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Seo SJ, Lee SS, Hwang JT, Han SH, Lee JR, Kim S. Effect of polydeoxyribonucleotide and polynucleotide on rotator cuff healing and fatty infiltration in a diabetic rat model. Sci Rep 2024; 14:20623. [PMID: 39232106 PMCID: PMC11375112 DOI: 10.1038/s41598-024-71206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
Failure rate after chronic rotator cuff repair is considerably high. Moreover, diabetes mellitus is known as a compromising factor of rotator cuff tear. The effect of Polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and fatty infiltration is unclear as tissue regeneration activator in diabetic state. Therefore, a diabetic rat model with chronic rotator cuff tear was made for mechanical, histologic and blood tests. In the animal study using a diabetic rat cuff repair model, the administration of PDRN and PN increased the load to failure of repaired cuffs and improved tendon healing and decreased fatty infiltration. Also, the plasma levels of vascular endothelial growth factor and fibroblast growth factor were elevated in PDRN and PN administrated groups. We concluded that PDRN and PN appear to boost tendon recovery and reduce the presence of fatty infiltration following cuff repair in diabetic state. Also, PN showed a later onset and a longer duration than PDRN associated with the mean plasma growth factors.
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Affiliation(s)
- Su-Jung Seo
- Department of Orthopedic Surgery, Hallym University Medical College, Chuncheon-Si, Gangwon-Do, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-Ro, Chuncheon-Si, Gangwon-Do, 24253, Republic of Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-Ro, Chuncheon-Si, Gangwon-Do, 24253, Republic of Korea.
| | - Sang Hak Han
- Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-Ro, Chuncheon-Si, Gangwon-Do, 24253, Republic of Korea.
| | - Jae-Ryeong Lee
- Department of Pharmacology, Institute of Natural Medicine, Hallym University Medical College, Chuncheon-Si, Gangwon-Do, Republic of Korea
| | - Sungsu Kim
- Department of Pharmacology, Institute of Natural Medicine, Hallym University Medical College, Chuncheon-Si, Gangwon-Do, Republic of Korea
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Rahman E, Carruthers JDA, Rao P, Abu-Farsakh HN, Garcia PE, Ioannidis S, Sayed K, Philipp-Dormston WG, Mosahebi A, Webb WR. Regenerative Aesthetics: A Genuine Frontier or Just a Facet of Regenerative Medicine: A Systematic Review. Aesthetic Plast Surg 2024:10.1007/s00266-024-04287-5. [PMID: 39198280 DOI: 10.1007/s00266-024-04287-5] [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: 05/11/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Regenerative aesthetics claims to enhance cosmetic outcomes through advanced biological interventions like Stem cell and Exosome therapy, Polydeoxyribonucleotide (PDRN), Photobiomodulation, bioactive peptides and treatment for cellular senescence yet lacks substantial scientific and regulatory validation. OBJECTIVE To evaluate the scientific and clinical foundations of regenerative medicine techniques in non-surgical aesthetics and assess the legitimacy of regenerative aesthetics as a medical specialty. METHODS A systematic review was conducted according to PRISMA guidelines, searching databases including PubMed, Scopus, and Web of Science for studies published in the last ten years. We included 19 studies, comprising 14 randomized controlled trials (RCTs) and 5 prospective studies, focusing on interventions that purportedly use regenerative medicine principles in aesthetic applications. RESULTS The review highlights a prevalent gap in molecular and clinical evidence supporting the efficacy and safety of regenerative aesthetics. Despite the robust design of the included RCTs and prospective studies, there remains a significant lack of consistent, high-quality evidence proving the effectiveness of these interventions. Issues such as inadequate reporting, unclear molecular mechanisms, and absence of long-term safety data were common. CONCLUSION The field of regenerative aesthetics lacks the necessary scientific rigour and regulatory compliance to be recognized as a legitimate medical specialty. This review underscores the need for stringent scientific validation and regulatory oversight to ensure patient safety and treatment efficacy before these techniques can be recommended for clinical use. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Eqram Rahman
- Research and Innovation Hub, Innovation Aesthetics, London, WC2H 9JQ, UK
| | - Jean D A Carruthers
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Parinitha Rao
- The Skin Address, Aesthetic Dermatology Practice, Bangalore, India
| | | | | | | | - Karim Sayed
- Nomi Oslo, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
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Tarantino D, Forte AM, Picone A, Sirico F, Ruosi C. The Effectiveness of a Single Hyaluronic Acid Injection in Improving Symptoms and Muscular Strength in Patients with Knee Osteoarthritis: A Multicenter, Retrospective Study. J Pers Med 2024; 14:784. [PMID: 39201976 PMCID: PMC11355087 DOI: 10.3390/jpm14080784] [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: 07/01/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 09/03/2024] Open
Abstract
Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due to increased wear of the knee articular cartilage. Arthrogenic muscle inhibition, which is usually found in patients with KOA, is associated with joint inflammation, pain, and swelling, also causing muscle atrophy, primarily of the anterior thigh muscles, and hindering the rehabilitation process. The aim of our work was to determine if a single HA infiltration could minimize the effects of arthrogenic muscle inhibition in patients with KOA in the short term, using isokinetic dynamometry to evaluate the strength of the knee extensor and flexor muscles of the thigh. Thirty patients with KOA who underwent both clinical and isokinetic assessment, and that received a single injection of HA, were retrospectively included. Our results showed that a single intra-articular injection of HA significantly reduces pain and improves joint function at four weeks, while non-statistically significant improvements were observed for the reference isokinetic parameter (maximum torque) at both 90°/s and 180°/s. Further high-quality studies are necessary to confirm the results of our study.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | | | - Antonio Picone
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | - Felice Sirico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
| | - Carlo Ruosi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.P.); (F.S.); (C.R.)
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Choi SH, Kim HC, Jang SG, Lee YJ, Heo JY, Kweon GR, Ryu MJ. Effects of a Combination of Polynucleotide and Hyaluronic Acid for Treating Osteoarthritis. Int J Mol Sci 2024; 25:1714. [PMID: 38338992 PMCID: PMC10855695 DOI: 10.3390/ijms25031714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Knee osteoarthritis (OA), an age-related degenerative disease characterized by severe pain and disability, is treated using polynucleotides (PNs) and hyaluronic acid (HA). The intra-articular (IA) injection of HA has been studied extensively in both animal models and in humans; however, the efficacy and mechanisms of action remain unclear. In addition, there has been a paucity of research regarding the use of PN alone or in combination with HA in OA. To investigate the effect of the combined injection of PN and HA in vivo, pathological and behavioral changes were assessed in an OA model. Anterior cruciate ligament transection and medial meniscectomy were performed in Sprague-Dawley rats to create the OA animal model. The locomotor activity improved following PNHA injection, while the OARSI grade improved in the medial tibia and femur. In mild OA, TNFα levels decreased histologically in the PN, HA, and PNHA groups but only the PNHA group showed behavioral improvement in terms of distance. In conclusion, PNHA exhibited anti-inflammatory effects during OA progression and improved locomotor activity regardless of the OARSI grade.
