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Song C, Liu Y, Tao X, Cheng K, Cai W, Zhou D, Zhou Y, Wang L, Shi H, Hao Q, Liu Z. Immunomodulation Pathogenesis and Treatment of Bone Nonunion. Orthop Surg 2024; 16:1770-1782. [PMID: 38946017 PMCID: PMC11293939 DOI: 10.1111/os.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
Fractures and bone nonunion commonly require surgical intervention. Serious outcomes of non-healing in the late stages of fracture place a significant financial burden on society and families. Bone nonunion occurs when a fracture stops healing, for many reasons, and leads to a variety of bad outcomes. Numerous factors, including biomechanics and immunology, are involved in the complicated mechanisms of bone nonunion. The immune-inflammatory response plays a significant part in the emergence of bone nonunion, and the occurrence, control, and remission of inflammation in the bone healing process have a significant influence on the ultimate success of bone tissue repair. In the bone microenvironment, immune cells and associated cytokines control bone repair, which is significantly influenced by macrophages, T cells, and fibroblast growth factor. To limit acute inflammation and balance osteogenesis and osteoblastogenesis for tissue repair and regeneration, immune cells and various cytokines in the local microenvironment must be precisely regulated. As a bad complication of late-stage fractures, bone nonunion has a significant effect on patients' quality of life and socioeconomic development. Therefore, in-depth research on its pathogenesis and treatment methods has important clinical value. To provide more precise, focused therapeutic options for the treatment of bone nonunion, we discuss the regulatory roles of the key immune cells engaged in bone healing within the microenvironment during bone healing and their effect on osteogenesis.
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Affiliation(s)
- Chao Song
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Yong Liu
- Department of Bone and Joint Sports MedicineXingguo People's Hospital, Gannan Medical CollegeXingguoChina
| | - Xingxing Tao
- College of Integrative Chinese and Western Medicine, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Kang Cheng
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Weiye Cai
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Daqian Zhou
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Yang Zhou
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Liquan Wang
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Houyin Shi
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Qi Hao
- Orthopedic Surgery, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
| | - Zongchao Liu
- Department of Orthopedics and Traumatology (Trauma and Bone‐Setting), Laboratory of Integrated Chinese and Western Medicine for Orthopedic and Traumatic Diseases Prevention and Treatment, The Affiliated Traditional Chinese Medicine HospitalSouthwest Medical UniversityLuzhouChina
- Department of OrthopedicsLuzhou Longmatan District People's HospitalLuzhouChina
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Kale P, Shrivastava S, Balusani P, Pundkar A. Therapeutic Potential of Platelet-Rich Plasma in Fracture Healing: A Comprehensive Review. Cureus 2024; 16:e62271. [PMID: 39006629 PMCID: PMC11245593 DOI: 10.7759/cureus.62271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Fracture healing is a dynamic process essential for the restoration of bone integrity and function. However, factors such as patient age, comorbidities, and the severity of the fracture can impede this process, leading to delayed healing or nonunion. Platelet-rich plasma (PRP) has emerged as a promising therapeutic option for enhancing fracture healing. PRP is an autologous blood product containing a concentrated mixture of platelets, growth factors, and cytokines known to promote tissue regeneration and repair. This comprehensive review provides an overview of the fracture healing process, emphasizing the importance of timely and efficient bone repair. We discuss the mechanisms underlying the purported efficacy of PRP in fracture healing, drawing upon both preclinical and clinical evidence. Preclinical studies in animal models have demonstrated the ability of PRP to accelerate fracture healing, stimulate osteogenesis, and enhance bone regeneration. Clinical studies have yielded mixed results, with some reporting positive outcomes in terms of accelerated healing and improved functional outcomes, while others have shown no significant benefits over standard treatments. Factors influencing the efficacy of PRP, such as timing of administration, PRP concentration, and patient-specific variables, are also examined. Furthermore, safety considerations and potential adverse effects associated with PRP therapy are discussed. Despite the promising preclinical findings, challenges remain in standardizing PRP formulations, optimizing administration protocols, and addressing unanswered questions regarding its long-term efficacy and safety. This review aims to provide insights into the therapeutic potential of PRP in fracture healing, informing future research directions and guiding clinical practice.
