Rev. Soc. Esp. Dolor. 2023; 30(4): 243-249 / DOI: 10.20986/resed.2023.4075/2023
Julián Alfonso Sierra, Juan Carlos Acevedo
RESUMEN
El dolor lumbar es un problema de salud común que afecta a una gran cantidad de personas en todo el mundo. Entre las principales causas de este dolor se encuentra el proceso degenerativo de los discos intervertebrales, los cuales se ven afectados por una pérdida en el equilibrio entre los procesos anabólicos y catabólicos, lo que conlleva a una degradación de la matriz extracelular, una pérdida de la adecuada hidratación del núcleo pulposo y una muerte celular por inflamación y estrés oxidativo.
Aunque existen múltiples tratamientos para el dolor lumbar, ninguno de ellos es completamente curativo. Por esta razón, se han desarrollado opciones terapéuticas que buscan detener y revertir estos procesos degenerativos, entre las cuales se encuentran los exosomas.
Con el objetivo de evaluar la eficacia de estas nuevas terapias, se ha realizado una revisión exhaustiva de la literatura existente en inglés. En ella, se incluyeron artículos experimentales in vitro o in vivo, revisiones sistemáticas y estudios aleatorizados. Los resultados de esta revisión destacan siete grupos celulares que han sido utilizados en la producción de exosomas y que cuentan con indicación biológica en el manejo de la enfermedad discal degenerativa.
Cada uno de estos grupos ha sido estudiado en modelos in vivo e in vitro, y aunque solo el plasma rico en plaquetas cuenta con un ensayo clínico, los resultados experimentales y clínicos son alentadores.
Es importante mencionar que aún faltan muchos estudios que permitan depurar esta información y establecer protocolos de uso. Sin embargo, es necesario cambiar nuestra mentalidad al tratar a los pacientes con dolor lumbar, reconociendo que solo una modificación en los factores de riesgo, acompañada de terapias regenerativas, podrían permitir obtener mejores resultados a largo plazo.
Finalmente, es necesario llevar a cabo ensayos clínicos aleatorizados controlados para evaluar a fondo la eficacia de estos tratamientos y establecer su efectividad en el manejo de la enfermedad discal degenerativa.
ABSTRACT
Low back pain is a common and debilitating health issue that affects a significant portion of the global population. One of the primary factors contributing to this pain is the degenerative deterioration of the intervertebral discs, which is characterized by an imbalance between anabolic and catabolic processes, leading to the degradation of the extracellular matrix, inadequate hydration of the nucleus pulposus, and cell death due to inflammation and oxidative stress. While various treatments for low back pain are available, none of them is entirely curative. Thus, new therapeutic options have been developed to halt and reverse the degenerative processes involved, such as the use of exosomes.
To assess the efficacy of these innovative therapies, an extensive review of the existing English-language literature was conducted, encompassing experimental studies in vitro or in vivo, systematic reviews, and randomized controlled trials. The results of this review revealed seven distinct cell groups that have been employed in the production of exosomes, demonstrating promising biological indications in the management of degenerative disc disease Each of these cell groups has been thoroughly investigated in both in vivo and in vitro models, and while only platelet-rich plasma has been subjected to clinical trials, the experimental and clinical results are encouraging.
It is important to acknowledge that further studies are required to refine this information and establish optimal protocols for clinical use. Nonetheless, it is essential to adopt a new perspective when treating patients with low back pain, recognizing that only the implementation of regenerative therapies and a modification of risk factors could enable improved long-term outcomes.
In conclusion, randomized controlled clinical trials are needed to evaluate comprehensively the effectiveness of these treatments and determine their appropriate role in the management of degenerative disc disease.
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