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Affiliation(s)
- Seung Hee Choi
- Joonghun Pharmaceutical Co., Ltd., 15 Gukhoe-daero 62-gil, Yeongdeungpo-gu, Seoul 07236, Republic of Korea; (S.H.C.); (H.C.K.); (S.G.J.); (Y.J.L.)
| | - Hyun Chul Kim
- Joonghun Pharmaceutical Co., Ltd., 15 Gukhoe-daero 62-gil, Yeongdeungpo-gu, Seoul 07236, Republic of Korea; (S.H.C.); (H.C.K.); (S.G.J.); (Y.J.L.)
| | - Seul Gi Jang
- Joonghun Pharmaceutical Co., Ltd., 15 Gukhoe-daero 62-gil, Yeongdeungpo-gu, Seoul 07236, Republic of Korea; (S.H.C.); (H.C.K.); (S.G.J.); (Y.J.L.)
| | - Yeon Jae Lee
- Joonghun Pharmaceutical Co., Ltd., 15 Gukhoe-daero 62-gil, Yeongdeungpo-gu, Seoul 07236, Republic of Korea; (S.H.C.); (H.C.K.); (S.G.J.); (Y.J.L.)
| | - Jun Young Heo
- Department of Biochemistry, College of Medicine, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea; (J.Y.H.); (G.R.K.)
| | - Gi Ryang Kweon
- Department of Biochemistry, College of Medicine, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea; (J.Y.H.); (G.R.K.)
| | - Min Jeong Ryu
- Joonghun Pharmaceutical Co., Ltd., 15 Gukhoe-daero 62-gil, Yeongdeungpo-gu, Seoul 07236, Republic of Korea; (S.H.C.); (H.C.K.); (S.G.J.); (Y.J.L.)
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Kuppa SS, Kim HK, Kang JY, Lee SC, Yang HY, Sankaranarayanan J, Seon JK. Polynucleotides Suppress Inflammation and Stimulate Matrix Synthesis in an In Vitro Cell-Based Osteoarthritis Model. Int J Mol Sci 2023; 24:12282. [PMID: 37569659 PMCID: PMC10418450 DOI: 10.3390/ijms241512282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Osteoarthritis (OA) is characterized by degeneration of the joint cartilage, inflammation, and a change in the chondrocyte phenotype. Inflammation also promotes cell hypertrophy in human articular chondrocytes (HC-a) by activating the NF-κB pathway. Chondrocyte hypertrophy and inflammation promote extracellular matrix degradation (ECM). Chondrocytes depend on Smad signaling to control and regulate cell hypertrophy as well as to maintain the ECM. The involvement of these two pathways is crucial for preserving the homeostasis of articular cartilage. In recent years, Polynucleotides Highly Purified Technology (PN-HPT) has emerged as a promising area of research for the treatment of OA. PN-HPT involves the use of polynucleotide-based agents with controlled natural origins and high purification levels. In this study, we focused on evaluating the efficacy of a specific polynucleotide sodium agent, known as CONJURAN, which is derived from fish sperm. Polynucleotides (PN), which are physiologically present in the matrix and function as water-soluble nucleic acids with a gel-like property, have been used to treat patients with OA. However, the specific mechanisms underlying the effect remain unclear. Therefore, we investigated the effect of PN in an OA cell model in which HC-a cells were stimulated with interleukin-1β (IL-1β) with or without PN treatment. The CCK-8 assay was used to assess the cytotoxic effects of PN. Furthermore, the enzyme-linked immunosorbent assay was utilized to detect MMP13 levels, and the nitric oxide assay was utilized to determine the effect of PN on inflammation. The anti-inflammatory effects of PN and related mechanisms were investigated using quantitative PCR, Western blot analysis, and immunofluorescence to examine and analyze relative markers. PN inhibited IL-1β induced destruction of genes and proteins by downregulating the expression of MMP3, MMP13, iNOS, and COX-2 while increasing the expression of aggrecan (ACAN) and collagen II (COL2A1). This study demonstrates, for the first time, that PN exerted anti-inflammatory effects by partially inhibiting the NF-κB pathway and increasing the Smad2/3 pathway. Based on our findings, PN can potentially serve as a treatment for OA.
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Affiliation(s)
- Sree Samanvitha Kuppa
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun 58128, Republic of Korea
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
| | - Hyung-Keun Kim
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
| | - Ju-Yeon Kang
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
| | - Seok-Cheol Lee
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
| | - Hong-Yeol Yang
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
| | - Jaishree Sankaranarayanan
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun 58128, Republic of Korea
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
| | - Jong-Keun Seon
- Department of Biomedical Sciences, Chonnam National University Medical School, Hwasun 58128, Republic of Korea
- Department of Orthopaedics Surgery, Center for Joint Disease of Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup 519-763, Republic of Korea
- Korea Biomedical Materials and Devices Innovation Research Center, Chonnam National University Hospital, 42, Jebong-ro, Dong-gu, Gwangju 501-757, Republic of Korea
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Kim TW, Chang MJ, Shin CY, Chang CB, Kang SB. A randomized controlled trial for comparing efficacy and safety between intraarticular polynucleotide and hyaluronic acid for knee osteoarthritis treatment. Sci Rep 2023; 13:9419. [PMID: 37296122 PMCID: PMC10256705 DOI: 10.1038/s41598-023-35982-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Although the use of intra-articular polynucleotide (IA PN) injection as a viscosupplement for knee osteoarthritis (OA) treatment has been proposed, its efficacy and safety compared to high molecular weight hyaluronic acid (HMWHA) injection has not yet been established. The present double-blind, multicenter, randomized controlled trial aimed to investigate the efficacy and safety of IA PN injection compared to IA HMWHA injection. A total of 60 patients (15 men, 45 women, 64.5 ± 7.5 years) with knee OA (Kellgren-Lawrence grade 1-4) were randomly allocated to each group. All patients were given three IA injections of PN (n = 30) or HMWHA (n = 30) at intervals of 1 week. The primary endpoint was the change rate in weight-bearing pain (WBP) 16 weeks from the baseline. The secondary endpoint included multiple measurements: the change rate in WBP rate at 8 weeks; the change rate in pain level at rest and during walking at 8 and 16 weeks; the Korean-Western Ontario and McMaster University Osteoarthritis index; the Euro-Quality of Life-5 Dimension; Clinical Global Impression, Patient Global Impression at 8 and16 weeks, and total consumption of rescue medicine. The mean change rate in the WBP at 16 weeks from the baseline was - 54.0 ± 38.1% in the IA PN group and - 42.8 (± 35.8%) in the IA HMWHA group, and there was no significant difference between the two groups (p = 0.296). All secondary endpoints related with pain and functional outcome also showed no significant difference between the two groups. Pain at the injection site and swelling were reported as adverse events, and the incidence was similar between the two groups. IA PN showed comparable efficacy and safety to IA HMWHA at 3 times injection with an interval of 1 week. IA PN can be useful alternative to IA HMWHA for the treatment of knee OA.
