RESUMEN
The number of patients with functional loss of bone and cartilage tissue has shown an increasing trend. Insufficient or inappropriate conventional treatments applied for trauma, orthopedic diseases, or other bone and cartilage-related disorders can lead to bone and cartilage damage. This represents a worldwide public health issue and a significant economic burden. Advanced therapeutic medicinal products (ATMPs) proposed promising alternative therapeutic modalities by application of cell-based and tissue engineering approaches. Recently, several ATMPs have been developed to promote bone and cartilage tissue regeneration. Fifteen ATMPs, two related to bone and 13 related to cartilage, have received regulatory approval and marketing authorization. However, four ATMPs were withdrawn from the market for various reasons. However, ATMPs that are still on the market have demonstrated positive results, their broad application faced limitations. The development and standardization of methodologies will be a major challenge in the coming decades. Currently, the number of ATMPs in clinical trials using mesenchymal stromal cells or chondrocytes indicates a growing recognition that current ATMPs can be improved. Research on bone and cartilage tissue regeneration continues to expand. Cell-based therapies are likely to be clinically supported by the new ATMPs, innovative fabrication processes, and enhanced surgical approaches. In this study, we highlighted the available ATMPs that have been used in bone and cartilage defects and discussed their advantages and disadvantages in clinical applications.
Asunto(s)
Ingeniería de Tejidos , Humanos , Ingeniería de Tejidos/métodos , Animales , Enfermedades de los Cartílagos/terapia , Enfermedades Óseas/terapia , Cartílago/lesiones , Regeneración Ósea/efectos de los fármacosRESUMEN
ABSTRACT Introduction: Hydrokinesitherapy is a rehabilitation method used for the treatment of different types of orthopedic, neurological, respiratory problems, etc. However, the existing literature presents not so much evidence regarding the greater efficacy of water treatment compared to dry treatment in patients with post-traumatic outcomes. Objective: Through the administration of a questionnaire, we tried to investigate the rehabilitation experience of hydrokinetic therapists (trained with the so-called Sequential and Preparatory Approach) in order to understand hydrokinesitherapy areas and methods of proper application based on experts' opinion. Methods: A cross-sectional study was carried out in 2020 by administering a questionnaire to physiotherapists trained in hydrokinesitherapy according to the Sequential and Preparatory Approach method, with the aim to investigate their opinion on the use of hydrokinesitherapy in patients with various orthopedic-traumatological problems. Microsoft FORMS® platform was used for the administration of the questionnaire. Results: Sixty-two users participated in the study. From their answers emerged that the use of hydrokinesitherapy is not recommended for the treatment of post-traumatic hypersensitization of peri-lesional tissues (hypersensitive scars; general hypersensitization) and neuropathic syndromes (of the upper and lower limbs). Conclusions: The data obtained from administering the questionnaire were not sufficient to create a specific path to define the appropriateness of hydrokinesitherapy for some orthopedic-traumatological problems but could be considered a good starting point on which to build future developments through further studies.
RESUMEN Introducción: La terapia hidrocinética es un método rehabilitador utilizado para el tratamiento de diferentes tipos de problemas ortopédicos, neurológicos, respiratorios, entre otros. Sin embargo, en la literatura existente no abundan evidencias en cuanto a la mayor eficacia del tratamiento con agua en comparación con el tratamiento seco en pacientes con resultados traumáticos. Objetivo: A través de un cuestionario, se intentó investigar la experiencia de rehabilitación de los terapeutas hidrocinéticos (entrenados con el llamado Enfoque Secuencial y Preparatorio) para comprender las áreas de la terapia hidrocinética y los métodos de aplicación adecuados con base en la opinión de expertos. Métodos: Se realizó un estudio transversal en el año 2020 mediante la administración de un cuestionario a fisioterapeutas formados en la terapia hidrocinética según el método de Abordaje Secuencial y Preparatorio, con el objetivo de averiguar su opinión sobre el uso de la terapia hidrocinética en pacientes con diversos problemas ortopédico-traumatológicos. Se utilizó la plataforma Microsoft FORMS® para la administración del cuestionario. Resultados: Sesenta y dos usuarios participaron en el estudio. De sus respuestas surgió que no se recomienda el uso de la terapia hidrocinética para el tratamiento de la hipersensibilización postraumática de los tejidos perilesionales (cicatrices hipersensibles; hipersensibilización general) y síndromes neuropáticos (de miembros superiores e inferiores). Conclusiones: Los datos obtenidos del cuestionario no fueron suficientes para crear una ruta específica que defina la idoneidad de la terapia hidrocinética para algunos problemas ortopédicos-traumatológicos, pero podría considerarse un buen punto de partida para construir futuros desarrollos a través de estudios adicionales.
