FHAN if the balance is not restored. Based on the hypothesis that FHAN has a cellular origin, it is believed that therapies based on cell therapy (cytotherapy) have significant potential. Cytotherapy can also help avoid total arthroplasty among young patients. For the treatment of FHAN, transplantation of autogenous cancellous bone tissue (ACBT) was proposed, which gave positive results. The efficacy of ACBT mononuclear cells may be related to the local population of adult stem cells in the ACBT, which have osteogenic properties. Implantation of the ACBT in the focus of avascular necrosis of the head leads to a localized increase in the number of these cells in the necrotic head of the femur. Another possible explanation for the therapeutic effect of ACBT implantation is that in this procedure, stromal cells are introduced that produce angiogenic cytokines, which leads to increased angiogenesis and further improvement of osteogenesis. Based on the average bone matrix, which consists of 33 % of the ACBT, the number of osteocytes in 1 cm3 of cancellous bone can be estimated in the range of 20 million. Given the number of precursors in the range of 2,500 per 1 ml of the prepared mixture of MSCs, each precursor had to divide at least 12 or 14 times to obtain 1 ml of new bone, assuming that all progenitor cells retain the ability to produce trabecular bone (2,500 • 214 = 20 million osteoblasts). These calculations assume that all introduced cells remain in place and that no osteogenic cells have been introduced into the pathology area. Tissue engineering can combine ACBT mesenchymal stem cells, synthetic scaffolds, and molecular signals (growth factors) to form hybrid constructs. In the classical approach, bone engineering consists of collecting the ACBT from a patient, isola-ting MSCs by attaching them to a tissue culture plate, expanding and differentiating these cells in culture, and then seeding them to a suitable synthetic scaffold before implantation in the same patient. The autogenic approach to the isolation and osteogenic differentiation of MSCs is quite demanding in terms of logistics, production and safety of cultivation conditions, which leads to the high cost of the therapeutic procedure. The combination of biomaterials with osteoprogenitor cells causes technical (i.e. cell sources, types, doses, timing) and regulatory problems (combination of devices and drugs).

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References

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Published

2021-11-03

How to Cite

Zazirnyi, I., Semeniv, I., Klymovytsky, V., & Andreev, A. (2021). Application of cellular technologies in the treatment of the femoral head avascular necrosis. TRAUMA, 21(3), 48–55. https://doi.org/10.22141/1608-1706.3.21.2020.208421

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Section

To General Practitioner

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