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Badanie: dlaczego unieruchomienie wspomaga proces gojenia po urazie?

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Naukowcy z UT Southwestern Medical Center przeprowadzili badania, których celem było sprawdzenie, w jaki sposób unieruchomienie wpływa na proces gojenia urazu w obrębie kończyny. Wyniki badań mogą pomóc w optymalizacji leczenia tego rodzaju urazów.

Zespół lekarzy pod kierownictwem prof. Benjamina Leviego odkrył, że unieruchomienie kończyny, która uległa urazowi, za pomocą gipsu lub szyny wpływa na to, jakie interakcje zachodzą pomiędzy komórkami macierzystymi a ich pozakomórkowym otoczeniem. Dzięki temu komórki przekształcają się w tkankę tłuszczową, a nie kostną.

Jak wyjaśnia prof. Benjamin Levi, dotychczas mechanizmy te nie były wystarczająco poznane. Lekarze nie mieli pewności, dlaczego w części przypadków w procesie gojenia urazu kończyny zachodzi mechanizm zwany kostnieniem heterotopowym, polegający na powstawaniu tkanki kostnej w obrębie mięśni i ścięgien. Zespół prof. Leviego zaobserwował, że mechanizm ten zachodzi częściej w obrębie stawów, czyli obszarów poddawanych największemu obciążeniu mechanicznemu po urazie lub operacji.

Badania na myszach

W celu lepszego zrozumienia mechanizmów gojenia po urazie naukowcy wykorzystali badania na myszach. Część badanych zwierząt poddano unieruchomieniu. Pozostałe zachęcano do biegania na kołowrotku lub wykonywania ćwiczeń podobnych do tych, jakie wykonują pacjenci po operacjach. Zaobserwowano, że tylko u myszy, które zostały unieruchomione, nie doszło do kostnienia heterotopowego.

Zmiany na poziomie komórkowym

Dzięki badaniom na myszach badacze odkryli, że mechanizmy kostnienia heterotopowego mają podłoże genetyczne.

Naukowcy pobrali z miejsca urazu u myszy mezenchymalne komórki macierzyste, które odgrywają kluczową rolę w procesie gojenia. Analiza komórek pozwoliła stwierdzić zwiększoną ekspresję w szlakach molekularnych, które mają wpływ na to, w jaki sposób komórki przyczepiają się do powierzchni tkanki oraz jak reagują z macierzą pozakomórkową. Dezaktywacja tych szlaków molekularnych za pomocą małych cząsteczek powstrzymała rozwój kostnienia heterotopowego u myszy, które pozostawały w ruchu po urazie.

Zespół naukowców stwierdził ponadto zmiany w macierzy pozakomórkowej. U aktywnych myszy włókna kolagenu układały się w równe rzędy, co sprawiało, że mezenchymalne komórki macierzyste rozciągały się wzdłuż włókien. W przypadku myszy, którym ograniczono ruch, kolagen układał się natomiast w przypadkowe wzory, co powstrzymało komórki macierzyste przed rozciąganiem. Dalsze badania potwierdziły, że ta zmiana w ułożeniu komórek macierzystych ma wpływ na to, czy rozwiną się one w tkankę kostną czy tłuszczową.

Wpływ badań na leczenie urazów

Jak tłumaczy prof. Benjamin Levi, dzięki uzyskanym przez jego zespół wynikom badań możliwe będzie usprawnienie terapii urazów kończyn:

– Badania dowiodły, że kiedy unieruchamiany staw, zmienia to całkowicie środowisko rany zarówno na poziomie tkanki, jak i na poziomie komórkowym. Możemy wykorzystać tę wiedzę, by poprawić efektywność terapii. Są na to dwa sposoby. Pierwszy to lepsze dostosowanie protokołów mobilizacji pacjenta po urazie lub operacji. Drugi to natomiast dezaktywacja genów, które powodują, że komórki niewłaściwie reagują z macierzą pozakomórkową.

Ekspert dodaje, że odkrycia dokonane przez jego zespół znajdują już zastosowanie w praktyce klinicznej, np. w zakresie leczenia oparzeń. W wielu ośrodkach wdrażane są obecnie znacznie mniej agresywne procedury mobilizacji pacjentów z oparzeniami, dzięki czemu zmniejsza się ryzyko wykształcenia u nich kostnienia heterotopowego, a proces gojenia przebiega sprawniej.

Źródło: news-medical.net

Przeczytaj także: Naukowcy opracowali biomateriał, który stymuluje gojenie ran

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