Asunto(s)
Humanos , Heridas y Lesiones/terapia , Enfermedades Óseas/terapia , Hidroterapia/métodos , Estudios TransversalesRESUMEN
MicroRNAs (miRNAs) are a class of small (20-24 nucleotides), highly conserved, non-coding RNA molecules whose main function is the post-transcriptional regulation of gene expression through sequence-specific manners, such as mRNA degradation or translational repression. Since these key regulatory molecules are implicated in several biological processes, their altered expression affects the preservation of cellular homeostasis and leads to the development of a wide range of pathologies. Over the last few years, relevant investigations have elucidated that miRNAs participate in different stages of bone growth and development. Moreover, the abnormal expression of these RNA molecules in bone cells and tissues has been significantly associated with the progression of numerous bone diseases, including osteoporosis, osteosarcoma, osteonecrosis and bone metastasis, among others. In fact, miRNAs regulate multiple pathological mechanisms, including altering either osteogenic or osteoblast differentiation, metastasis, osteosarcoma cell proliferation, and bone loss. Therefore, in this present review, aiming to impulse the research arena of the biological implications of miRNA transcriptome in bone diseases and to explore their potentiality as a theragnostic target, we summarize the recent findings associated with the clinical significance of miRNAs in these ailments.
Asunto(s)
Biomarcadores , Enfermedades Óseas/etiología , Enfermedades Óseas/terapia , Susceptibilidad a Enfermedades , Regulación de la Expresión Génica , MicroARNs/genética , Interferencia de ARN , Animales , Enfermedades Óseas/metabolismo , Enfermedades Óseas/patología , Manejo de la Enfermedad , Exosomas , Humanos , Metástasis de la Neoplasia , Osteogénesis/genética , Osteonecrosis/etiología , Osteonecrosis/metabolismo , Osteonecrosis/patología , Osteoporosis/genética , Osteoporosis/metabolismo , Osteoporosis/patología , Osteosarcoma/etiología , Osteosarcoma/metabolismo , Osteosarcoma/patología , Transporte de ARN , Transducción de SeñalRESUMEN
Signaling lipid mediators released from 5 lipoxygenase (5LO) pathways influence both bone and muscle cells, interfering in their proliferation and differentiation capacities. A major limitation to studying inflammatory signaling pathways in bone and muscle healing is the inadequacy of available animal models. We developed a surgical injury model in the vastus lateralis (VL) muscle and femur in 129/SvEv littermates mice to study simultaneous musculoskeletal (MSK) healing in male and female, young (3 months) and aged (18 months) WT mice compared to mice lacking 5LO (5LOKO). MSK defects were surgically created using a 1-mm punch device in the VA muscle followed by a 0.5-mm round defect in the femur. After days 7 and 14 post-surgery, the specimens were removed for microtomography (microCT), histopathology, and immunohistochemistry analyses. In addition, non-injured control skeletal muscles along with femur and L5 vertebrae were analyzed. Bones were microCT phenotyped, revealing that aged female WT mice presented reduced BV/TV and trabecular parameters compared to aged males and aged female 5LOKO mice. Skeletal muscles underwent a customized targeted lipidomics investigation for profiling and quantification of lipid signaling mediators (LMs), evidencing age, and gender related-differences in aged female 5LOKO mice compared to matched WT. Histological analysis revealed a suitable bone-healing process with osteoid deposition at day 7 post-surgery, followed by woven bone at day 14 post-surgery, observed in all young mice. Aged WT females displayed increased inflammatory response at day 7 post-surgery, delayed bone matrix maturation, and increased TRAP immunolabeling at day 14 post-surgery compared to 5LOKO females. Skeletal muscles of aged animals showed higher levels of inflammation in comparison to young controls at day 14 post-surgery; however, inflammatory process was attenuated in aged 5LOKO mice compared to aged WT. In conclusion, this new model shows that MSK healing is influenced by age, gender, and the 5LO pathway, which might serve as a potential target to investigate therapeutic interventions and age-related MSK diseases. Our new model is suitable for bone-muscle crosstalk studies.
Asunto(s)
Araquidonato 5-Lipooxigenasa/fisiología , Enfermedades Óseas/terapia , Huesos/lesiones , Modelos Anatómicos , Músculo Esquelético/lesiones , Enfermedades Musculares/terapia , Cicatrización de Heridas , Factores de Edad , Animales , Enfermedades Óseas/etiología , Enfermedades Óseas/patología , Huesos/patología , Huesos/cirugía , Femenino , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Músculo Esquelético/cirugía , Enfermedades Musculares/etiología , Enfermedades Musculares/patología , Factores SexualesRESUMEN
Los implantes dentales son un tipo más de tratamiento para la resolución de casos de edentulismo. Desde su inicio, en los años 70, han sido una alternativa creciente para rehabilitar pacientes, sobre todo en casos en los que las rehabilitaciones convencionales no eran posibles. Cada vez de forma más frecuente nos enfrentamos a retratamientos de implantes y casos con atrofias más complejas. En el siguiente caso, mostramos un retratamiento de implantes fracasados unido a una situación de atrofia extrema vertical y horizontal combinada. En casos de atrofia severa maxilar y mandibular, el uso de los implantes cortos puede acortar los tiempos de tratamiento y simplificar las técnicas quirúrgicas sin renunciar a la predictibilidad como en el caso mostrado. (AU)