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Affiliation(s)
- Prathamesh Kale
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prashanth Balusani
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditya Pundkar
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Du X, Zhao J, Ren Q, Ma Y, Duan P, Huang Y, Wang S. Clinical application of platelet rich plasma to promote healing of open hand injury with skin defect. Regen Ther 2024; 26:308-314. [PMID: 39022599 PMCID: PMC11253146 DOI: 10.1016/j.reth.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 05/30/2024] [Accepted: 06/09/2024] [Indexed: 07/20/2024] Open
Abstract
Background Skin defects caused by open hand trauma are difficult to treat clinically and severely affect the recovery of hand function. Autologous platelet-rich plasma (PRP) has been widely used in the treatment of refractory chronic wounds, but its use in hand trauma skin defects remains scarce. Methods This study compared the outcomes of 27 patients treated with PRP to 31 patients undergoing skin flap transplantation for hand wounds. We assessed several parameters, including healing times, duration of surgery, postoperative pain (VAS score), intraoperative amputation length, finger function, sensation restoration, nail bed preservation, and hospitalization expenses. Results PRP-treated patients showed a mean healing time of 21.59 ± 3.17 days. Surgical times were significantly shorter in the PRP group (22.04 ± 7.04 min) compared to the flap group (57.45 ± 8.15 min, P < 0.0001). PRP patients experienced longer postoperative healing times (20.15 ± 2.16 days) than those in the skin flap group (12.84 ± 1.08 days, P < 0.0001), but reported lower pain scores (1.3 ± 1.44 vs 2.55 ± 2.06, P = 0.0119). Range of Motion (ROM) at the proximal interphalangeal joint was better in the PRP group (96.26° ± 6.69) compared to the flap group (86.16° ± 15.24, P = 0.0028). Sensory outcomes favored the PRP group, with a two-point discrimination of 2.37 ± 1.34 mm versus 2.52 ± 1.27 mm in the flap group (P = 0.0274). Costs were lower in the PRP group ($2081.6 ± 258.14 vs $2680.18 ± 481.15, P < 0.0001). Conclusion PRP treatment for skin defects from hand trauma is effective, offering advantages in terms of reduced surgical time, pain, and cost, with comparable or superior functional outcomes to flap transplantation. Despite longer healing times, PRP may represent a preferable option for open hand injuries, preserving more nail beds and resulting in better sensation and joint motion.
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Affiliation(s)
- Xinhui Du
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, 832000, China
| | - Jiarui Zhao
- Hanzhong Downtown Hospital, No. 557, West Labour Road, Hantai District, Hanzhong City, Shaanxi Province, China
| | - Qian Ren
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, 832000, China
| | - Yibo Ma
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, 832000, China
| | - Pengxia Duan
- The First Affiliated Hospital of Shihezi University, Shihezi City, Xinjiang Uygur Autonomous Region, 832000, China
| | - Yansheng Huang
- Department of Spine Surgery, Xi'an HongHui Hospital, Beilin District, Xi'an, Shannxi Province, 710000, China
| | - Sibo Wang
- Department of Spine Surgery, Xi'an HongHui Hospital, Beilin District, Xi'an, Shannxi Province, 710000, China
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Yang H, Zhang W, Fang J, Tang Z, Zhou Y, Hu H, Miao M, Yao Y. Intrauterine infusion of platelet-rich plasma improves fibrosis by transforming growth factor beta 1/Smad pathway in a rat intrauterine adhesion model. Reprod Biol 2024; 24:100882. [PMID: 38604016 DOI: 10.1016/j.repbio.2024.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
This study aims to elucidate the effects of Platelet-rich plasma (PRP) in fibrosis development in intrauterine adhesion (IUA), and the associated underlying mechanisms are also explored, which are expected to be a potential therapeutic scheme for IUA. In this research, PRP was obtained and prepared from the peripheral venous blood of rats. A rat model was induced by mechanical injury. Further, PRP was directly injected into the uterus for treatment. The appearance and shape of the uterus were assessed based on the tissues harvested. The fibrosis biomarker levels were analyzed. The transforming growth factor beta 1 (TGF-β1) and Mothers against decapentaplegic homolog 7 (Smad7) levels, the phosphorylation of Smad2 (p-Smad2), and the phosphorylation of Smad3 (p-Smad3) were analyzed, and the molecular mechanism was investigated by rescue experiments. It was found that PRP improved the appearance and shape of the uterus in IUA and increased endometrial thickness and gland numbers. The administration of PRP resulted in a decrease in the expressions of fibrosis markers including collagen I, α-SMA, and fibronectin. Furthermore, PRP increased Smad7 levels and decreased TGF-β1 levels, p-Smad2, and p-Smad3. Meanwhile, administration of TGF-β1 activator reversed the therapeutic effects of PRP in IUA. Collectively, the intrauterine infusion of PRP can promote endometrial damage recovery and improve endometrial fibrosis via the TGF-β1/Smad pathway. Hence, PRP can be a potential therapeutic strategy for IUA.
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Affiliation(s)
- Hongwen Yang
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China.
| | - Wenmin Zhang
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China
| | - Jingchuan Fang
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China
| | - Zhihan Tang
- University of South China, 28 West Changsheng Road, Hengyang, Huan, China
| | - Yanni Zhou
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China
| | - Hongzhen Hu
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China
| | - Miao Miao
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China
| | - Yu Yao
- Shenzhen Futian District Maternity & Child Healthcare Hospital, 2002, Jintian Road, Futian District, Shenzhen, China
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Ogéus T. Treatment of a fractured humerus and partially torn supraspinatus tendon in a professional boxer with liquid platelet-rich fibrin and heat-coagulated albumin gel: a case report. J Med Case Rep 2024; 18:124. [PMID: 38519995 PMCID: PMC10960399 DOI: 10.1186/s13256-024-04458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Fractures with delayed healing can be a serious complication, especially for athletes depending on quick return to sports. To our knowledge, no cases of increased healing of delayed union fractures with autologous biomedical interventions have been reported. CASE PRESENTATION A 33-year-old Swedish professional boxer with a fractured humerus with a delayed union and a partially torn supraspinatus tendon was treated with injections of liquid platelet-rich fibrin and heat-coagulated albumin gel. He recovered almost completely from both injuries in only 1 month and could return to professional boxing in 3 months. CONCLUSION This case raises the hypothesis that liquid platelet-rich fibrin and heat-coagulated albumin gel may be an effective, minimally invasive intervention in fractures with a delayed union. Further research is required to test this theory.
