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Li P, Li H, Shu X, Wu M, Liu J, Hao T, Cui H, Zheng L. Intra-articular delivery of flurbiprofen sustained release thermogel: improved therapeutic outcome of collagenase II-induced rat knee osteoarthritis. Drug Deliv 2021; 27:1034-1043. [PMID: 32627602 PMCID: PMC8216450 DOI: 10.1080/10717544.2020.1787555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Knee osteoarthritis (OA) is a common degenerative disease. Intra-articular administration of flurbiprofen is frequently employed in clinic to treat OA, while repeated injections are required because of the limited effective duration. To improve therapeutic outcome and prolong the treatment interval, a poly(ε-caprolactone-co-lactide)-b-poly(ethylene glycol)-b-poly(ε-caprolactone-co-lactide) (PCLA-PEG-PCLA) triblock copolymer based flurbiprofen thermosensitive gel for the sustained intra-articular drug delivery was designed in this study. The anti-OA effects of this flurbiprofen thermogel were investigated on collagenase II-induced rat knee OA model by multiple approaches and compared with that of conventional sodium hyaluronate and flurbiprofen injecta. In vitro drug release studies indicated that flurbiprofen was sustained released from the thermosensitive gel for more than three weeks. This sustained drug release system exerted comparable short-term analgesic effects and distinctly improved long-term analgesic efficacy in terms of the increased percentage of the total ipsilateral paw print intensity and the reduced Knee-Bend scores of OA rats. The inflammatory response was attenuated in the samples of flurbiprofen gel treated group by showing decreased IL-1, IL-6, and IL-11 levels in the joint fluid and down-regulated IL-1, IL-6, IL-11, COX-2, TNF-α, and NF-κB/p65 expression in the articular cartilages. The results suggest the suitability of thermosensitive copolymer PCLA-PEG-PCLA for sustained intra-articular effects of flurbiprofen and provide in vivo experimental evidence for potential clinical application of this flurbiprofen delivery system to better management of OA cases.
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Affiliation(s)
- Peinan Li
- Department of Orthopedic Surgery, Second Clinical College, Dalian Medical University, Dalian, China
| | - Haokun Li
- Department of Orthopedic Surgery, Second Clinical College, Dalian Medical University, Dalian, China
| | - Xiaohong Shu
- College of Pharmacy, Dalian Medical University, Dalian, China
| | - Moli Wu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Jia Liu
- Department of Cell Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Tangna Hao
- Department of Pharmacy, Second Clinical College, Dalian Medical University, Dalian, China
| | - Hongxia Cui
- College of Pharmacy, Dalian Medical University, Dalian, China
| | - Lianjie Zheng
- Department of Orthopedic Surgery, Second Clinical College, Dalian Medical University, Dalian, China
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Camurcu Y, Sofu H, Ucpunar H, Kockara N, Cobden A, Duman S. Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: A pilot study. J Back Musculoskelet Rehabil 2018; 31:603-610. [PMID: 29710676 DOI: 10.3233/bmr-171066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The synergistic and protective effect of platelet-rich plasma (PRP) added to methlyprednisolone (MP) has been demonstrated via in-vitro studies. However, there is no report in the literature about this issue. OBJECTIVE The aim of this study was to evaluate clinical outcomes of intra-articular (IA) MP injection prior to PRP injection in comparison with single-dose MP and PRP injections alone in patients with knee osteoarthritis (OA). METHODS The treatment groups were "PRP group" (n= 37) who underwent single-dose IA PRP injection, "PRP + MP group" (n= 40) who underwent MP injection one week prior to single-dose PRP injection, and "MP group" (n= 38) who underwent single-dose MP injection. Visual Analog Scale (VAS) and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were applied at first admission and at 1st, 3rd, 6th, and 12th month follow-ups. RESULTS At the end of the 1st month, WOMAC score in PRP + MP group was significantly lower than PRP group. At the 3rd month, WOMAC score in PRP + MP group was significantly lower than PRP and MP groups. At the 6th month, VAS and WOMAC score in PRP + MP group was significantly lower than MP group. At the end of the 12th month, no significant difference was observed among three groups in VAS and WOMAC scores. CONCLUSION According to our results, IA MP injection prior to PRP injection resulted in significantly better clinical outcomes compared to PRP and MP injections alone in patients who had mild to moderate knee OA.