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Affiliation(s)
- Tae Woo Kim
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chung Yeop Shin
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Araco A, Araco F, Raichi M. Clinical efficacy and safety of polynucleotides highly purified technology (PN-HPT®) and cross-linked hyaluronic acid for moderate to severe nasolabial folds: A prospective, randomized, exploratory study. J Cosmet Dermatol 2023; 22:146-155. [PMID: 35531796 PMCID: PMC10084116 DOI: 10.1111/jocd.15064] [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: 12/06/2021] [Revised: 02/04/2022] [Accepted: 05/02/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The mandibular profile undergoes progressive wasting with aging, and the deepening of nasolabial folds (NLFs) has a leading role. Hyaluronic acid (HA) efficiently controls tissue hydration and permeability to small and large molecules. NLFs are an acknowledged HA target; at the same time, another class of agents, PN-HPT® (Polynucleotides Highly Purified Technology), enjoy growing acknowledgement in aesthetic medicine. This exploratory, prospective study probed the rationale of sequentially associating PN-HPT® as a first priming agent acting in the skin followed by HA dermal filler injections for correcting moderate to severe NLFs. METHODS Following strict inclusion and exclusion criteria, the authors screened Caucasian ambulatory women aged 40-65 with moderate to severe NLFs and randomly selected two NLFs for each enrolled woman. Due to the purely explorative nature of the study, the authors initially planned to enroll no >10 women. According to a split-face design, the selected right-side NLFs received 4 ml of PN-HPT® intradermally in the initial priming phase ("NLF Rx group"); the selected left-side NLFs received 4 ml of saline (placebo) ("NLF Lx group"). After 3 and 6 weeks, all patients received 2 ml of subdermal cross-linked HA over both NLF areas (4 ml overall). The total study follow-up was 6 months after the first injection, with objective assessments, based on the qualitative and quantitative Antera 3D® and Vectra H2® skin imaging technologies, after 6 weeks and 3 and 6 months. RESULTS Because of the favorable early outcomes, the authors let enrollment progress between January and June 2020 up to a total of 20 women and 40 NLFs. All treated women completed the six-month follow-up without reporting side effects, even clinically minor. The Antera 3D® device demonstrated that wrinkles and skin texture significantly improved in the NLF Rx after 6 weeks (monotherapy phase) and 3 and 6 months (PN-HPT® priming + HA phase) compared with baseline. HA levels, measured with the quantitative Vectra H2® assessment technology in the right NLFs, were significantly higher than contralaterally at both 3 and 6 months. CONCLUSIONS Although conceived only as an exploratory investigation, the study confirmed that PN-HPT® monotherapy might be a valuable and effective option to rapidly improve the skin dermis texture and quality in individuals with moderate to severe NLFs. Acting as a priming agent in the skin, PN-HPT® prolong the clinical efficacy of cross-linked HA. Well-designed trials in larger treatment groups will hopefully confirm these early promising results.
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Affiliation(s)
- Antonino Araco
- Cosmetic and Plastic Surgeon, Aesthetic Medicine Department, Tor Vergata University, Rome, Italy
| | - Francesco Araco
- Cosmetic and Plastic Surgeon, San Giovanni Evangelista Hospital, Tivoli, Italy
| | - Mauro Raichi
- Clinical Pharmacology Consultant in Aesthetic Medicine, Milan, Italy
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Giudici S, Maggio F, Bertocchi M, Lucido MR, Corvò R, Orsatti M. Topical natural-origin polynucleotides in radiation-induced skin and mucosal toxicity. Folia Med (Plovdiv) 2022; 64:716-724. [PMID: 36876545 DOI: 10.3897/folmed.64.e66980] [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: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022] Open
Abstract
Seventy to 90 percent of patients who have received radiation treatment struggle with radiation skin and mucosal toxicity. The inflicted damage to progenitor cells and local microcirculation makes it more likely that wounds, infections, and fibrosis may occur; lesions of variable severity often co-exist. Acute erythema, hyperpigmentation, and mild desquamation usually wane in weeks and require only minor treatment. Conversely, the management of persistent radiation dermatitis and telangiectasia remains unsatisfactory; chronic lesions may progress to tissue atrophy and disfiguring fibrosis.
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Affiliation(s)
| | | | | | | | - Renzo Corvò
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Moon JY, Kim J, Lee JY, Ko Y, Park HJ, Jeon YH. Comparison of polynucleotide, sodium hyaluronate, and crosslinked sodium hyaluronate for the management of painful knee osteoarthritis: a multi-center, randomized, double-blind, parallel-group study. PAIN MEDICINE 2022; 24:496-506. [PMID: 36255262 DOI: 10.1093/pm/pnac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the clinical effectiveness of sodium polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid for the management of painful knee osteoarthritis. DESIGN Randomized, double-blind, parallel-group clinical trial. SETTING Multicenter study. SUBJECTS Patients with chronic painful knee osteoarthritis. METHODS Ninety patients were selected and randomized into polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid groups (30 per group). Intra-articular injections of the viscosupplement for each group were administered to the patients three times at one-week intervals. The primary outcome was differences in changes of weight-bearing pain scores at 16 weeks between the groups. The secondary outcomes were changes in the intensity of knee pain during weight-bearing, walking, and rest, and functional disability, quality of life, and adverse events during the 16-week follow-up period. RESULTS At 16 weeks, the polynucleotide group showed a higher reduction in pain score using a Visual Analog Scale score (0-100) than the classic hyaluronic acid (-17.6 [95% CI = -35.1 to -0.1]; P = 0.048) and crosslinked hyaluronic acid (-22.4 [95% CI = -41.5 to -3.3]; P = 0.016) groups. The polynucleotide and crosslinked hyaluronic acid groups showed an early-onset reduction in knee pain during weight-bearing, walking, and rest. All three groups showed reductions in functional disability and improved quality of life at 16 weeks without inter-group differences. No severe adverse events were reported throughout the study period. CONCLUSION Polynucleotide significantly relieves pain more and relieves pain faster in patients with knee osteoarthritis than classic and crosslinked hyaluronic acid, with improved health-related quality of life. CLINICAL TRIAL NUMBER AND REGISTRY URL Clinical Research Information Service (https://cris.nih.go.kr/cris/index.jsp; Identifier: KCT0005308).