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Affiliation(s)
- Torbjörn Ogéus
- Stockholms led- & smärtklinik, 11424, Stockholm, Sweden.
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Cen C, Cao Y, Zhang Y, Hu C, Wang Y, Xia K, Liu C, Qiu B. Synergistic effects of autologous platelet-rich plasma combined with an extracorporeal shock wave in treatment of long diaphysis aseptic nonunion. Orthop Traumatol Surg Res 2024; 110:103417. [PMID: 37010140 DOI: 10.1016/j.otsr.2022.103417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/27/2022] [Accepted: 08/25/2022] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Union of long bone fractures is a complicated biological mechanism affected by numerous systemic and local variables. Disruption of any of these components may result in fracture nonunion. There are various types of clinically available treatment strategies for aseptic nonunion. Both activated platelet plasma and extracorporeal shock waves play important roles in fracture healing. This study aimed to investigate the interaction of platelet-rich plasma (PRP) and extracorporeal shock wave (ESW) in bone healing of nonunion. HYPOTHESIS PRP and ESW have synergistic effects in treating long bone nonunion. METHODS Between January 2016 and December 2021, a total of 60 patients with established nonunion of a long bone (18 tibias, 15 femurs, 9 humerus, 6 radii, and 12 ulnae) were included in this study, comprising 31 males and 29 females, ranging from 18 to 60 years old. Patients with bone nonunion were separated into two groups: PRP alone (Monotherapy group) and those treated with PRP combined with ESW (Combined treatment group). The two groups were compared to assess the therapeutic benefits, callus development, local problems, bone healing time, and Johner Wruhs functional classification of operated limbs. RESULTS Fifty-five patients were followed up, 5 patients were lost to follow-up, two in the PRP group and three in the PRP+ESW group, the follow-up time varied from 6 to 18 months, with an average of 12.7±5.2 months. At 8, 12, 16, 20, and 24 weeks following intervention, the callus score in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). Both groups had no swelling and infection in the soft tissue of the nonunion operation site. In the PRP+ESW group, the fracture union rate was 92.59% and the healing time was 16.3±5.2 weeks. In the PRP group, the fracture union rate was 71.43% and the healing time was 21.5±3.7 weeks. The clinical healing time of the monotherapy group was significantly longer than the combined treatment group (p<0.05). All the nonunion patients with no signs of healing were treated with revision surgery. The excellent and good rate of Johner-Wruhs functional classification of affected limbs in the monotherapy group was significantly lower than in the combined treatment group (p<0.05). CONCLUSION PRP combined with ESW has a certain synergistic effect in treating aseptic nonunion after fracture surgery. It can significantly improve the formation of new bone, it is a minimally invasive and effective strategy to treat aseptic nonunion in a clinical setting. LEVEL OF EVIDENCE III, retrospective, single-centre, case-control study.
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Affiliation(s)
- Chaode Cen
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Yongfei Cao
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Yong Zhang
- Department of Gynaecology and Obstetrics, Guiyang First People's Hospital, Guiyang 550000, China
| | - Chaoran Hu
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Yusong Wang
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Keming Xia
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Chengwei Liu
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China
| | - Bing Qiu
- Department of Orthopedics, The Guizhou Provincial Orthopedics Hospital, Guiyang 550007, China.
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Goncharov EN, Koval OA, Nikolaevich Bezuglov E, Engelgard M, Igorevich EI, Velentinovich Kotenko K, Encarnacion Ramirez MDJ, Montemurro N. Comparative Analysis of Stromal Vascular Fraction and Alternative Mechanisms in Bone Fracture Stimulation to Bridge the Gap between Nature and Technological Advancement: A Systematic Review. Biomedicines 2024; 12:342. [PMID: 38397944 PMCID: PMC10887176 DOI: 10.3390/biomedicines12020342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Various stimulation methods, including electrical, ultrasound, mechanical, and biological interventions, are explored, each leveraging intricate cellular and molecular dynamics to expedite healing. The advent of stromal vascular fraction (SVF) marks a significant stride, offering multifarious benefits in bone healing, from enhanced bone formation to optimal vascular integration, drawing a harmonious balance between innate mechanisms and scientific advancements. METHODS This systematic review was conducted focusing on literature from 2016 to 2023 and encompassing various bone healing stimulation mechanisms like SVF, electrical, ultrasound, and mechanical stimulation. The extracted data underwent meticulous synthesis and analysis, emphasizing comparative evaluations of mechanisms, applications, and outcomes of each intervention. RESULTS The reviewed studies reveal the potential of SVF in bone fracture healing, with its regenerative and anti-inflammatory effects. The purification of SVF is crucial for safe therapeutic use. Characterization involves flow cytometry and microscopy. Studies show SVF's efficacy in bone regeneration, versatility in various contexts, and potential for clinical use. SVF appears superior to electrical, ultrasound, and mechanical stimulation, with low complications. CONCLUSIONS This review compares bone healing methods, including SVF. It provides valuable insights into SVF's potential for bone regeneration. However, due to limited human studies and potential bias, cautious interpretation is necessary. Further research is essential to validate these findings and determine the optimal SVF applications in bone healing.
