Nel样分子1型蛋白在脊柱融合术后促进骨性融合的作用与机制

背景:在脊柱融合术中进行充分植骨是非常必要的,然而,老龄患者自身成骨细胞数量有限和骨微环境改变以及骨形态发生蛋白2体内应用会引起例如异位骨等不利影响,导致目前的治疗方法会引起骨不连和其他并发症.在此情况下,Nel样分子1型(Nel-like type 1 molecular,Nell-1)进入研究人员的视野,Nell-...

Role and mechanism of Nel-like molecule-1 in promoting bone fusion after spinal fusion

BACKGROUND:Adequate bone grafting is very necessary during spinal fusion.However,due to the limited number of osteoblasts and the function of the bone microenvironment in elderly patients,as well as the in vivo application of bone morphogenetic protein 2 will cause adverse effects such as ectopic bone.The current method can cause nonunion and other complications.In this case,Nel-like molecule-1(Nell-1)has entered the field of vision of researchers.Nell-1 is not only equivalent to BMP-2 in osteogenic activity,but also has anti-fat,anti-inflammatory,and pro-vascular properties.These laid the foundation for clinical trial approval of Nell-1 in promoting spinal fusion.OBJECTIVE:To review the effect and mechanism of Nell-1 on bone fusion after spinal fusion.METHODS:Relevant documents were retrieved in Baidu Academic,PubMed,Web of Science,Wanfang,and CNKI.The Chinese and the English search terms were“Nell-1,spinal fusion,bone fusion,pre-osteoblast differentiation,neovascularization,progenitor cell migration”.Finally,68 articles were included for review.RESULTS AND CONCLUSION:Autologous bone grafting has complications and supply problems related to bone grafting.Bone graft replacement therapy represented by bone morphogenetic protein 2 will produce many non-target effects.Therefore,neither can meet the increasing demand for spinal fusion.In this context,the emergence of Nell-1 provides the possibility to solve this dilemma.Although the role of Nell-1 in promoting bone fusion after spinal fusion is still in the preliminary stage of research,there are still deficiencies in the lack of an optimal route of administration;the molecular mechanism is not fully understood;and whether there are adverse reactions related to the application.Nevertheless,it has the triple effect of promoting progenitor cell migration,pre-osteoblast differentiation,and vascularization,so it has great potential for promoting bone fusion after spinal fusion.Future research should further reveal the detailed underlying mechanism,optimize the dosage and schedule,explore the combined effect with other osteogenic growth factors and stem cells,and translate the potential of Nell-1 for promoting spinal fusion into clinical practice.