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Heu Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Jeon
- Department of Anesthesiology and Pain Medicine, Kyugpook National University College of Medicine, Daegu, Republic of Korea
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Jang JY, Kim JH, Kim MW, Kim SH, Yong SY. Study of the Efficacy of Artificial Intelligence Algorithm-Based Analysis of the Functional and Anatomical Improvement in Polynucleotide Treatment in Knee Osteoarthritis Patients: A Prospective Case Series. J Clin Med 2022; 11:2845. [PMID: 35628972 PMCID: PMC9148053 DOI: 10.3390/jcm11102845] [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] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 12/19/2022] Open
Abstract
Knee osteoarthritis (OA) is one of the most common degenerative diseases in old age. Recent studies have suggested new treatment approaches dealing with subchondral remodeling, which is a typical feature of OA progression. However, diagnostic tools or therapeutic approaches related to such a process are still being researched. The automated artificial intelligence (AI) algorithm-based texture analysis is a new method used for OA-progression detection. We designed a prospective case series study to examine the efficacy of the AI algorithm-based texture analysis in detecting the restoration of the subchondral remodeling process, which is expected to follow therapeutic intervention. In this study, we used polynucleotide (PN) filler injections as the therapeutic modality and the treatment outcome was verified by symptom improvement, as well as by the induction of subchondral microstructural changes. We used AI algorithm-based texture analysis to observe these changes in the subchondral bone with the bone structure value (BSV). A total of 51 participants diagnosed with knee OA were enrolled in this study. Intra-articular PN filler (HP cell Vitaran J) injections were administered once a week and five times in total. Knee X-rays and texture analyses with BSVs were performed during the screening visit and the last visit three months after screening. The Visual Analogue Scale (VAS) and Korean-Western Ontario MacMaster (K-WOMAC) measurements were used at the screening visit, the fifth intra-articular injection visit, and the last visit. The VAS and K-WOMAC scores decreased after PN treatment and lasted for three months after the final injection. The BSV changed in the middle and deep layers of tibial bone after PN injection. This result could imply that there were microstructural changes in the subchondral bone after PN treatment, and that this change could be detected using the AI algorithm-based texture analysis. In conclusion, the AI- algorithm-based texture analysis could be a promising tool for detecting and assessing the therapeutic outcome in knee OA.
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Affiliation(s)
- Ji Yoon Jang
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.J.); (J.H.K.); (M.W.K.)
| | - Ji Hyun Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.J.); (J.H.K.); (M.W.K.)
| | - Min Woo Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.J.); (J.H.K.); (M.W.K.)
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.J.); (J.H.K.); (M.W.K.)
| | - Sang Yeol Yong
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (J.Y.J.); (J.H.K.); (M.W.K.)
- Yonsei Institute of Sports Science and Exercise Medicine, Wonju 26426, Korea
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11
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Wang F, Liu M, Wang N, Luo J. G Protein-Coupled Receptors in Osteoarthritis. Front Endocrinol (Lausanne) 2022; 12:808835. [PMID: 35154008 PMCID: PMC8831737 DOI: 10.3389/fendo.2021.808835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Osteoarthritis (OA) is the most common chronic joint disease characterized, for which there are no available therapies being able to modify the progression of OA and prevent long-term disability. Critical roles of G-protein coupled receptors (GPCRs) have been established in OA cartilage degeneration, subchondral bone sclerosis and chronic pain. In this review, we describe the pathophysiological processes targeted by GPCRs in OA, along with related preclinical model and/or clinical trial data. We review examples of GPCRs which may offer attractive therapeutic strategies for OA, including receptors for cannabinoids, hormones, prostaglandins, fatty acids, adenosines, chemokines, and discuss the main challenges for developing these therapies.
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Affiliation(s)
- Fanhua Wang
- Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Mingyao Liu
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, China
| | - Ning Wang
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
| | - Jian Luo
- Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, Shanghai, China
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12
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Bączkowicz D, Skiba G, Szmajda M, Vařeka I, Falkowski K, Laudner K. Effects of Viscosupplementation on Quality of Knee Joint Arthrokinematic Motion Analyzed by Vibroarthrography. Cartilage 2021; 12:438-447. [PMID: 31072141 PMCID: PMC8461162 DOI: 10.1177/1947603519847737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the influence of viscosupplementation on osteoarthritic knee arthrokinematics analyzed by VAG. It is considered that intra-articular hyaluronic acid injection may improve the function of synovial joints by recovery of friction-reducing properties of articular environment. DESIGN Thirty-five patients with knee osteoarthritis (grade II according to the Kellgren-Lawrence system) and 50 asymptomatic subjects were enrolled in the study. Patients were analyzed at 3 time points: 1 day before and 2 weeks and 4 weeks after single injection of 1.5% cross-linked hyaluronate. Control subjects were tested once. The vibroarthrographic signals were collected during knee flexion/extension motion using an accelerator and described by variation of mean square (VMS), mean range (R5), and power spectral density for frequency of 50 to 250 Hz (P1), and 250 to 450 Hz (P2). RESULTS Patients before viscosupplementation were characterized by about 2-fold higher values of vibroarthrographic parameters than controls. Two weeks after the procedure, the values of R5, P1, and P2 significantly decreased, in comparison to pre-injection. At 4 weeks post-injection, we noted a significant increase in R5, P1, and P2 values, when compared to 2 weeks post-injection. Finally, at 4 weeks post-injection, the level of VMS, R5, and P2 parameters did not differ from values obtained at pre-injection. CONCLUSIONS We showed that viscosupplementation may be effective in providing arthrokinematics improvement, but with a relatively short period of duration. This phenomenon is observed as decreased vibroacoustic emission, which reflects a more smooth movement in the joint.
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Affiliation(s)
- Dawid Bączkowicz
- Institute of Physiotherapy, Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,Dawid Bączkowicz, Institute of Physiotherapy, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 76 Prószkowska Street, Opole 45-758, Poland.
| | | | - Mirosław Szmajda
- Institute of Automatic Control, Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, Opole, Poland
| | - Ivan Vařeka
- Department of Rehabilitation, Faculty Hospital in Hradec Králové, Hradec Králové, Czech Republic
| | - Krzysztof Falkowski
- Department of Trauma and Orthopaedic Surgery, University Clinical Hospital in Opole, Opole, Poland
| | - Kevin Laudner
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
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13
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Stagni C, Rocchi M, Mazzotta A, Del Piccolo N, Rani N, Govoni M, Vivarelli L, Veronesi F, Fini M, Dallari D. Randomised, double-blind comparison of a fixed co-formulation of intra-articular polynucleotides and hyaluronic acid versus hyaluronic acid alone in the treatment of knee osteoarthritis: two-year follow-up. BMC Musculoskelet Disord 2021; 22:773. [PMID: 34511091 PMCID: PMC8436495 DOI: 10.1186/s12891-021-04648-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background A first-year interim analysis of this two-year study suggested that intra-articular injections of highly purified, natural-origin polynucleotides and hyaluronic acid (HA) as a fixed combination (PNHA) might improve knee function and joint pain more effectively than HA alone in patients with knee osteoarthritis (OA). The purpose of the second-year analysis herein described was to verify whether the first-year interim outcomes persist over the whole two-year period. Methods Randomised, double-blind, HA-controlled clinical trial in 100 knee OA patients (98 randomised, 79 completing the study) in a high-specialisation tertiary care setting. The hypothesised difference of efficacy between PNHA and HA for the original sample size estimate is 20%. Treatment cycle: three intra-articular knee injections of either PNHA or HA, at baseline and weekly for two weeks. Evaluations: Western Ontario and McMaster Universities (WOMAC) score and Knee Society Score (KSS) as, respectively, primary and secondary endpoints, evaluated at baseline and after 2, 6, 12, and 24 months; synovial fluid levels of mediators (at baseline and the end of the treatment cycle). Adverse effects investigated at each control visit. Statistical analysis: Kruskal-Wallis test for independent samples (nonparametric one-way analysis of variance) after correction of means for age, Body Mass Index and Kellgren-Lawrence grade. If significant, pairwise post-hoc Sidak multiple comparisons. Results KSS total score and KSS pain item: significant improvement in both groups, with significantly more pain improvement in patients treated with PNHA (2-point reduction) than HA (1-point reduction). Both groups experienced significant long-term reductions in WOMAC total scores: significantly stronger in PNHA-treated patients after 24 months with a steady difference of 16% favouring PNHA in WOMAC pain subscore. No clinically significant adverse events in either group. Conclusions The outcomes of the 2-year study confirmed that a short cycle of intra-articular treatment (3 weekly double-blind injections) with polynucleotides (long-acting viscosupplementation properties, chondrocyte activation, pain-relieving properties) in fixed combination with high molecular weight hyaluronic acid is more effective in improving knee function and pain in knee OA patients than HA alone. PNHA may be elective for viscosupplementation in knee OA patients with fastidious and resistant pain and worsening disease. Trial registration NCT02417610. Registration, 15/04/2015. ClinicalTrials.gov database link:
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Affiliation(s)
- Cesare Stagni
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Martina Rocchi
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy.
