Abstract
Key events occurring during the bone healing include well-orchestrated and complex
interactions between immune cells, multipotential stromal cells (MSCs), osteoblasts
and osteoclasts. Through three overlapping phases of this physiological process, innate
and adaptive immune cells, cytokines and chemokines have a significant role to play.
The aim of the escalating immune response is to achieve an osseous healing in the
shortest time and with the least complications facilitating the restoration of function.
The uninterrupted progression of these biological events in conjunction with a favourable
mechanical environment (stable fracture fixation) remains the hallmark of successful
fracture healing. When failure occurs, either the biological environment or the mechanical
one could have been disrupted. Not infrequently both may be compromised. Consequently,
regenerative treatments involving the use of bone autograft, allograft or synthetic
matrices supplemented with MSCs are increasingly used. A better understanding of the
bone biology and osteoimmunology can help to improve these evolving cell-therapy based
strategies. Herein, an up to date status of the role of immune cells during the different
phases of bone healing is presented. Additionally, the known and yet to know events
about immune cell interactions with MSCs and osteoblasts and osteoclasts and the therapeutic
implications are being discussed.
Keywords
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