【610科学前沿】关节内脂肪在骨关节炎发展中起重要作用！

浙江大学医学院附属第二医院骨科沈炜亮

骨关节炎(OA)一直以来都被视为全关节疾病。先前的研究主要集中在研究软骨和软骨下骨的通路。然而有数据表明滑膜炎参与了OA发展和软骨损坏。

髌骨下脂肪垫（IFP）是一种关节内脂肪组织，可以释放炎症因子参与滑膜炎的发展；而且相比来自同一骨关节炎病人的皮下脂肪组织(SCAT)会释放更多的炎症因子！

就目前的研究而言，我们只知道IFP在骨关节炎中被研究过；在膝关节中髌骨上脂肪垫（SPFP）与关节囊紧密联系；除了膝关节，髋臼中也存在髋臼脂肪垫(AFP)。这些统称为关节内脂肪组织（IAATs）。

本文研究者就此提出两个问题：

是否IFP在IAATs中具有自己的特性？

是否来自不同关节的IAATs都具有相同的特性？

研究者通过组织学、小分子和功能特性获取来自同一OA患者的IFP、SPFP、SCAT数据，同时还有与髋关节的对比。分析得出结论：OA患者的IAATs相比于SCAT具有更高的：成纤维化系数、炎症反应和成血管化变化！而且膝关节和髋关节具有共同的表型。

本研究认为IAATs可以考虑为一类脂肪组织的子群，如内脏、肌肉、血管周等脂肪组织；同时IAATs在关节内与滑膜密切的联系可以将二者归为同一功能单位，成为OA发展的又一新的重要角色。

同一个体膝关节和髋关节的关节内脂肪组织与皮下脂肪组织对比：骨关节炎中起核心作用的一个特征性的表型

Knee and hip intra-articular adipose tissues (IAATs) compared with autologous subcutaneous adipose tissue: a specific phenotype for a central player in osteoarthritis

2017.3

法国圣安托万研究中心

Annals of the Rheumatic Diseases

Abstract

Osteoarthritis (OA) is a whole-joint disease. In this context, many studies have focused on cartilage/subchondral bone crosstalk. Although synovitis was thought to mainly result from cartilage breakdown, several data suggest that it could be also involved in early stages of OA even before cartilage damage.Moreover, researchers and others have shown that knee OA synovitis may also depend on the release of inflam-matory factors by the infrapatellar fat pad (IFP),located at the posterior surface of synovium.IFP from patients with knee OA releases many inflammatory factors in higher amounts compared with autologous subcutaneous adipose tissue(SCAT). In the best of our knowledge, only IFP has been studied in OA, The suprapatellar fat pad (SPFP) are located above the patella and behind the suprapatellar bursa,respectively .Whether IFP has unique properties among IAATs iscurrently unknown？ In addition, IAATs are not restricted to the knee. the coxofemoral joint contains one IAAT located in acetabular fossa and surrounding the ligamentum teres (acetabular fat pad (AFP). Whether IAATs from different joints share similar properties is unknown？Paper used histological, molecular and functional characterisation of IFP, SPFP and SCAT from patients with autologous OA. In parallel, OA AFP and autologous SCATwere characterised. To conclude, knee and hip OA IAATs share a common phenotype, including a less adipogenic profile but higher fibrotic and inflammatory characteristics than autologous SCAT. Of note ,IAATs could be considered a subgroup of AT, such as visceral, muscular or perivascular AT. The IAAT impact on joint homeostasis could be related to its inflammatory and metabolic profile and mediatedby close interactions with synovium in a same functional unit.IAATs may be new players in OA disease progression.

二次整理者：阮登峰/沈炜亮

浙江大学医学院附属第二医院·骨科；

浙江大学骨科研究所；

浙江大学李达三·叶耀珍再生医学发展基金；

浙江省组织工程与再生医学技术重点实验室；

中国医师协会骨科医师分会再生医学工作组；

本人专业诊治范围：
1，肌腱病&肌腱/韧带损伤：肘-网球肘；肩-肩周炎，肩袖损伤；膝-弹跳膝，跑步者膝，前交叉韧带损伤；踝-跟腱炎，跟腱断裂；手腕部-腱鞘炎；筋膜炎
2，再生医学技术治疗运动系统疑难杂症，包括：软骨/半月板/肌腱/韧带的修复、重建和再生；
门诊类型：肌腱病专科门诊！

致谢：浙江省组织工程与再生医学技术重点实验室