Dental implants are an alternative treatment for extended the resolution of cases of edentulism. Since its inception in the year 70 have been a growing alternative to rehabilitate patients, especially in cases where conventional rehabilitations were not possible. Every time, in the dental office were more often we re-treatments of implants and cases with more complex atrophies. In the following case we show a re-treatment of failed implants attached to a situation of extreme atrophy combined vertical and horizontal. In cases of severe maxillary and mandibular atrophy, the use of short implants can shorten treatment times and simplify surgical techniques without sacrificing predictability as in the case shown. (AU)
Asunto(s)
Humanos , Femenino , Anciano , Enfermedades Óseas/terapia , Implantes Dentales , Retratamiento , Periimplantitis/terapiaRESUMEN
The apoptosis-associated Speck-like protein containing a caspase-1 recruitment domain (ASC), present in inflammasomes, regulates inflammation events and is involved in osteogenic phenotype. Nevertheless, its function in bone repair induced by bone substitute biomaterials is unclear. This study aimed to unveil the role of ASC on osteoprogenitor and tissue response to stoichiometric-hydroxyapatite (HA), nanostructured carbonated-hydroxyapatite (CHA), and CHA containing 5% Strontium (SrCHA), characterized previously by XRD, uXRF-SR, and FTIR spectroscopy implants. Thereafter, conditioned media by the biomaterials were used later to treat pre-osteoblasts and an osteogenic stimulus was shown in response to the materials, with higher expression of Runx2, Osterix, ALP, and Collagen 1a1 genes, with significant involvement of inflammatory-related genes. Thus, to better address the involvement of inflammasome, primary cells obtained from both genotypes [Wild-Type (WT) and ASC Knockout (ASC-KO) mice] were subjected to conditioned media up to 7 days, and our data reinforces both HA and CHA induces lower levels of alkaline phosphatase (ALP) than SrCHA, considering both genotypes (p < 0.01), and ASC seems contribute with osteogenic stimulus promoted by SrCHA. Complimentarily, the biomaterials were implanted into both subcutaneous and bone defects in tibia. Histological analysis on 28 days after implantation of biomaterials into mice's subcutaneous tissue revealed moderate inflammatory response to them. Both histomorphometry and µCT analysis of tibias indicated that the biomaterials did not reverse the delay in bone repair of ASC KO, reinforcing the involvement of ASC on bone regeneration and bone de novo deposition. Also, the bone density in CHA was >2-fold higher in WT than ASC-KO samples. HA was virtually not resorbed throughout the experimental periods, in opposition to CHA in the WT group. CHA reduced to half-area after 28 days, and the bone deposition was higher in CHA for WT mice than HA. Taken together, our results show that biomaterials did not interfere with the healing pattern of the ASC KO, but CHA promoted higher bone deposition in the WT group, probably due to its greater biodegradability. These results reinforce the importance of ASC during bone de novo deposition and healing.
Asunto(s)
Materiales Biocompatibles/química , Sustitutos de Huesos/química , Caspasa 1/química , Animales , Apoptosis/efectos de los fármacos , Materiales Biocompatibles/farmacología , Materiales Biocompatibles/uso terapéutico , Enfermedades Óseas/diagnóstico por imagen , Enfermedades Óseas/patología , Enfermedades Óseas/terapia , Sustitutos de Huesos/farmacología , Sustitutos de Huesos/uso terapéutico , Carbonatos/química , Caspasa 1/deficiencia , Caspasa 1/genética , Células Cultivadas , Medios de Cultivo Condicionados/química , Medios de Cultivo Condicionados/farmacología , Durapatita/química , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Nanoestructuras/química , Osteoblastos/citología , Osteoblastos/metabolismo , Osteogénesis/efectos de los fármacos , Prótesis e Implantes , Estroncio/química , Tibia/diagnóstico por imagen , Tibia/patologíaRESUMEN
Los micro-ARNs (miARNs) son pequeñas moléculas de ARN no codificante (de aproximadamente 15-25 nucleótidos), que regulan la expresión de genes involucrados en numerosas funciones biológicas, a través de la inhibición o degradación de un ARN mensajero diana. La homeostasis ósea se mantiene por el balance entre la formación osteoblástica y la resorción osteoclástica. La sobreexpresión o inhibición de miARNs específicos afecta la proliferación, diferenciación y actividad de osteoblastos, osteocitos y osteoclastos. Estas acciones son llevadas a cabo modulando la expresión de distintos factores transcripcionales y moléculas de señalización de las vías esenciales para la osteoblastogénesis u osteoclastogénesis. Estos efectos modifican el balance entre la formación y la resorción, determinando cambios en la homeostasis ósea. Esta revisión enumera una serie de miARNs que participan en la homeostasis ósea. Profundizando en el conocimiento de los mecanismos por medio de los cuales los miARNs actúan sobre el hueso, podrían revelarse nuevos usos potenciales futuros, entre los que se encuentran su utilidad como nuevos biomarcadores óseos o como agentes terapéuticos para el tratamiento de trastornos metabólicos óseos, pérdida de masa ósea o enfermedades óseas. (AU)