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Affiliation(s)
| | | | | | - Mikhail Engelgard
- Petrovsky Russian Scientific Center of Surgery, 121359 Moscow, Russia
| | | | | | | | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), 56100 Pisa, Italy
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Bartold M, Ivanovski S. Biological processes and factors involved in soft and hard tissue healing. Periodontol 2000 2024. [PMID: 38243683 DOI: 10.1111/prd.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 01/21/2024]
Abstract
Wound healing is a complex and iterative process involving myriad cellular and biologic processes that are highly regulated to allow satisfactory repair and regeneration of damaged tissues. This review is intended to be an introductory chapter in a volume focusing on the use of platelet concentrates for tissue regeneration. In order to fully appreciate the clinical utility of these preparations, a sound understanding of the processes and factors involved in soft and hard tissue healing. This encompasses an appreciation of the cellular and biological mediators of both soft and hard tissues in general as well as specific consideration of the periodontal tissues. In light of good advances in this basic knowledge, there have been improvements in clinical strategies and therapeutic management of wound repair and regeneration. The use of platelet concentrates for tissue regeneration offers one such strategy and is based on the principles of cellular and biologic principles of wound repair discussed in this review.
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Affiliation(s)
- Mark Bartold
- University of Queensland, Brisbane, Queensland, Australia
| | - Saso Ivanovski
- University of Queensland, Brisbane, Queensland, Australia
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Kale P, Shrivastava S, Pundkar A, Balusani P. Harnessing Healing Power: A Comprehensive Review on Platelet-Rich Plasma in Compound Fracture Care. Cureus 2024; 16:e52722. [PMID: 38384641 PMCID: PMC10879731 DOI: 10.7759/cureus.52722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
This comprehensive review explores the applications of platelet-rich plasma (PRP) in the context of compound fracture care, providing a thorough examination of its biological mechanisms, preparation techniques, and clinical implications. The analysis highlights PRP's potential in accelerating bone healing, enhancing soft tissue repair, reducing inflammation and infection risks, and managing pain during fracture recovery. The review underscores the importance of ethical and regulatory considerations in integrating PRP into orthopaedic practice, emphasising informed consent, transparent patient communication, and ongoing monitoring of ethical concerns. Looking ahead, the implications for the future of compound fracture care suggest a transformative shift with the potential for personalised medicine approaches and emerging technologies. However, the conclusion calls for a balanced perspective, acknowledging the promising applications of PRP while emphasising the need for responsible and ethical use. The collaborative efforts of healthcare professionals, researchers, and regulatory bodies are crucial in navigating this evolving landscape and harnessing the healing power of PRP to redefine orthopaedic care for individuals with compound fractures.
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Affiliation(s)
- Prathamesh Kale
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sandeep Shrivastava
- Orthopaedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Aditya Pundkar
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Prashanth Balusani
- Orthopaedics and Traumatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Godbout C, Ryan G, Ramnaraign DJ, Hegner C, Desjardins S, Gagnon S, Bates BD, Whatley I, Schemitsch EH, Nauth A. Optimal delivery of endothelial progenitor cells in a rat model of critical-size bone defects. J Orthop Res 2024; 42:193-201. [PMID: 37416978 DOI: 10.1002/jor.25658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/21/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
Nonunion and segmental bone defects are complex issues in orthopedic trauma. The use of endothelial progenitor cells (EPCs), as part of a cell-based therapy for bone healing is a promising approach. In preclinical studies, culture medium (CM) is commonly used to deliver EPCs to the defect site, which has the potential for immunogenicity in humans. The goal of this study was to find an effective and clinically translatable delivery medium for EPCs. Accordingly, this study compared EPCs delivered in CM, phosphate-buffered saline (PBS), platelet-poor plasma (PPP), and platelet-rich plasma (PRP) in a rat model of femoral critical-size defects. Fischer 344 rats (n = 35) were divided into six groups: EPC+CM, EPC+PBS, EPC+PPP, EPC+PRP, PPP alone, and PRP alone. A 5 mm mid-diaphyseal defect was created in the right femur and stabilized with a miniplate. The defect was filled with a gelatin scaffold impregnated with the corresponding treatment. Radiographic, microcomputed tomography and biomechanical analyses were performed. Overall, regardless of the delivery medium, groups that received EPCs had higher radiographic scores and union rates, higher bone volume, and superior biomechanical properties compared to groups treated with PPP or PRP alone. There were no significant differences in any outcomes between EPC subgroups or between PPP and PRP alone. These results suggest that EPCs are effective in treating segmental defects in a rat model of critical-size defects regardless of the delivery medium used. Consequently, PBS could be the optimal medium for delivering EPCs, given its low cost, ease of preparation, accessibility, noninvasiveness, and nonimmunogenic properties.