| | - Alessandro Mazzotta
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Nicolandrea Del Piccolo
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Rani
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - Francesca Veronesi
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Milena Fini
- Surgical Sciences and Technologies Complex Structure, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques - Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136, Bologna, Italy
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14
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Polydeoxyribonucleotide and Polynucleotide Improve Tendon Healing and Decrease Fatty Degeneration in a Rat Cuff Repair Model. Tissue Eng Regen Med 2021; 18:1009-1020. [PMID: 34387852 DOI: 10.1007/s13770-021-00378-5] [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: 05/14/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND After surgical repair of chronic rotator cuff tears, healing of the repaired tendons often fails and is accompanied by high-level fatty degeneration. Our purpose was to explore the effects of polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and the reversal of fatty degeneration in a chronic rotator cuff tear model using a rat infraspinatus. METHODS Sixty rats were randomly assigned to the following three groups (20 rats per group: 12 for histological evaluation and 8 for mechanical testing): saline + repair (SR), PDRN + repair (PR), and PN + repair (PNR). The right shoulder was used for experimental intervention, and the left served as a control. Four weeks after detaching the infraspinatus, the torn tendon was repaired. Saline, PDRN, and PN were applied to the repair sites. Histological evaluation was performed 3 and 6 weeks after repair and biomechanical analysis was performed at 6 weeks. RESULTS Three weeks after repair, the PR and PNR groups had more CD168-stained cells than the SR group. The PR group showed a larger cross-sectional area (CSA) of muscle fibers than the SR and PNR groups. Six weeks after repair, the PR and PNR groups showed more adipose cells, less CD68-stained cells, and more parallel tendon collagen fibers than the SR group. The PR group had more CD 68-stained cells than the PNR group. The PR group showed a larger CSA than the SR group. The mean load-to-failure values of the PR and PNR groups were higher than that of the SR group, although these differences were not significant. CONCLUSION PDRN and PN may improve tendon healing and decrease fatty degeneration after cuff repair.
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Abstract
Knee osteoarthritis is a degenerative condition characterized by progressive cartilage degradation, subchondral damage, and bone remodelling. Among the approaches implemented to achieve symptomatic and functional improvements, injection treatments have gained increasing attention due to the possibility of intra-articular delivery with reduced side effects compared to systemic therapies. In addition to well-established treatment options such as hyaluronic acid (HA), cortico-steroids (CS) and oxygen-ozone therapy, many other promising products have been employed in the last decades such as polydeoxyribonucleotide (PDRN) and biologic agents such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs). Moreover, ultrasound-guided intra-meniscal injection and X-ray-guided subchondral injection techniques have been introduced into clinical practice. Even when not supported by high evidence consensus, intra-articular CS and HA injections have gained precise indications for symptomatic relief and clinical improvement in OA. Biological products are strongly supported by in vitro evidence but there is still a lack of robust clinical evidence. PRP and MSCs seem to relieve OA symptoms through a regulation of the joint homeostasis, even if their capability to restore articular cartilage is still to be proved in vivo. Due to increasing interest in the subchondral bone pathology, subchondral injections have been developed with promising results in delaying joint replacement. Nevertheless, due to their recent development and the heterogeneity of the injected products (biologic agents or calcium phosphate), this approach still lacks strong enough evidence to be fully endorsed. Combined biological treatments, nano-molecular approaches, monoclonal antibodies and ‘personalized’ target therapies are currently under development or under investigation with the aim of expanding our armamentarium against knee OA.
Cite this article: EFORT Open Rev 2021;6:501-509. DOI: 10.1302/2058-5241.6.210026
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Affiliation(s)
- Gerardo Fusco
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy.,These authors contributed equally to the article and should both be considered first authors
| | - Francesco M Gambaro
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy.,These authors contributed equally to the article and should both be considered first authors
| | - Berardo Di Matteo
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,First Moscow State Medical University - Sechenov University, Moscow, Russia
| | - Elizaveta Kon
- Humanitas University, Department of Biomedical Sciences, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
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16
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Kim JY, Kim YN, Lee YJ, Sim SE, Ko YR, Shim JW, Lee KS, Joo M, Park HJ. Pilot Study to Evaluate the Efficacy of Polynucleotide Sodium Compared to Sodium Hyaluronate and Crosslinked Sodium Hyaluronate in Patients with Knee Osteoarthritis. J Clin Med 2021; 10:jcm10051138. [PMID: 33803080 PMCID: PMC7963169 DOI: 10.3390/jcm10051138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/18/2022] Open
Abstract
Degenerative arthritis of the knee joint has become a major social problem worldwide due to population aging. There are several treatment options for knee osteoarthritis, and the intraarticular injection of sodium hyaluronate is commonly selected by many clinicians as a nonsurgical treatment. However, the efficacy of the treatment is controversial. In this pilot study, we aimed to compare polynucleotide sodium (Conjuran®) with sodium hyaluronate (Hyruan Plus®) and 1,4-butanediol diglycidyl ether-crosslinked sodium hyaluronate (Synovian®) in terms of analgesic efficacy after intraarticular injection in patients with knee osteoarthritis. One of the three intraarticular agents was selected according to what agents were available for outpatients when each patient was enrolled in the study. The 15 enrolled patients were subdivided into 3 groups of 5 patients each. Three injections were performed under ultrasound guidance at a 1-week intervals over a total of 3 weeks. The visual analog scale (VAS) score, the Korean version of the Western Ontario and McMaster Universities Arthritis Index (K-WOMAC), the EuroQol five-dimension scale (EQ-5D) score, and the Korean version of the painDETECT Questionnaire (K-PDQ) score were evaluated before injection and at 1, 2, and 6 weeks after the start of the treatment protocol. The primary endpoint was the change in weight-bearing pain at 4 weeks after the last injection. Secondary endpoints included pain at rest and during walking and the K-WOMAC, EQ-5D, and K-PDQ scores. Weight-bearing pain decreased significantly more from pretreatment to 6 weeks after the start of the treatment protocol in the polynucleotide sodium-treated patients than in the patients who were treated with other agents (p = 0.006, one-way ANOVA). There were no significant between-group differences in the other secondary endpoints. No adverse events occurred. In conclusion, polynucleotide sodium could effectively reduce weight-bearing pain in the patients with knee osteoarthritis compared to standard hyaluronic acid viscosupplementation.