MicroRNAs (miRNAs) are endogenous small noncoding RNA molecules (of approximately 1525 nucleotides), which regulate the expression of genes controlling numerous biological functions, through the inhibition or degradation of the target messenger RNA. Bone homeostasis is maintained by a balance between osteoblastic bone formation and osteoclastic bone resorption. The overexpression or inhibition of specific miRNAs affects cell proliferation, differentiation and activity of osteoblast, osteocytes and osteoclast. This action is done by modulating the expression of different transcription factors and signaling molecules of the most relevant pathways of osteoblastogenesis or osteoclastogenesis. This effect is able to modify the balance between bone formation and resorption, determining changes in bone homeostasis. The present review is an overview of a series of miRNAs involved in bone homeostasis. An in depth knowledge of the mechanisms by which miRNAs act on bone may reveal potential uses in the future as new bone biomarkers or therapeutic agents for treating metabolic bone disorders, bone loss and bone diseases. (AU)
Asunto(s)
Humanos , Remodelación Ósea , MicroARNs/uso terapéutico , Osteoblastos , Osteoclastos , Osteocitos , Esqueleto/metabolismo , Enfermedades Óseas/terapia , Resorción Ósea/terapia , Biomarcadores , MicroARNs/fisiología , Fracturas Óseas/prevención & controlRESUMEN
The biology of stem cells is one of the most dynamic and promising fields of the biological sciences, since it is the basis for the development of organisms. Its biological complexity demands efforts from several lines of research aimed mainly at its therapeutic use. Nanotechnology has been emerging as a new field of study, which shows great potential in the treatment of various diseases. This new area of health has been called "Nanomedicine" or "Bionanotechnology", which can be applied in Medicine by transport and drug delivery systems, robotic tools to be used in diagnostic and surgical processes, nanobiomaterials, gene therapies, nanobiomedical devices, among others. Because stem cells and Nanotechnology are two areas of extremely promising science, a new field of study, called "stem cell Nanotechnology", has gradually emerged. In this, Nanotechnology is used to help the stem cells apply their therapeutic potential in the treatment, cure, and repair of the damaged tissues, in an effective and safe way. In this way, stem cell Nanotechnology has generated great interest, since it may result in significant contributions to Regenerative Medicine and tissue engineering. The present work aims to present the state-of-the-art regarding its therapeutic use in Human Medicine.
Asunto(s)
Células Madre Adultas , Células Madre Multipotentes , Nanotecnología/métodos , Medicina Regenerativa/métodos , Enfermedades Óseas/terapia , Enfermedades Cardiovasculares/terapia , Humanos , Nanomedicina/métodos , Nanoestructuras/uso terapéutico , Neoplasias/terapia , Enfermedades del Sistema Nervioso/terapia , Ingeniería de Tejidos/métodosRESUMEN
ABSTRACT The biology of stem cells is one of the most dynamic and promising fields of the biological sciences, since it is the basis for the development of organisms. Its biological complexity demands efforts from several lines of research aimed mainly at its therapeutic use. Nanotechnology has been emerging as a new field of study, which shows great potential in the treatment of various diseases. This new area of health has been called "Nanomedicine" or "Bionanotechnology", which can be applied in Medicine by transport and drug delivery systems, robotic tools to be used in diagnostic and surgical processes, nanobiomaterials, gene therapies, nanobiomedical devices, among others. Because stem cells and Nanotechnology are two areas of extremely promising science, a new field of study, called "stem cell Nanotechnology", has gradually emerged. In this, Nanotechnology is used to help the stem cells apply their therapeutic potential in the treatment, cure, and repair of the damaged tissues, in an effective and safe way. In this way, stem cell Nanotechnology has generated great interest, since it may result in significant contributions to Regenerative Medicine and tissue engineering. The present work aims to present the state-of-the-art regarding its therapeutic use in Human Medicine.
RESUMO A biologia das células-tronco é um dos campos mais dinâmicos e promissores das ciências biológicas, pois é a base do desenvolvimento dos organismos. Sua complexidade biológica demanda esforços de diversas linhas de pesquisa, visando principalmente à sua utilização terapêutica. A Nanotecnologia surge como um novo campo de estudo, o qual demonstra grande potencial no que tange ao tratamento de diversas doenças. Esta nova área da saúde vem sendo denominada "Nanomedicina" ou "Bionanotecnologia", a qual pode ser aplicada na Medicina por meio da utilização de sistemas de transporte e liberação de fármacos, ferramentas robóticas a serem utilizadas em processos de diagnóstico e cirurgia, nanobiomateriais, terapias gênicas, dispositivos nanobiomédicos, entre outros. Em razão das células-tronco e a Nanotecnologia serem duas áreas da ciência extremante promissoras, um novo campo de estudo, denominado "Nanotecnologia das células-tronco", surge gradativamente. Neste, a Nanotecnologia é utilizada de forma a auxiliar as células-tronco a exercerem seu potencial terapêutico no tratamento, na cura e na reparação dos tecidos lesionados, de forma eficaz e segura. A Nanotecnologia das células-tronco tem gerado grande interesse, podendo resultar em contribuições significativas na Medicina Regenerativa e na engenharia de tecidos. O presente trabalho teve por objetivo apresentar o estado da arte visando à sua utilização terapêutica na Medicina Humana.