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Affiliation(s)
- Charles Godbout
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Gareth Ryan
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David J Ramnaraign
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Christian Hegner
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Desjardins
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Stéphane Gagnon
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Brent D Bates
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Ian Whatley
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Emil H Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
| | - Aaron Nauth
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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11
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Zhu L, Li P, Qin Y, Xiao B, Li J, Xu W, Yu B. Platelet-rich plasma in orthopedics: Bridging innovation and clinical applications for bone repair. J Orthop Surg (Hong Kong) 2024; 32:10225536231224952. [PMID: 38217531 DOI: 10.1177/10225536231224952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
In the burgeoning domain of orthopedic therapeutic research, Platelet-Rich Plasma (PRP) has firmly established its position, transforming paradigms ranging from tissue regeneration to the management of chondral lesions. This review delves into PRP's recent integrations with cutting-edge interventions such as 3D-printed scaffolds, its role in bone and cartilage defect management, and its enhanced efficacy when combined with molecules like Kartogenin (KGN) for fibrocartilage zone repair. Significant attention is paid to tissue engineering for meniscal interventions, where a combination of KGN, PRP, and bone marrow-derived mesenchymal stem cells are under exploration. Within the sphere of osteochondral regenerative therapy, the synergy of PRP with Bone Marrow Aspirate Concentrate (BMAC) represents a noteworthy leap towards cartilage regeneration. The innovative incorporation of PRP with biomaterials like hydroxyapatite and graphene oxide further underscores its versatility in supporting structural integrity and ensuring sustained growth factor release. However, while PRP's autologous and nontoxic nature makes it an inherently safe option, concerns arising from its preparation methods, particularly with bovine thrombin, necessitate caution. As of 2023, despite the burgeoning promise of PRP in bone healing, the quest for its standardization, optimization, and substantiation through rigorous clinical trials continues. This comprehensive review elucidates the contemporary applications, challenges, and future trajectories of PRP in orthopedics, aiming to spotlight areas primed for further research and exploration.
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Affiliation(s)
- Liangbo Zhu
- Orthopaedic Hospital, Yichun People'S Hospital, Yichun, China
| | - Ping Li
- Department of Pulmonary and Critical Care Medicine, Yichun People'S Hospital, Yichun, China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiang Xi Hospital of China-Japan Friendship Hospital, Nanchang, P.R. China
| | - Yuhong Qin
- Orthopaedic Hospital, Yichun People'S Hospital, Yichun, China
| | - Baowei Xiao
- Orthopaedic Hospital, Yichun People'S Hospital, Yichun, China
| | - Junning Li
- Orthopaedic Hospital, Yichun People'S Hospital, Yichun, China
| | - Wenhua Xu
- Orthopaedic Hospital, Yichun People'S Hospital, Yichun, China
| | - Bo Yu
- Orthopaedic Hospital, Yichun People'S Hospital, Yichun, China
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Enhancement of Immunosuppressive Activity of Mesenchymal Stromal Cells by Platelet-Derived Factors is Accompanied by Apoptotic Priming. Stem Cell Rev Rep 2022; 19:713-733. [PMID: 36417151 PMCID: PMC10070232 DOI: 10.1007/s12015-022-10471-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/24/2022]
Abstract
Abstract
The pro-inflammatory phase of bone healing, initiated by platelet activation and eventually hematoma formation, impacts bone marrow mesenchymal stromal cells (MSCs) in unknown ways. Here, we created platelet-rich plasma (PRP) hydrogels to study how platelet-derived factors modulate functional properties of encapsulated MSCs in comparison to a non-inflammatory fibrin (FBR) hydrogel environment. MSCs were isolated from human bone marrow, while PRP was collected from pooled apheresis thrombocyte concentrates and used for hydrogel preparation. After their encapsulation in hydrogels for 72 h, retrieved MSCs were analyzed for immunomodulatory activities, apoptosis, stem cell properties, senescence, CD9+, CD63+ and CD81+ extracellular vesicle (EV) release, and metabolism-related changes. PRP-hydrogels stimulated immunosuppressive functions of MSCs, along with their upregulated susceptibility to cell death in communication with PBMCs and augmented caspase 3/7 activity. We found impaired clonal growth and cell cycle progression, and more pronounced β-galactosidase activity as well as accumulation of LC3-II-positive vacuoles in PRP-MSCs. Stimuli derived from PRP-hydrogels upregulated AKT and reduced mTOR phosphorylation in MSCs, which suggests an initiation of survival-related processes. Our results showed that PRP-hydrogels might represent a metabolically stressful environment, inducing acidification of MSCs, reducing polarization of the mitochondrial membrane and increasing lipid accumulation. These features were not detected in FBR-MSCs, which showed reduced CD63+ and CD81+ EV production and maintained clonogenicity. Our data revealed that PRP-derived hematoma components cause metabolic adaptation of MSCs followed by increased immune regulatory functions. For the first time, we showed that PRP stimuli represent a survival challenge and “apoptotic priming” that are detrimental for stem cell-like growth of MSCs and important for their therapeutic consideration.
