臨床整形外科59巻9号

2024年09月発行

特集 変形性関節症に対するBiologics

変形性膝関節症に対する滑膜由来幹細胞注射の基礎と臨床

著者： 関矢一郎¹

所属機関： ¹東京医科歯科大学再生医療研究センター

ページ範囲：P.1101 - P.1106

変形性膝関節症の保存療法には限界があり，新たな治療法の開発が求められている．滑膜由来の間葉系幹細胞(滑膜幹細胞)は，軟骨分化能が高く，関節内投与後に滑膜に生着し，潤滑・抗炎症・軟骨基質産生に関与する遺伝子の発現を増加させる．自家滑膜幹細胞の関節注射による前向き臨床研究では，注射後30週間で軟骨厚さが増加し，膝痛や機能の改善も認められた．滑膜のエコー下採取による低侵襲化を可能にし，現在，二重盲検試験を実施している．滑膜幹細胞注射が，変形性膝関節症の新たな治療選択肢となることを期待している．

参考文献

1) Horwitz EM, Le Blanc K, Dominici M, et al. Clarification of the nomenclature for MSC:The International Society for Cellular Therapy position statement. Cytotherapy 2005;7(5):393-5.

2) Sekiya I, Koga H, Katano H, et al. Second-look arthroscopy after meniscus repair and synovial mesenchymal stem cell transplantation to treat degenerative flaps and radial tears of the medial meniscus:a case report. J Orthop Sci 2022;27(4):821-34.

3) Sekiya I, Koga H, Otabe K, et al. Additional use of synovial mesenchymal stem cell transplantation following surgical repair of a complex degenerative tear of the medial meniscus of the knee:a case report. Cell Transplant 2019;28(11):1445-54.

4) Sekiya I, Vuoristo JT, Larson BL, et al. In vitro cartilage formation by human adult stem cells from bone marrow stroma defines the sequence of cellular and molecular events during chondrogenesis. Proc Natl Acad Sci U S A 2002;99(7):4397-402.

5) Sakaguchi Y, Sekiya I, Yagishita K, et al. Comparison of human stem cells derived from various mesenchymal tissues:superiority of synovium as a cell source. Arthritis Rheum 2005;52(8):2521-9.

6) Mochizuki T, Muneta T, Sakaguchi Y, et al. Higher chondrogenic potential of fibrous synovium- and adipose synovium-derived cells compared with subcutaneous fat-derived cells:distinguishing properties of mesenchymal stem cells in humans. Arthritis Rheum 2006;54(3):843-53.

7) Ozeki N, Muneta T, Koga H, et al. Not single but periodic injections of synovial mesenchymal stem cells maintain viable cells in knees and inhibit osteoarthritis progression in rats. Osteoarthritis Cartilage 2016;24(6):1061-70.

8) Sekiya I, Katano H, Ozeki N. Characteristics of MSCs in synovial fluid and mode of action of intra-articular injections of synovial MSCs in knee osteoarthritis. Int J Mol Sci 2021;22(6):2838. doi:10.3390/ijms22062838.

9) Sekiya I, Katano H, Mizuno M, et al. Alterations in cartilage quantification before and after injections of mesenchymal stem cells into osteoarthritic knees. Sci Rep 2021;11(1):13832. doi:10.1038/s41598-021-93462-8.

10) Ozeki N, Nakagawa Y, Mizuno M, et al. Ultrasound-guided harvesting of synovium for regenerative medicine of cartilage and meniscus using synovial mesenchymal stem cells. Arthrosc Tech 2021;10(7):e1723-e7. doi:10.1016/j.eats.2021.03.020.