Asunto(s)
Humanos , Nanotecnología/métodos , Células Madre Multipotentes , Medicina Regenerativa/métodos , Células Madre Adultas , Enfermedades Óseas/terapia , Enfermedades Cardiovasculares/terapia , Ingeniería de Tejidos/métodos , Nanoestructuras/uso terapéutico , Nanomedicina/métodos , Neoplasias/terapia , Enfermedades del Sistema Nervioso/terapiaRESUMEN
Existen numerosas patologías que generan situaciones invalidantes debido a problemas asociados a nivel de defectos óseos. Esto genera, en muchas oportunidades, cuestiones sanitarias de alto impacto. La ingeniería de tejidos óseos pretende generar propuestas novedosas para reparar pérdidas o fracturas óseas, promoviendo regenerar el tejido mediante el implante de matrices biodegradables que puedan actuar como estructuras para la adhesión celular, favoreciendo el crecimiento y la diferenciación hasta formar hueso de novo. El incremento notable de los conocimientos en las áreas biotecnológicas, de síntesis química, así como de biomedicina, permiten el desarrollo de numerosos tipos de matrices de tercera generación, biodegradables y no tóxicas, con características que proponen sean consideradas en la regeneración tisular ósea. Este trabajo intenta resumir los tipos de matrices que mayor impacto han tenido hasta el momento en la medicina regenerativa ósea, mostrando los casos más relevantes de resultados experimentales y clínicos, y propone algunas perspectivas que se deberían considerar para poder aplicarlas a la práctica clínica. Esta es un área que invita a los investigadores a posicionarse en un pensamiento complejo desde el punto de vista científico-filosófico. (AU)
There are several pathologies that generate disability due to complications associated with bone defects. This often generates high impact health troubles. Bone tissue engineering aims to generate novel means to repair bone loss or bone fractures, promoting tissue regeneration through the implantation biodegradables scaffolds, which can act as structures for cell adhesion, that promts cell growth and differentiation for the novo bone formation. The remarkable for the novo bone formation in biotechnology, chemical synthesis, and biomedical knowledge allows the development of numerous types of third generation scaffolds, applied to promote bone tissue regeneration. This brief report aims to review the scaffolds that have had more impact in bone regenerative medicine so far, describing the most relevant experimental and clinical results. This is an area that invites researchers to situate themselves in a complex thought of scientific-philosophical point of view. (AU)
Asunto(s)
Humanos , Ingeniería de Tejidos/métodos , Medicina Regenerativa/métodos , Huesos/metabolismo , Huesos/química , Enfermedades Óseas/terapia , Regeneración Ósea , Oseointegración , Ingeniería de Tejidos/tendencias , Medicina Regenerativa/tendencias , Fracturas Óseas/terapiaRESUMEN
Existe escasa información sobre baja masa ósea y osteoporosis en mujeres premenopáusicas. Solo el 2% de las mujeres jóvenes consulta para evaluar la presencia de osteoporosis. En el 50% de las mujeres premenopáusicas que presentan una disminución de su masa ósea se diagnostican enfermedades o medicaciones que la provocan. Las causas deben ser cuidadosamente investigadas para no emitir un diagnóstico apresurado de osteoporosis premenopáusica. Al diagnóstico de baja masa ósea se arriba luego de descartar las causas que ocasionan osteoporosis secundaria y su etiología se relaciona genéticamente con un bajo pico de masa ósea. El cuadro de osteoporosis primaria presenta una densidad mineral ósea (DMO) muy disminuida y fracturas óseas por fragilidad. La etiología no es clara aún, la genética marca el 50-80% de lo que sucede con la masa ósea. Se ha encontrado en diferentes poblaciones, una disminución de la función osteoblástica, resistencia a IGF1, disminución de la hormona de crecimiento, bajos niveles de estradiol, alteración de la expresión del receptor a-estrogénico de los osteoblastos, alteración de la dinámica de secreción de la PTH y aumento de la excresión de interleuquina 1. El diagnóstico se realiza por densitometría, marcadores bioquímicos óseos y radiografías de columna dorsal y lumbar que permiten visualizar fracturas vertebrales asintomáticas. La International Society for Clinical Densitometry (ISCD) y las guías argentinas para osteoporosis sugieren definir la DMO premenopáusica por Z-score y se considera normal hasta -2.0. El tratamiento se basa fundamentalmente en generar hábitos saludables para el hueso: ingesta de calcio y vitamina D o suplementos de calcio y vitamina D, actividad física, evitar sustancias perjudiciales como alcohol y tabaco en exceso. Cuando la DMO es muy baja o existe una pérdida acelerada de DMO o fracturas por fragilidad, el tratamiento con teriparatide ha demostrado ser efectivo. Los bifosfonatos solo deben indicarse en situaciones especiales de osteoporosis. Cuando se diagnostica una osteoporosis secundaria, el tratamiento es el de la enfermedad que la provoca. Cada paciente debe ser analizada con mucha prudencia para arribar al diagnóstico correcto y al mejor tratamiento.