Graphical Abstract
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13
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Mochizuki T, Ushiki T, Watanabe S, Omori G, Kawase T. The levels of TGFβ1, VEGF, PDGF-BB, and PF4 in platelet-rich plasma of professional soccer players: a cross-sectional pilot study. J Orthop Surg Res 2022; 17:465. [PMID: 36303196 PMCID: PMC9615199 DOI: 10.1186/s13018-022-03362-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Regenerative therapy using platelet-rich plasma (PRP), a rich source of growth factors, has become popular in orthopedic sports medicine. Elite athletes prefer PRP therapy for their injured muscles and tendons primarily to avoid the possible risks of surgical treatment. However, the clinical effectiveness of PRP therapy in elite athletes compared to that in non-athletes remains unknown. Therefore, to investigate the effectiveness of PRP therapy in professional athletes (pro-athletes), we focused on the quality of PRP preparations and compared the levels of bioactive molecules between pro-athletes and non-athletes.
Methods PRP was prepared from healthy, non-smoking male professional soccer players (pro-athletes) (n = 22) and non-athletes (VEGF: n = 34, others: n = 38). The levels of TGFβ1, PDGF-BB, VEGF, and PF4 were determined using ELISA kits. Polyphosphate was probed with 4’,6-diamidino-2-phenylindole and monitored using a fluorometer. The body composition of the donors was determined using a bathroom weighing scale. Results The levels of TGFβ1 and VEGF were significantly lower in pro-athletes than in non-athletes, whereas PF4 levels were significantly higher in pro-athletes. No significant difference was found in PDGF-BB levels between these groups. Biomolecule levels were not correlated with polyphosphate levels. Conclusion TGFβ1, VEGF, and PDGF-BB levels in pro-athletes were not higher than those in non-athletes. These findings suggest that growth factor levels in PRP may not be a predominant determinant of the clinical effectiveness of PRP therapy in pro-athletes. Increased PF4 levels in pro-athletes suggest an immunological function of PRP that may positively influence tissue regeneration.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan.,Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.,Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
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Liang Y, Li J, Wang Y, He J, Chen L, Chu J, Wu H. Platelet Rich Plasma in the Repair of Articular Cartilage Injury: A Narrative Review. Cartilage 2022; 13:19476035221118419. [PMID: 36086807 PMCID: PMC9465610 DOI: 10.1177/19476035221118419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE This paper reviews the research of platelet-rich plasma (PRP) in articular cartilage injury repair, to assess the mechanism, utilization, and efficacy of PRP in the treatment of articular cartilage injury, hoping to provide a theoretical basis for the clinical application of PRP in the future. MATERIALS AND METHODS A comprehensive database search on PRP applications in cartilage repair was performed. Among them, the retrieval time range of PRP in clinical trials of repairing knee cartilage injury was from January 1, 2021 to January 1, 2022. Non-clinical trials and studies unrelated to cartilage injury were excluded. RESULT PRP can affect inflammation, angiogenesis, cartilage protection, and cellular proliferation and differentiation after articular cartilage injury through different pathways. In all, 13 clinical trials were included in the analysis. CONCLUSION PRP is an emergent therapeutic approach in tissue engineering. Most studies reported that PRP has a positive effect on cartilage injury, improving the joint function, meanwhile there is a lack of standardized standards. The technology of PRP in the repair and treatment of articular cartilage injury is worthy of further research.
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Affiliation(s)
- Yinru Liang
- Stem Cell Research & Cellular
Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang,
China,Key Laboratory of Stem Cell and
Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, China
| | - Juan Li
- Department of Plastic Surgery,
Guangzhou Huadu Affiliated Hospital of Guangdong Medical University (Guangzhou Huadu
District Maternal and Child Health Care Hospital), Guangzhou, China
| | - Yuhui Wang
- Department of Surgery, The Third
Affiliated Hospital of Guangdong Medical University (Longjiang Hospital of Shunde
District), Foshan, China
| | - Junchu He
- Key Laboratory of Stem Cell and
Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, China
| | - Liji Chen
- Key Laboratory of Stem Cell and
Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, China
| | - Jiaqi Chu
- Stem Cell Research & Cellular
Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang,
China,Jiaqi Chu, Stem Cell Research &
Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University,
Zhanjiang 524001, China.