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Affiliation(s)
- Ji Yeong Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
| | - Yoo Na Kim
- Mapo Hapjung Bone Orthopedics, Seoul 06591, Korea;
| | | | - Sung Eun Sim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
| | - Yu Ri Ko
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
| | - Jin Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
| | - Ku Sang Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
| | - Mina Joo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (J.Y.K.); (S.E.S.); (Y.R.K.); (J.W.S.); (K.S.L.); (M.J.)
- Correspondence: ; Tel.: +82-2-2258-2236 (ext. 6157)
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Saltzman BM, Frank RM, Davey A, Cotter EJ, Redondo ML, Naveen N, Wang KC, Cole BJ. Lack of standardization among clinical trials of injection therapies for knee osteoarthritis: a systematic review. PHYSICIAN SPORTSMED 2020; 48:266-289. [PMID: 32027200 DOI: 10.1080/00913847.2020.1726716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose: Osteoarthritis (OA) of the knee is a debilitating, expensive, and prevalent disease, and interest in the non-surgical management of knee OA has grown recently. Our objective was to systematically assess the level of heterogeneity among all clinical trials and published studies regarding injections for knee osteoarthritis, in terms of treatment of interest, outcomes evaluated, and time points of outcome assessment. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to review all published studies and publically available clinical trials from 1 January 2013 to 3 May 2019evaluating intra-articular injections to treat knee OA. Their treatment group and specifics of methodology were scrutinized and compared. Results: 84 published studies and 114 clinical trials were included. Within the 84 published studies, the most common injection treatment studied was hyaluronic acid [N = 22; 26.2%]. In total, 29 different injection treatment groups were utilized. The most common time point for patient evaluation post-injection was 6 months (N = 33 studies; 50.0%), and ranged from 1 week (N = 9 studies; 13.6%) to 7 years (N = 1 study; 1.5%). The most common patient-reported outcome (PRO) measure assessed in the included studies was Western Ontario and McMaster's University Osteoarthritis Index (WOMAC) [N = 44 studies; 66.7%]. For the 114 clinical trials identified, the most common injection treatment studied is platelet-rich plasma in isolation (N = 19; 16.7%). Forty-two different injection treatment types/groups are utilized. The most common PRO measure assessed was WOMAC (N = 77 trials; 67.5%). Overall there were 34 different patient-reported outcome measures used. Conclusions: Research efforts to find the most effective injection therapy for knee OA continue with a tremendous number of injection therapies still being evaluated. Substantial heterogeneity exists in these completed and ongoing trials in terms of patient demographics, OA grades, outcome scores and relatively short-term timing of assessments, with no clear standardization of testing protocol despite proposing to answer the same clinical question. We recommend that studies of this genre going forward be standardized in terms of outcome measures and longer-term follow-up time points, and should incorporate functional assessment evaluations and imaging studies.
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Affiliation(s)
- Bryan M Saltzman
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Rachel M Frank
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Annabelle Davey
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Eric J Cotter
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Michael L Redondo
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Neal Naveen
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Kevin C Wang
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
| | - Brian J Cole
- Orthopaedic Surgery, Rush University Medical Center , Chicago, IL, USA
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18
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Efficacy of Intra-Articular Polynucleotides Associated With Hyaluronic Acid Versus Hyaluronic Acid Alone in the Treatment of Knee Osteoarthritis: A Randomized, Double-Blind, Controlled Clinical Trial. Clin J Sport Med 2020; 30:1-7. [PMID: 31855906 DOI: 10.1097/jsm.0000000000000569] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Pain and range of motion loss are the main clinical features of osteoarthritis (OA). Hyaluronic acid (HA) is one of the infiltrative therapies for OA treatment; however, its effectiveness is a matter of an ongoing debate in clinical practice. Polynucleotides (PNs), a DNA-derived macromolecule with natural origin and trophic activity, were found to favor cell growth and collagen production, in preclinical and clinical studies regarding cartilage regeneration. This study aimed at evaluating whether injection of PNs, in combination with HA [PNs associated with HA (PNHA)], can ameliorate pain and function of knees affected by OA, more than HA alone. DESIGN A randomized, double-blind, controlled clinical trial. PATIENTS The study enrolled 100 patients, then randomized to receive PNHA or HA alone (3 weekly knee I.A. injections). INTERVENTIONS AND MAIN OUTCOME MEASURES Pain reduction, decrease of proinflammatory synovial fluid (SF) factors, and improvement in knee function were evaluated by Knee Society Score and WOMAC scores, after 2, 6, and 12 months and by biochemical and immunoenzymatic analyses of SF at the end of the treatment. RESULTS Knee Society Score total score and pain item significantly ameliorated in both groups, showing better results in PNHA- than in the HA-treated group. A significant reduction in the WOMAC score was observed over time for both groups. No significant adverse events were reported in either group. CONCLUSIONS These findings suggest that I.A. injection of PNs, in combination with HA, is more effective in improving knee function and pain, in a joint affected by OA, compared with HA alone.
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Kim MS, Cho RK, In Y. The efficacy and safety of polydeoxyribonucleotide for the treatment of knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17386. [PMID: 31574892 PMCID: PMC6775356 DOI: 10.1097/md.0000000000017386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The purpose of this study was to use meta-analysis techniques to evaluate the efficacy and safety of polydeoxyribonucleotide (PDRN) injections for knee osteoarthritis (OA) treatment. METHODS Multiple comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched in November 2018 for studies that compared the effectiveness and safety of intra-articular PDRN injection for the knee joint with hyaluronic acid (HA) injection. Two reviewers independently determined study inclusion and they extracted data using a standardized data extraction form. The predefined primary outcome was Visual Analogue Scale. Secondary outcomes included Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and adverse events. RESULTS Five randomized controlled trials were included in the meta-analysis. After 1 and 2 months, patients in the PDRN group showed significantly better improvement in pain than the HA group (P = .04 and P = .02, respectively). There was no significant difference in pain after 4 months. The pooled analysis showed that no significant differences were seen in function (KOOS and KSS) scores between the PDRN and HA groups (all P > .05) at all time points. There was no significant difference in adverse events between 2 groups (relative risks = 2.15, 95% confidential interval: 0.17-26.67, P = .55). CONCLUSION The intra-articular use of PDRN was similar in function to HA, and the pain-relief effect was superior to HA for 2 months post-injection. Therefore, it could be a favorable alternative to HA to treat persistent pain associated with knee OA while avoiding side effects.Level of evidence I.