There is little information about low bone mass and osteoporosis in premenopausal women. Only 2% of young women consult to evaluate the presence of osteoporosis. A total of 50% of premenopausal women have a disease or take a medication that lessens their bone mass. The causes must be carefully investigated to arrive at a correct diagnosis. Diagnosing low bone mass up after ruling out secondary osteoporosis and its etiology is genetically related to low peak bone mass. Primary osteoporosis presents a very reduced bone mineral density (BMD) with bone fragility fractures. The etiology is not clear yet: genetics marks 50-80% of what happens with bone mass. Decreased osteoblast function, IGF1 resistance, decreased growth hormone, low estradiol levels, altered expression receptor a-estrogenic of osteoblasts, altered dynamics of PTH secretion, and increased excretion of interleukin-1 have been found in different populations. The diagnosis is not only performed by densitometry but also through bone biochemical markers and radiographs of thoracic and lumbar spine radiographs that can diagnose asymptomatic vertebral fractures. The International Society for Clinical Densitometry (ISCD) and Argentine guidelines suggest definition premenopausal osteoporosis by BMD Z -score, in which a value up to -2.0 is considered normal. The treatment is based primarily on healthy habits for the bone: intake of calcium and vitamin D or calcium and vitamin D supplements, physical activity, and avoiding damaging substances to the bone, like alcohol and tobacco in excess. When BMD is very low or there is a rapid loss of BMD or fragility fractures, teriparatide treatment has proven effective. The bisphosphonates should be indicated only in special patients with osteoporosis. When a secondary osteoporosis is diagnosed, the treatment given is for the disease that has caused it. Each patient must be analyzed with great care to arrive at the correct diagnosis and the best treatment.
Há pouca informação sobre baixa massa óssea e osteoporose em mulheres na pré-menopausa. Apenas 2% das mulheres jovens consulta para avaliar a presença de osteoporose. 50% das mulheres premenopáusicas que apresentam diminuição da massa óssea são diagnosticadas como causas doenças ou medicamentos. As causas devem ser cuidadosamente investigadas para emitir um diagnóstico rápido de osteoporose premenopáusica. Chega-se ao diagnóstico de baixa massa óssea após descartar as causas que provocam osteoporose secundária e sua etiologia é geneticamente relacionada com baixo pico de massa óssea. O quadro de osteoporose primária apresenta densidade mineral óssea (DMO) muito diminuída e fraturas ósseas por fragilidade. A etiologia ainda não está clara, a genética marca 50-80% do que acontece com a massa óssea. Foi encontrada em diferentes populações diminuição da função osteoblástica, resistência a IGF1, diminuição do hormônio de crescimento, baixos níveis de estradiol, alteração da expressão do receptor a-estrogênico dos osteoblastos, alteração da dinâmica de secreção de PTH, aumento da excreção de interleucina 1. O diagnóstco é realizado por densitometria, marcadores bioquímicos ósseos e radiografias de coluna dorsal e lombar que permitem visualizar fraturas vertebrais assintomáticas. A International Society for Clinical Densitometry (ISCD) e os Guias argentinos para osteoporose sugerem definir a DMO por Z-score e se considera normal até -2,0. O tratamento baseia-se principalmente em gerar hábitos saudáveis para o osso: ingestão de cálcio e vitamina D ou suplementos de cálcio e vitamina D, atividade física, evitar substâncias prejudiciais como álcool e tabaco em excesso. Quando a DMO é muito baixa ou há uma rápida perda de DMO ou fraturas por fragilidade, o tratamento com teriparatide demonstrou ser eficaz. Os bifosfonatos só devem ser indicados em situações especiais osteoporose. Quando uma osteoporose secundária é diagnosticada, o tratamento é o da doença que a provoca. Cada paciente deve ser analisado com muito cuidado para chegar ao diagnóstico correto e o melhor tratamento.
Asunto(s)
Adulto , Persona de Mediana Edad , Enfermedades Óseas/diagnóstico , Enfermedades Óseas/tratamiento farmacológico , Osteoporosis Posmenopáusica , Osteoporosis , Enfermedades Óseas/terapiaRESUMEN
Autogenous bone grafts are used to repair bone defects, and the stabilization is needed for bone regeneration. Laser photobiomodulation is a modality of treatment in clinical practice for tissue regeneration, and it has therapeutic effects as an anti-inflammatory, analgesic and modulating cellular activity. The aim of the present study was to evaluate the effects of low-level laser therapy (LLLT) on an autogenous bone graft integration process stabilized with a new heterologous fibrin sealant. Forty rats were divided into two groups: Autogenous Fibrin Graft (AFG, n=20), in which a 5mm dome osteotomy was conducted in the right parietal bone and the graft was adhered to the left side using fibrin sealant; and Autogenous Fibrin Graft Laser (AFGL, n=20), which was subjected to the same procedures as AFG with the addition of LLLT. The treatment was performed immediately following surgery and then three times a week until euthanasia, using an 830nm laser (30mW, 6J/cm(2), 0.116cm(2), 258.6mW/cm(2), 2.9J). Five animals from each group were euthanized at 10, 20, 30 and 40days postoperative, and the samples were submitted to histomorphological and histomorphometric analysis. Partial bone regeneration occurred, with new bone tissue integrating the graft to the recipient bed and small areas of connective tissue. Comparative analysis of the groups at the same intervals revealed minor interfaces in group AFGL, with statistically significant differences (p<0.05) at all of the analyzed intervals (10days p=0.0087, 20days p=0.0012, 30days p<0.0001, 40days p=0.0142). In conclusion, low-level laser therapy stimulated bone regeneration and accelerated the process of integration of autogenous bone grafts.