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Affiliation(s)
- Yalkin Camurcu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hakan Sofu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hanifi Ucpunar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Nizamettin Kockara
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Adem Cobden
- Department of Orthopedics and Traumatology, Sivas Numune Hospital, Sivas, Turkey
| | - Serda Duman
- Department of Orthopedics and Traumatology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
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Liu G, Zhang L, Zhou X, Zhang BL, Guo GX, Xu P, Wang GY, Fu SJ. Selection and Investigation of a Primate Model of Spontaneous Degenerative Knee Osteoarthritis, the Cynomolgus Monkey (Macaca Fascicularis). Med Sci Monit 2018; 24:4516-4527. [PMID: 29961076 PMCID: PMC6057266 DOI: 10.12659/msm.908913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim of this study was to identify a primate model of degenerative knee osteoarthritis (KOA) that may be more relevant for research studies on degenerative KOA in humans. MATERIAL AND METHODS Sixteen specific-pathogen-free (SPF) male cynomolgus monkeys (Macaca fascicularis) were divided into group A (n=8), an old group (22.0-25.3 years of age), and group B (n=8), a young group (3.0-5.2 years of age). For each primate, the behavior was observed, knee circumference was measured, knee joint X-rays were performed, and peripheral blood white blood cell (WBC) counts were measured, and the Kellgren and Lawrence (K-L) system was used for the classification of osteoarthritis. An enzyme-linked immunoassay (ELISA) was performed on knee joint fluid to measure levels of interleukin (IL)-1β, transforming growth factor (TGF)-β1, and matrix metalloproteinase (MMP)13. Changes in articular cartilage were evaluated using the Brittberg score and the Mankin histopathology grading score, respectively. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) and Western blot were used to measure the expression of the NOTCH3, JAG1, and ACAN genes in knee cartilage specimens, and the findings in the two groups of primates were compared. RESULTS Seven old aged primates in group A were compared with group B, and showed significant differences in WBC count, synovial fluid IL-1β, TGF-β1, and MMP13 levels, expression levels of the NOTCH3, JAG1, and ACAN genes in knee cartilage specimens, and in the Brittberg and Mankin scores (all, P<0.05). CONCLUSIONS Cynomolgus monkeys (Macaca fascicularis) might be a model for age-related degenerative KOA.
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Affiliation(s)
- Gang Liu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Xin Zhou
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Bao L Zhang
- College of Nursing, Affiliated to Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guang X Guo
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Ping Xu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Guo Y Wang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Shi J Fu
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland)
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Liu SH, Dubé CE, Eaton CB, Driban JB, McAlindon TE, Lapane KL. Longterm Effectiveness of Intraarticular Injections on Patient-reported Symptoms in Knee Osteoarthritis. J Rheumatol 2018; 45:1316-1324. [PMID: 29907665 DOI: 10.3899/jrheum.171385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA). METHODS Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup. RESULTS Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82-1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10-0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94-4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI -0.11 to 1.11; stiffness: -0.07, 95% CI -0.38 to 0.24; and functioning: 0.49, 95% CI -1.34 to 2.32). CONCLUSION Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.
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Affiliation(s)
- Shao-Hsien Liu
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA. .,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School.
| | - Catherine E Dubé
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Charles B Eaton
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Jeffrey B Driban
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Timothy E McAlindon
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Kate L Lapane
- From the Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, Brown University, Providence; Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island; Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts, USA.,S.H. Liu, PhD, Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, and the Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.E. Dubé, EdD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School; C.B. Eaton, MD, Departments of Family Medicine and Epidemiology, Warren Alpert Medical School and School of Public Health, and Center for Primary Care and Prevention, Memorial Hospital of Rhode Island; J.B. Driban, PhD, Division of Rheumatology, Tufts Medical Center; T.E. McAlindon, MD, Division of Rheumatology, Tufts Medical Center; K.L. Lapane, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School
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