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Bekisz JM, Lopez CD, Corciulo C, Mediero A, Coelho PG, Witek L, Flores RL, Cronstein BN. The Role of Adenosine Receptor Activation in Attenuating Cartilaginous Inflammation. Inflammation 2018; 41:1135-1141. [PMID: 29656316 DOI: 10.1007/s10753-018-0781-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Adenosine receptor activation has been explored as a modulator of the inflammatory process that propagates osteoarthritis. It has been reported that cartilage has enhanced regenerative potential when influenced by adenosine receptor activation. As adenosine's role in maintaining chondrocyte homeostasis at the cellular and molecular levels is explored, successful in vivo applications of adenosine delivery for cartilage repair continue to be reported. This review summarizes the role adenosine receptor ligation plays in chondrocyte homeostasis and regeneration of articular cartilage damaged in osteoarthritis. It also reports on all the modalities reported for delivery of adenosine through in vivo applications.
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Affiliation(s)
- Jonathan M Bekisz
- New York University School of Medicine, 550 First Avenue, MSB 521, New York, NY, 10016, USA. .,Hansjörg Wyss Department of Plastic Surgery at New York University School of Medicine, 307 East 33rd Street, New York, NY, 10016, USA.
| | - Christopher D Lopez
- Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.,Division of Translational Medicine at New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.,Department of Biomaterials and Biomimetics at New York University College of Dentistry, 433 First Avenue, New York, NY, 10010, USA
| | - Carmen Corciulo
- Division of Translational Medicine at New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Aranzazu Mediero
- Division of Translational Medicine at New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA.,Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, Madrid, Spain
| | - Paulo G Coelho
- Hansjörg Wyss Department of Plastic Surgery at New York University School of Medicine, 307 East 33rd Street, New York, NY, 10016, USA.,Department of Biomaterials and Biomimetics at New York University College of Dentistry, 433 First Avenue, New York, NY, 10010, USA
| | - Lukasz Witek
- Department of Biomaterials and Biomimetics at New York University College of Dentistry, 433 First Avenue, New York, NY, 10010, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery at New York University School of Medicine, 307 East 33rd Street, New York, NY, 10016, USA
| | - Bruce N Cronstein
- New York University School of Medicine, 550 First Avenue, MSB 521, New York, NY, 10016, USA.,Division of Translational Medicine at New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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21
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Baek A, Kim Y, Lee JW, Lee SC, Cho SR. Effect of Polydeoxyribonucleotide on Angiogenesis and Wound Healing in an In Vitro Model of Osteoarthritis. Cell Transplant 2018; 27:1623-1633. [PMID: 30311500 PMCID: PMC6299200 DOI: 10.1177/0963689718804130] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Osteoarthritis (OA) is degenerative disease, leading to pain and functional disability. It is reported that polydeoxyribonucleotide (PDRN) is a suitable therapy for OA. However, the therapeutic mechanisms of PDRN in OA are not fully understood. To investigate the effect of PDRN in an in vitro model of OA, interleukin (IL)-1β or phosphate-buffered saline (PBS) was used to treat a human chondrocytic cell line in hypoxic conditions for 24 h (IL-1β group or control group). PDRN was then used to treat IL-1β group cells for 24 h (PDRN group). By Label-Based Human Antibody Array 1000, angiopoietin-2 (ANG-2), platelet-derived growth factor (PDGF), angiostatin, and endostatin, which were related to angiogenesis, were chosen for further validation studies. Quantitative real-time reverse transcription polymerase chain reaction and western blot analysis validated that the levels of PDGF and ANG-2, which were related to pro-angiogenesis, were significantly increased in the PDRN group compared with those in the control group or the IL-1β group. However, the levels of endostatin and angiostatin, which were related in anti-angiogenesis, were significantly decreased in the PDRN group compared with those in the control group or the IL-1β group. In the same manner, vascular endothelial growth factor, which was a mediator of angiogenesis, was significantly increased in the PDRN group compared with those in the control group or the IL-1β group. Furthermore, wound closure was significantly increased in the PDRN group compared with the control group or the IL-1β group by in vitro scratch assay. Moreover, PDRN decreased expression of metalloproteinase 13, as a catabolic factor for OA, but increased expression of aggrecan, which was an anabolic factor for OA. These data suggest that PDRN may promote angiogenesis and wound healing via down-regulation of catabolism and up-regulation of anabolism in an in vitro model of OA.
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Affiliation(s)
- Ahreum Baek
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Yoon Kim
- Department of Medicine, The Graduate School of Yonsei University, Seoul, Korea
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Sang Chul Lee, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul 03722, South Korea.
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea
- Yonsei Stem Cell Center, Avison Biomedical Research Center, Yonsei University College of Medicine, Seoul, South Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
- Sung-Rae Cho, Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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22
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Baek A, Kim M, Kim SH, Cho SR, Kim HJ. Anti-inflammatory Effect of DNA Polymeric Molecules in a Cell Model of Osteoarthritis. Inflammation 2018; 41:677-688. [PMID: 29302765 DOI: 10.1007/s10753-017-0722-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The DNA polymeric molecules polydeoxynucleotide (PDRN) and polynucleotide (PN) can be used as new alternative treatment for osteoarthritis (OA); however, the underlying mechanisms are not fully understood. In this study, we investigated the effect of PDRN and PN on gene-expression profiles in a cell model of OA using transcriptome analysis. Under hypoxic conditions, human chondrosarcoma cells were stressed for 24 h in the presence of interleukin (IL)-1β and subsequently treated with PDRN, PN, or hyaluronic acid (HA) for another 24 h, followed by transcriptome analysis. The results of the transcriptome study comprising differentially expressed genes were analyzed using the Database of Annotation Visualization and Integrated Discovery program, which yielded Kyoto Encyclopedia of Genes and Genomes pathways. Toll-like receptor (TLR)- and nucleotide-binding oligomerization domain-like receptor (NLR)-signaling pathways were related between the IL-1β group and the group treated with DNA polymeric molecules. The genes involved in the TLR- and NLR-signaling pathways were validated using real-time quantitative polymerase chain reaction and western blot. Among these genes, IL-6, IL-1β, IL-8, and chemokine (C-C motif) ligand 3 were dramatically upregulated in the IL-1β group, but significantly downregulated in the group treated with DNA polymeric molecules. Specifically, PN treatment resulted in a greater decrease in the expression of these genes as compared with PDRN treatment. Both PDRN and PN treatments were involved in the anti-inflammatory response associated with OA progression, with PN treatment exhibiting additional anti-inflammatory properties relative to PDRN treatment. These results provide insight into potential therapeutic approaches involving PDRN and PN treatment of OA.
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Affiliation(s)
- Ahreum Baek
- Department and Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - MinGi Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Sung Hoon Kim
- Department and Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea. .,Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea. .,Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hyun Jung Kim
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea.