Asunto(s)
Enfermedades Óseas/terapia , Trasplante Óseo , Adhesivo de Tejido de Fibrina/uso terapéutico , Terapia por Luz de Baja Intensidad , Animales , Regeneración Ósea , Huesos/patología , Masculino , Ratas , Ratas WistarRESUMEN
Since the introduction of bone morphogenetic proteins, their use has become an invaluable ally for the treatment of bone defects. These proteins are potent growth factors, related to angiogenic and osteogenic activity. The osteoinductive capacity of recombinant bone morphogenetic protein (rhBMP) in the formation of bone and cartilage has been confirmed in in vitro studies and evaluated in clinical trials. To obtain a therapeutic effect, administration is systemic, by injection over the physiological dose. Among the disadvantages, ectopic bone formation or high morbidity in cases of spinal fusion is observed. In this review, the roles of bone morphogenetic proteins in bone repair and clinical applications are analyzed. These findings represent advances in the study of bone regeneration and application of growth factors for more predictable results.
Asunto(s)
Enfermedades Óseas/terapia , Proteínas Morfogenéticas Óseas/administración & dosificación , Regeneración Ósea/efectos de los fármacos , Enfermedades Óseas/patología , Proteínas Morfogenéticas Óseas/efectos adversos , Humanos , Inyecciones , Osificación Heterotópica/inducido químicamente , Osteogénesis/efectos de los fármacos , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Fusión Vertebral/métodosRESUMEN
BACKGROUND: Langerhans cell histiocytosis (LCH), previously known as Histiocytosis X, is an infrequent disease that congregates a wide spectrum of clinical presentations with variable systemic involvement. Unification of these diseases under only one category is based on the almost identical histopathologic features of the lesions, but the etiology and proper approach for each presentation remains controversial. The localized alternative of Langerhans cell histiocytosis (LLCH), known as Eosinophilic Granuloma (EG) of bone, is the predominant clinical presentation of LCH. The maxilla is involved in 1 % of the head and neck region cases, representing an uncommon condition in this area. CASE PRESENTATION: In this clinical case report, it is described a case of a 16-year-old male patient with an asymptomatic osteolytic lesion at first upper left molar apical level, a finding detected on control radiographic images was reported as "Monostotic Eosinophilic granuloma of the maxillary bone", which was later confirmed through an incisional biopsy. A surgical excision was initially planned, but finally it was not performed due to a spontaneous healing of the lesion after the incisional biopsy. CONCLUSIONS: The presented case supports a conservative approach in the management of solitary EG of maxillary and mandibular bone lesions and even supports an expectant attitude in the course of treatment given the possibility of a spontaneous regression after the biopsy, especially in small lesions.
Asunto(s)
Granuloma Eosinófilo/patología , Maxilar/patología , Radiografía Panorámica/métodos , Adolescente , Biopsia con Aguja , Enfermedades Óseas/diagnóstico por imagen , Enfermedades Óseas/patología , Enfermedades Óseas/terapia , Tratamiento Conservador/métodos , Granuloma Eosinófilo/diagnóstico por imagen , Granuloma Eosinófilo/terapia , Humanos , Inmunohistoquímica , Masculino , Maxilar/diagnóstico por imagen , Enfermedades Raras , Remisión EspontáneaRESUMEN
Diabetes mellitus (DM) leads to a delay in bone healing. Thus, some therapeutic approaches have been used to accelerate the process of bone repair such as photobiomodulation (PBM). Therefore, the present study aimed to evaluate the effects of PBM, in different fluences, in bone repair in an experimental model of tibial bone defects in diabetic rats. Sixty-four Wistar rats were submitted to a surgical procedure to perform bone defect and distributed in four groups: diabetic control group (DCG), diabetic laser group 30 J/cm(2) (L30), diabetic laser group 60 J/cm(2) (L60), and diabetic laser group 120 J/cm(2) (L120). A 808 nm Ga-Al-As (DMC Equipment, São Carlos, SP, Brazil) laser, 100 mW; 0.028 cm(2); 3.57 W/cm(2); 30, 60, and 120 J/cm(2); 0.84, 1.68, and 3.36 J; 8, 16, and 33 s was used. Animals were euthanized 15 and 30 days after the surgery. Histological, morphometric, immunohistochemistry, and biomechanical analyses were performed. In the histological and morphometric evaluation, all laser-treated groups showed a better histological pattern and a higher amount of newly formed bone compared to DCG. An intense RUNX2 immunoexpression was observed in the laser-treated groups, 15 days after the surgery. Receptor activator of nuclear factor κ-ß ligand (RANK-L) immunohistochemistry analysis showed a significant decrease in the immunoreactivity for L30 and L120, 30 days after surgery. There was no statistical difference in the biomechanical analysis among the groups. In conclusion, PBM, in all fluences used, showed an osteogenic potential in bone healing of diabetic rats.
