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Title:Stromalne celice maščobnega tkiva za zdravljenje osteoartroze kolenskega sklepa in dejavniki povezani z uspešnostjo zdravljenja
Authors:ID Redek Žnidaršič, Lara (Author)
ID Hussein, Mohsen (Mentor) More about this mentor... New window
Files:.pdf 3738$$pdfa_lara_redek_znidarsic_magistrsko_delo_23.4.pdf (2,63 MB)
MD5: 6BF931CA8A3715498D03A1955C313B58
 
Language:Slovenian
Work type:Master's thesis/paper
Organization:UNM FZV - University of Novo mesto - Faculty of Health Sciences
Abstract:Teoretična izhodišča: Osteoartroza (OA) je kronična, vnetna in degenerativna bolezen sklepov ter najpogostejša sklepna bolezen v globalni geriatrični populaciji. Prevalenca OA narašča s starostjo, dejavniki tveganja pa vključujejo debelost, spol, genetiko, ponavljajoče se obremenitve, anatomske nepravilnosti, določena bolezenska stanja in poškodbe sklepov. Sodobne možnosti zdravljenja so omejene in se osredotočajo predvsem na lajšanje simptomov, vključujejo pa medikamentozno zdravljenje, redukcijo telesne teže, konservativne metode ter pri napredovali bolezni zamenjavo prizadetega sklepa. Nove možnosti zdravljenja predstavlja terapija s stromalno frakcijo celic iz maščobnega tkiva, ki je bogata z mezenhimskimi stromalnimi celicami (AD-MSC) ter obeta regeneracijo poškodovanega tkiva in izboljšanje funkcije sklepa. Metode: Raziskava je temeljila na kvantitativnem, kavzalno-neeksperimentalnem pristopu. Retrospektivna klinična raziskava je bila izvedena za obdobje med junijem 2020 in februarjem 2022 pri preiskovancih z OA kolenskega sklepa stopnje II–III, ocenjeno po klasifikaciji Kellgren-Lawrence (KL). Zdravljeni so bili z metodo aplikacije mezenhimskih stromalnih maščobnih celic (AD-MSC) in spremljani še eno leto po zdravljenju. Podatke smo pridobili iz kartotek pacientov. Rezultati: Rezultati naše raziskave so pokazali, da stopnja OA kolenskega sklepa, ocenjena po klasifikaciji KL, ni statistično povezana s predoperativnimi ocenami funkcionalnosti kolena, merjenimi s KOOS, niti z izboljšavami po zdravljenju z mezenhimskimi stromalnimi celicami iz maščobnega tkiva (AD-MSC). Terapija z AD-MSC je privedla do statistično značilnih in klinično pomembnih izboljšav v vseh domenah KOOS (bolečina, simptomi, šport, dnevne aktivnosti, kakovost življenja) po 3 in 12 mesecih, zlasti pri zmanjšanju bolečine in izboljšanju dnevnih aktivnosti, kar kaže na veliko klinično uspešnost terapije. Učinek zdravljenja z AD-MSC se je s časom ohranjal ali celo povečeval, kar nakazuje na trajnost in dolgoročne koristi terapije. Dejavniki, kot so višja doza apliciranih AD-MSC, normalni indeks telesne mase in nižja starost, so pozitivno vplivali na uspešnost zdravljenja, medtem ko sta povišan ITM in višja starost omejevala učinkovitost v določenih domenah. Med raziskavo nismo zaznali resnih neželenih učinkov, kar potrjuje varnost uporabe AD-MSC. Ugotovili smo tudi, da se po zdravljenju z AD-MSC uporabljajo večfazni, individualizirani rehabilitacijski protokoli, ki vključujejo nadzor bolečine, postopno povečevanje obremenitev in krepitev mišic, ter se izvajajo v specializiranih kliničnih okoljih v ZDA in Evropi. Razprava: Zdravljenje z AD-MSC je učinkovita in varna metoda za zdravljenje OA kolenskega sklepa, saj znatno izboljša funkcionalnost kolena. Za doseganje optimalne učinkovitosti zdravljenja je pomembno individualizirati zdravljenje, pri čemer upoštevamo dejavnike, kot so starost, indeks telesne mase in potrebna doza celic, ter vključimo ustrezne rehabilitacijske protokole. S takšnim pristopom lahko bolnikom z OA kolena omogočimo boljšo funkcionalnost in kakovost življenja, hkrati pa zmanjšamo potrebo po bolj invazivnih kirurških posegih.
Keywords:stromalne celice maščobnega tkiva, osteoartroza kolena, regenerativna medicina, varnost zdravljenja z AD-MSC, protokol rehabilitacije
Year of publishing:2025
PID:20.500.12556/ReVIS-11760 New window
Publication date in ReVIS:07.06.2025
Views:178
Downloads:2
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Secondary language

Language:English
Title:Stromal Cells of Adipose Tissue for the Treatment of Knee Osteoarthrosis and Factors Associated with Treatment Success
Abstract:Theoretical background: Osteoarthritis (OA) is a chronic, inflammatory, and degenerative joint disease and the most common joint disease in the global geriatric population. The prevalence of OA increases with age. Risk factors include obesity, gender, genetics, repetitive stress, anatomical abnormalities, certain medical conditions, and joint injuries. Modern treatment options are limited and focus mainly on symptom relief, including medication, weight reduction, conservative methods, and joint replacement in advanced stages of disease. New treatment possibilities involve therapy with adipose-derived mesenchymal stromal cells (AD-MSC), which promises regeneration of damaged tissue and improvement of joint function. Methods: The research was based on a quantitative, causal non-experimental approach. Data for the retrospective study were obtained from patient records. This retrospective clinical study was conducted between June 2020 and February 2022 on subjects with knee OA of grade II–III, assessed according to the Kellgren-Lawrence (KL) classification. They were treated with AD-MSC and were followed for one-year post-treatment. Results: The results of our study showed that the degree of knee OA, assessed by the KL classification, is not statistically associated with preoperative knee functionality scores measured by KOOS, nor with improvements following treatment with AD-MSC. Treatment with AD-MSC led to statistically significant and clinically meaningful improvements in all KOOS domains (pain, symptoms, sports, activities of daily living, quality of life) at 3 and 12 months post-treatment, especially in pain reduction and enhancement of daily activities, indicating a strong clinical significance of the therapy. The effect of AD-MSC treatment was maintained or even increased over time, suggesting the sustainability and long-term benefits of the therapy. Factors such as higher doses of administered AD-MSC, normal body mass index (BMI), and younger age positively influenced the success of the treatment, while elevated BMI and older age limited effectiveness in certain domains. No serious adverse effects were observed during the study, confirming the safety of AD-MSC use. We also found that multiphase, individualized rehabilitation protocols are employed after AD-MSC treatment, which include pain management, gradual load increase, and muscle strengthening, and are implemented in specialized clinical settings in the USA and Europe. Discussion: Treatment with AD-MSC is an effective and safe method for treating knee OA, as it significantly improves knee functionality. It is important to individualize the treatment by considering factors such as age, body mass index, and the required cell dosage, and by incorporating appropriate rehabilitation protocols. With such an approach, we can offer patients with knee OA improved functionality and quality of life, while also reducing the need for invasive surgical procedures.
Keywords:Adipose tissue stromal cells, Knee osteoarthritis, Regenerative medicine, Safety of AD-MSC therapy, Rehabilitation protocol


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