2023, Vol. 27 ›› Issue (6): 955-961

Action mechanism and prospect of bone microvascular endothelial cells for treating femoral head necrosis

Qin Yuxing1, Ren Qiangui2, Li Zilong1, Quan Jiaxing3, Shen Peifeng2, Sun Tao2, Wang Haoyu3     

Abstract: BACKGROUND: Femoral head necrosis brings a serious burden to patients and the society. The existing hypotheses cannot fully explain the mechanism of the femoral head necrosis. However, there is no doubt that the dysfunction of bone microcirculation system is its pathological basis. Given the importance of microcirculation during femoral head necrosis, recent studies indicate that bone microvascular endothelial cell injury exerts a crucial effect on the pathogenesis of femoral head necrosis.  
OBJECTIVE: To analyze the action mechanism of bone microvascular endothelial cells for treatment of femoral head necrosis, and to focus on the prospect of improving microcirculation and promoting osteogenesis based on bone microvascular endothelial cells, so as to treat femoral head necrosis.
METHODS: “Necrosis of femoral head; bone microvascular endothelial cells; microcirculation disorder; bone tissue engineering technology; microRNAs” were used as Chinese and English keywords. Totally 220 related articles were obtained by searching on CNKI (China National Knowledge Infrastructure), Wanfang database, and PubMed database. Insufficient timeliness, vague conclusions, and repetitive articles were excluded by reading the titles, abstracts and part of the content. Finally, 63 articles that met the inclusion criteria were included for review.  
RESULTS AND CONCLUSION: (1) The impaired angiogenesis, abnormal apoptosis, thrombosis and fat embolism caused by the dysfunction of bone microvascular endothelial cells are all involved in the occurrence and development of avascular necrosis of the femoral head. (2) Traditional Chinese medicine, bone tissue engineering technology, transfection-based method, and microRNAs can be employed to prevent and treat avascular necrosis of the femoral head by promoting angiogenesis, suppressing apoptosis and vascular embolism. (3) Combined transplantation of microvascular endothelial cells and bone marrow mesenchymal stem cells is one of the most promising strategies for the treatment of femoral head necrosis, but the optimal ratio between co-grafts and scaffolds with good biocompatibility and cultured cells needs further research. (4) For gene transfection, the transcriptional regulation mechanism of target gene in host cells has not been fully studied. In addition, there are few related clinical trials, and the therapeutic effect needs to be further verified.
Key words: femoral head necrosis, bone microvascular endothelial cell, microcirculation disorder, bone tissue engineering technology, miRNA, review