Asunto(s)
Enfermedades Óseas/terapia , Diabetes Mellitus Experimental/fisiopatología , Tibia/fisiopatología , Animales , Enfermedades Óseas/fisiopatología , Regeneración Ósea , Terapia por Láser , Láseres de Semiconductores/uso terapéutico , Masculino , Ratas , Ratas Wistar , Tibia/patologíaRESUMEN
La utilización de las plaquetas con fines terapéuticos ha cobrado gran interés en los últimos años por las grandes propiedades que presentan como reparadoras de tejidos. Además de su papel en la coagulación y la hemostasia, las plaquetas contienen gránulos alfa con varias moléculas (factores de crecimiento) que son secretadas tras su activación. Se realizó una revisión bibliográfica, donde se exponen las principales propiedades y funciones de las plaquetas que le confieren propiedades terapéuticas en diferentes lesiones del sistema osteomioarticular. Se presentan además sus componentes y funciones. Se llega a conclusiones destacando la utilidad de las plaquetas con fines terapéuticos en pacientes con afecciones ortopédicas(AU)
The use of platelets for therapeutic purposes has gained great interest in recent years by their large properties as tissue repair. Besides its role in clotting and hemostasis, platelet alpha granules contain several molecules (growth factors) that are secreted upon activation. A literature review was performed to present the main features and functions of platelets that give them therapeutic properties in different injuries of the osteomioarticular system. Its components and functions are also presented here. Platelets usefulness for therapeutic purposes in patients with orthopedic conditions is highlighted(AU)
Asunto(s)
Humanos , Factor de Crecimiento Derivado de Plaquetas/uso terapéutico , Enfermedades Musculares/terapia , Enfermedades Óseas/terapia , Coagulación Sanguínea , Bases de Datos BibliográficasRESUMEN
La utilización de las plaquetas con fines terapéuticos ha cobrado gran interés en los últimos años por las grandes propiedades que presentan como reparadoras de tejidos. Además de su papel en la coagulación y la hemostasia, las plaquetas contienen gránulos alfa con varias moléculas (factores de crecimiento) que son secretadas tras su activación. Se realizó una revisión bibliográfica, donde se exponen las principales propiedades y funciones de las plaquetas que le confieren propiedades terapéuticas en diferentes lesiones del sistema osteomioarticular. Se presentan además sus componentes y funciones. Se llega a conclusiones destacando la utilidad de las plaquetas con fines terapéuticos en pacientes con afecciones ortopédicas.
The use of platelets for therapeutic purposes has gained great interest in recent years by their large properties as tissue repair. Besides its role in clotting and hemostasis, platelet alpha granules contain several molecules (growth factors) that are secreted upon activation. A literature review was performed to present the main features and functions of platelets that give them therapeutic properties in different injuries of the osteomioarticular system. Its components and functions are also presented here. Platelets usefulness for therapeutic purposes in patients with orthopedic conditions is highlighted.
Asunto(s)
Humanos , Coagulación Sanguínea , Enfermedades Óseas/terapia , Factor de Crecimiento Derivado de Plaquetas/uso terapéutico , Bases de Datos Bibliográficas/estadística & datos numéricos , Enfermedades Musculares/terapiaRESUMEN
The clinical use of platelet-rich plasma (PRP) is based on the increase in the concentration of growth factors and in the secretion of proteins which are able to maximize the healing process at the cellular level. Since PRP is an autologous biologic material, it involves a minimum risk of immune reactions and transmission of infectious and contagious diseases, and it has been widely used for the recovery of musculoskeletal lesions. Despite the great potential for applicability, the implementation of the therapeutic employment of PRP as a clinical alternative has become difficult, due to the lack of studies related to the standardization of the techniques and/or insufficient description of the adopted procedures. Therefore, it is required establish standard criteria to be followed for obtaining a PRP of high quality, as well as a larger number of studies which should establish the proper concentration of platelets for the different clinical conditions. In this context, the purpose of this review is to discuss some methodological aspects used for achieving the PRP, as well as to discuss the bioactive properties of PRP, and to point out its therapeutic use in different fields of regenerative medicine.
Asunto(s)
Transfusión de Componentes Sanguíneos , Plasma Rico en Plaquetas , Animales , Factores Biológicos/farmacología , Factores Biológicos/uso terapéutico , Transfusión de Componentes Sanguíneos/métodos , Enfermedades Óseas/terapia , Modelos Animales de Enfermedad , Humanos , Enfermedades Musculares/terapia , Tendinopatía/terapiaRESUMEN
During recent years, attention has been given to the potential of therapeutic approaches using stem cells obtained from dental pulp tissue. The aim of this study, therefore, was to give an overview of the papers produced during the last 10 years that have described the use of stem cells obtained from human deciduous teeth in cell therapy or bioengineering. The PubMed database was investigated from January 2002 until July 2011 and the papers published during this period were analyzed according to criteria previously established, using the methodology of systematic review. The measurements were done using "stem cell" as the primary keyword, and "human deciduous teeth dental pulp cell" and "human exfoliated deciduous teeth" as the secondary keywords. Four hundred and seventy-five papers were found. The first screening resulted in 276 papers, from which 84 papers were selected. However, only 11 of them attained the aim proposed in our approach. There were few scientific studies related to direct therapeutic application using stem cells of human deciduous teeth and none of them had been applied to humans. However, the results indicated important and promising applications of the pulp stem-cells in cell therapy and bioengineering as demonstrated by studies in animal models of muscular dystrophy, Parkison's disease, and lupus erythematosus.