| | - Hongfu Wu
- Stem Cell Research & Cellular
Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang,
China,Key Laboratory of Stem Cell and
Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, China
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Jeyaraman M, Muthu S, Jeyaraman N, Gupta A. Photoactivated platelet-rich plasma: is it the future of platelet-rich plasma? Regen Med 2022; 17:607-609. [PMID: 35703033 DOI: 10.2217/rme-2022-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu, 600095, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, 201310, India
- South Texas Orthopedic Research Institute, Laredo, TX 78045, USA
- Indian Stem Cell Study Group Association, Lucknow, Uttar Pradesh, 226010, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, Uttar Pradesh, 201310, India
- Indian Stem Cell Study Group Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Orthopedics, Government Medical College and Hospital, Dindigul, Tamil Nadu, 624304, India
| | - Naveen Jeyaraman
- Indian Stem Cell Study Group Association, Lucknow, Uttar Pradesh, 226010, India
- Department of Orthopedics, Atlas Hospitals, Tiruchirappalli, Tamil Nadu, 620002, India
| | - Ashim Gupta
- South Texas Orthopedic Research Institute, Laredo, TX 78045, USA
- Future Biologics, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- Veterans in Pain, Valencia, CA 91354, USA
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16
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Efficacy of Platelet-Rich Plasma in the Treatment of Fractures: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5105725. [PMID: 35693268 PMCID: PMC9184162 DOI: 10.1155/2022/5105725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
Background Although numerous studies have reported the effectiveness of platelet-rich plasma (PRP) in promoting and enhancing bone healing, many orthopedic physicians remain skeptical of platelet-rich plasma in the treatment of fractures. The objective of this meta-analysis was to assess the efficacy of PRP in the treatment of fractures. Methods We search for research on PRP treatment of fractures in Pubmed, Embase, Medline, and Cochrane libraries. Two independent reviewers assessed included studies and met to develop a consensus on included studies. We also assessed the risk of bias using Review Manager 5.3 software. Results The present meta-analysis included 10 randomized controlled trials (RCT) containing 652 patients. In the fixed-effect meta-analysis of 10 RCTs, 8 RCTs found that fracture patients benefited from PRP treatment. The use of PRP reduced the time of fracture healing in 4 RCTs. Three RCTs found that PRP adjuvant therapy enhanced bone mineral density in the fracture trace and reduced the time of bone regeneration in mandibular fractures patients (standardized mean difference (SMD) = −1.99, 95%confidence interval (CI) = −2.64–−1.35). And 3 RCTs found that PRP adjuvant therapy decreased the risk of revision surgery in fracture patients (SMD = 1.83, 95%CI = 1.10–3.04). Conclusion PRP adjuvant therapy is beneficial for the treatment of fracture patients, particularly those with mandibular fractures, and decreased the risk of revision surgery in fracture patients.
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Wu S, Quan K, Mei J, Dai M, Song S. Cortical allograft strut augmented with platelet-rich plasma for the treatment of long bone non-union in lower limb- a pilot study. BMC Musculoskelet Disord 2022; 23:512. [PMID: 35637466 PMCID: PMC9150336 DOI: 10.1186/s12891-022-05375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background The autogenous iliac bone graft is the first choice of surgical treatment for long bone non-union. However, many factors limit the use of autogenous bone, such as insufficient bone harvest and complications in the donor site. This study aimed to pilot-test the effectiveness of the cortical allograft strut augmented with Platelet-rich plasma (PRP) on long bone non-union in the lower limb. Method This study was a one-armed pilot trial, with thirteen men and four women patients scheduled for surgery. Revision surgery for managing long bone non-union included debridement, internal fixation of the cortical allograft strut, and adding PRP in the fracture site. After surgery, outcome measurements of healing rate, healing time, the incidence of revision, and complications, were assessed at least one-year follow-up. Results Fourteen of seventeen participants completed all follow-ups. The mean age of 14 patients was 35.9 years (range, 18–56 years), and the mean BMI was 22.44 ± 1.53 kg/m2. All nonunions united after the operation. The mean healing time was 4.6 ± 0.7 months. There was no revision or complication. Conclusion Cortical allograft strut augmented with PRP led to healing long bone non-union in the lower limb. More clinical research is required before widespread use.
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Affiliation(s)
- Shenghui Wu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China
| | - Kun Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiong Mei
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China
| | - Min Dai
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Sa Song
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
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Löhning M, Shen P, Dzamukova M, Durán-Hernández N, Roodselaar J, Hauser AE, Fiedler A, Niesner RA, Gaber T, Buttgereit F. [The DRFZ-a pioneer in research on the interaction between immune and stromal cells during de- and regeneration of the musculoskeletal system]. Z Rheumatol 2022; 81:652-659. [PMID: 35412048 DOI: 10.1007/s00393-022-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Rheumatoid arthritis and osteoarthritis are two related chronic diseases of the musculoskeletal system which are particularly pronounced in the region of joints and bones. Their pathogeneses are associated with chronic inflammation, which can disrupt homeostasis in bones and articular cartilage. Degradation products deriving from articular cartilage can contribute to the exacerbation of inflammation in the joint region. Mechanical stimuli and blood vessels also play a central role in both the regulation of bone growth as well as in the regeneration of bone tissue. Not only chronic inflammatory processes but also hormonal changes after menopause or undesired effects of glucocorticoid therapy have an influence on the balance between bone resorption and deposition, by promoting the former and reducing the latter. This results in decreased bone quality and, in some cases, considerable loss of bone or osteoporosis. An in-depth understanding of these processes at the molecular, cellular, and tissue level, as well as of the changes present in chronic inflammatory diseases, has been the focus of research at the German Rheumatism Research Center (Deutsches Rheuma-Forschungszentrum, DRFZ) since its foundation. Based on an improved understanding of these mechanisms, the DRFZ aims to develop improved prevention and treatment strategies with effects even in early disease stages.
