Клеточно‑молекулярные аспекты дегенеративной болезни диска и потенциальные стратегии биологической терапии

Боль в спине – одна из основных мировых проблем здравоохранения, имеющая высокий уровень распространенности и инвалидизации больных. В большинстве случаев она ассоциирована с дегенеративным поражением позвоночника (дегенеративной болезнью диска), дорсопатией, дископатией (М51 и М53 по Международной классификации болезней 10-го пересмотра), затрагивающими все уровни межпозвонкового диска (МПД) как единого целого (цитологического, химического и биохимического) с участием биологических молекул, регулирующих гомеостаз межклеточного вещества диска (ростовых факторов, провоспалительных цитокинов, энзимов). Ключевой момент в дегидратации МПД – преобладание катаболических процессов над анаболическими вследствие изменения экспрессии генов соответствующих биологически активных молекул, явлений ангиогенеза в диске и неоиннервации структур фиброзного кольца и пульпозного ядра. Последнее обусловливает формирование и поддержание хронического болевого синдрома у пациентов.

Клетки, поддерживающие гомеостаз в пульпозном ядре, – хондроциты – осуществляют постоянный синтез и восстановление протеогликанов и гиалуроновой кислоты в пульпозном ядре, воспроизводя амортизирующие функции позвонково-двигательного сегмента. Снижение активности и гибель хондроцитов в аваскулярной структуре диска представляют собой серьезную проблему с точки зрения репаративной медицины. В соответствии с концепцией взаимодействия молекулярно-клеточных механизмов МПД разрабатываются многочисленные подходы к терапии дегенеративной болезни диска, каждый из которых, воздействуя на одно из звеньев патогенеза, оказывает прямое или опосредованное влияние на репарацию МПД.

В статье изложены морфологические, патогенетические и генетические основы дегенеративной болезни диска, описаны основные современные стратегии биологической терапии: тканевая инженерия, применение биологически активных субстанций локально в матрице МПД, в том числе PRP-терапия (лечение «богатой тромбоцитами плазмой» – Platelet Rich Plasma), методы генной (с использованием вирусного вектора) и клеточной терапии, а также опыт локального применения генно-инженерных биологических препаратов. Большинство успешных работ представляет комбинацию клеточной и генной терапии с использованием синтезированных матриксов.

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