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Affiliation(s)
- Max Löhning
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland. .,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
| | - Ping Shen
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Maria Dzamukova
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Nayar Durán-Hernández
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Jay Roodselaar
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Anja E Hauser
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Alexander Fiedler
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Institut für Veterinär-Physiologie, Freie Universität Berlin, Berlin, Deutschland
| | - Raluca A Niesner
- Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), Leibniz-Institut, Charitéplatz 1, 10117, Berlin, Deutschland.,Institut für Veterinär-Physiologie, Freie Universität Berlin, Berlin, Deutschland
| | - Timo Gaber
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Frank Buttgereit
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
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Willems A, Iҫli C, Waarsing JH, Bierma-Zeinstra SMA, Meuffels DE. Bone Union Assessment with Computed Tomography (CT) and Statistical Associations with Mechanical or Histological Testing: A Systematic Review of Animal Studies. Calcif Tissue Int 2022; 110:147-161. [PMID: 34417861 PMCID: PMC8784489 DOI: 10.1007/s00223-021-00904-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/09/2021] [Indexed: 11/02/2022]
Abstract
Objective and accurate assessment of bone union after a fracture, arthrodesis, or osteotomy is relevant for scientific and clinical purposes. Bone union is most accurately imaged with computed tomography (CT), but no consensus exists about objective assessment of bone union from CT images. It is unclear which CT-generated parameters are most suitable for bone union assessment. The aim of this review of animal studies is to find which CT-generated parameters are associated most strongly with actual bone union. Scientific databases were systematically searched. Eligible studies were studies that (1) were animal studies, (2) created a fracture, (3) assessed bone union with CT, (4) performed mechanical or histological testing as measure of actual bone union, and (5) associated CT-generated outcomes to mechanical or histological testing results. Two authors selected eligible studies and performed risk of bias assessment with QUADAS-2 tool. From 2567 studies that were screened, thirteen studies were included. Most common CT parameters that were investigated were bone mineral density, bone volume, and total callus volume. Studies showed conflicting results concerning the associations of these parameters with actual bone union. CT-assessed torsional rigidity (assessed by three studies) and callus density (assessed by two studies) showed best results. The studies investigating these two parameters reported moderate to strong associations with actual bone union. CT-assessed torsional rigidity and callus density seem the most promising parameters to represent actual bone union after a fracture, arthrodesis, or osteotomy.Prospero trial registration number: CRD42020164733.
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Affiliation(s)
- A Willems
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands.
| | - C Iҫli
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - D E Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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Boivin J, Tolsma R, Awad P, Kenter K, Li Y. The Biological Use of Platelet-Rich Plasma in Skeletal Muscle Injury and Repair. Am J Sports Med 2021; 51:1347-1355. [PMID: 34904902 DOI: 10.1177/03635465211061606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Platelet-rich plasma (PRP) is a blood product that contains several growth factors and active proteins. PRP is thought to be used autologously to assist in the repair of injured tissues as well as to treat pain at the site of injury. The mechanism behind PRP in regenerative medicine has been well investigated and includes the identification and concentration of released growth factors and exosomes. The benefits of PRP have been highly recommended and are used widely in orthopaedics and sports medicine, including repair of injured skeletal muscle. This current report summarizes some of the more recent studies in the use of PRP as it relates to muscle healing, in both the in vitro and clinical arenas.
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Affiliation(s)
- Jordan Boivin
- Department of Orthopaedic Surgery, Biomedical Engineering at Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Rachael Tolsma
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Peter Awad
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Keith Kenter
- Department of Orthopaedic Surgery, Biomedical Engineering at Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Yong Li
- Department of Orthopaedic Surgery, Biomedical Engineering at Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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21
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Fracture Healing Research-Shift towards In Vitro Modeling? Biomedicines 2021; 9:biomedicines9070748. [PMID: 34203470 PMCID: PMC8301383 DOI: 10.3390/biomedicines9070748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 01/07/2023] Open
Abstract
Fractures are one of the most frequently occurring traumatic events worldwide. Approximately 10% of fractures lead to bone healing disorders, resulting in strain for affected patients and enormous costs for society. In order to shed light into underlying mechanisms of bone regeneration (habitual or disturbed), and to develop new therapeutic strategies, various in vivo, ex vivo and in vitro models can be applied. Undeniably, in vivo models include the systemic and biological situation. However, transferability towards the human patient along with ethical concerns regarding in vivo models have to be considered. Fostered by enormous technical improvements, such as bioreactors, on-a-chip-technologies and bone tissue engineering, sophisticated in vitro models are of rising interest. These models offer the possibility to use human cells from individual donors, complex cell systems and 3D models, therefore bridging the transferability gap, providing a platform for the introduction of personalized precision medicine and finally sparing animals. Facing diverse processes during fracture healing and thus various scientific opportunities, the reliability of results oftentimes depends on the choice of an appropriate model. Hence, we here focus on categorizing available models with respect to the requirements of the scientific approach.
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