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Mun JU, Cho HR, Choi YS, Kim YU. Effect of multiple intra-articular injections of polynucleotides on treatment of intractable knee osteoarthritis: A case report. Medicine (Baltimore) 2017; 96:e9127. [PMID: 29245352 PMCID: PMC5728967 DOI: 10.1097/md.0000000000009127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE Knee osteoarthritis (KOA) is a chronic joint degenerative disease. Intra-articular injection (IAI) of hyaluronic acid (HA) is widely used to treat KOA. However, some HA injections have no effect at all. Polynucleotides (PN) are recently noted as a valid substitute for HA. PATIENT CONCERNS A 61-year-old female was admitted to the pain center with symptoms of pain over the knee and warmth feeling with stiffness in the left knee. The patient reported chronic severe pain in the left knee area despite 6 times IAI of HA. She had past medical history of breast cancer and thyroid cancer. DIAGNOSES She was diagnosed as having KOA. INTERVENTIONS Ultrasound-guided IAI of PN was carried out 3 times in 3 weeks. OUTCOMES She was followed-up for more than 5 months with good improvement in intractable knee pain without any adverse event. LESSONS IAI of PN is an efficient therapeutic option for KOA treatment if HA injection is unsuccessful.
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Affiliation(s)
- Jong-Uk Mun
- Department of Orthopaedic Surgery, Changwon Gyeongsang National University Hospital, Republic of Korea
| | - Hyung Rae Cho
- Myongji Hospital, College of Medicine, Seonam University, Goyang, Korea
| | - Young Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary‘s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International St. Mary‘s Hospital, Incheon, Republic of Korea
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24
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Veronesi F, Dallari D, Sabbioni G, Carubbi C, Martini L, Fini M. Polydeoxyribonucleotides (PDRNs) From Skin to Musculoskeletal Tissue Regeneration via Adenosine A 2A Receptor Involvement. J Cell Physiol 2017; 232:2299-2307. [PMID: 27791262 DOI: 10.1002/jcp.25663] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 12/17/2022]
Abstract
Polydeoxyribonucleotides (PDRNs) are low molecular weight DNA molecules of natural origin that stimulate cell migration and growth, extracellular matrix (ECM) protein production, and reduce inflammation. Most preclinical and clinical studies on tissue regeneration with PDRNs focused on skin, and only few are about musculoskeletal tissues. Starting from an overview on skin regeneration studies, through the analysis of in vitro, in vivo, and clinical studies (1990-2016), the present review aimed at defining the effects of PDRN and their mechanisms of action in the regeneration of musculoskeletal tissues. This would also help future researches in this area. A total of 29 studies were found by PubMed and www.webofknowledge.com searches: 20 were on skin (six in vitro, six in vivo, one vitro/vivo, seven clinical studies), while the other nine regarded bone (one in vitro, two in vivo, one clinical studies), cartilage (one in vitro, one vitro/vivo, two clinical studies), or tendon (one clinical study) tissues regeneration. PDRNs improved cell growth, tissue repair, ECM proteins, physical activity, and reduced pain and inflammation, through the activation of adenosine A2A receptor. PDRNs are currently used for bone, cartilage, and tendon diseases, with a great variability regarding the PDRN dosage to be used in clinical practice, while the dosage for skin regeneration is well established. PDRNs are usually administered from a minimum of three to a maximum of five times and they act trough the activation of A2A receptor. Further studies are advisable to confirm the effectiveness of PDRNs and to standardize the PDRN dose. J. Cell. Physiol. 232: 2299-2307, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Via Di Barbiano, Bologna, Italy
| | - Dante Dallari
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Giacomo Sabbioni
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Chiara Carubbi
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Lucia Martini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Via Di Barbiano, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopedic Institute, Via Di Barbiano, Bologna, Italy
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25
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Infiltrative therapy as conservative treatment in hip osteoarthritis: a literature review. Hip Int 2016; 26 Suppl 1:8-13. [PMID: 27174067 DOI: 10.5301/hipint.5000402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a very common disease, its prevalence increases with age and is a frequent cause of disability.Osteoarthritis is characterised by joint pain, stiffness and loss of range of motion. Overall, as many as 40% of those aged over 65 years in the community may have symptomatic OA of the knee or hip (1). OA results from a complex interaction of biomechanical and biochemical factors and is characterised by cartilage disruption and hypertrophy of bone. Intraarticular proinflammatory cytokines and proteinases in OA interfere with the synthesis of hyaluronic acid (HA), a complex glycosaminoglycan composed of repeated disaccharide units to form a linear polymer, resulting in an HA with a significantly reduced molecular weight and a reduction in synovial fluid viscoelasticity (2-3). Loss of normal characteristics of HA leads to the degradation of the articular cartilage and the disruption of the mechanical and homeostasis of the joint.Several pharmaceutical approaches, such as analgesics, non steroidal antiinflammatory drugs, COX-2 inhibitors and steroids, have been proposed (4), with the aim of reducing pain and maintaining and/or improving joint function. However, none of these options has shown to delay the progression of osteoarthritis or reverse joint damage.Infiltrative hip therapy involves injecting into the joint the drugs or medicinal substances that are used primarily to control the symptoms of the disease, such as pain and functional limitation.The aim of this review is to analyse existing infiltrative alternatives for hip osteoarthritis, and describe our experience.
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26
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Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, Tschon M, Giavaresi G. Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. Am J Sports Med 2016; 44:664-71. [PMID: 26797697 DOI: 10.1177/0363546515620383] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effectiveness of intra-articular platelet-rich plasma (PRP) injections has been evaluated in knee chondroplasty and osteoarthritis (OA); however, little evidence of its efficacy in hip OA exists. PURPOSE To compare the therapeutic efficacy of autologous PRP, hyaluronic acid (HA), or a combination of both (PRP+HA) in hip OA. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients aged between 18 and 65 years who were treated with outpatient surgery and who had hip OA and pain intensity at baseline of >20 on a 100-mm visual analog scale (VAS) were recruited for this study. Exclusion criteria were extensive surgery; presence of excessive deformities; or rheumatic, infective, cardiovascular, or immune system disorders. The primary outcome measure was a change in pain intensity as assessed by the VAS at 2, 6, and 12 months after treatment. Secondary outcome measures were the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and concentration of growth factors in PRP and their correlation with clinical outcomes. Clinical outcomes were evaluated by assessors and collectors blinded to the type of treatment administered. RESULTS A total of 111 patients were randomly assigned to 3 groups and received 3 weekly injections of either PRP (44 patients), PRP+HA (31 patients), or HA (36 patients). At all follow-ups, the PRP group had the lowest VAS scores. In particular, at 6-month follow-up, the mean VAS score was 21 (95% CI, 15-28) in the PRP group, 35 (95% CI, 26-45) in the PRP+HA group, and 44 (95% CI, 36-52) in the HA group (P < .0005 [PRP vs HA] and P = .007 [PRP vs PRP+HA]; F = 0.663). The WOMAC score of the PRP group was significantly better at 2-month follow-up (mean, 73; 95% CI, 68-78) and 6-month follow-up (mean, 72; 95% CI, 67-76) but not at 12-month follow-up. A significant, "moderate" correlation was found between interleukin-10 and variations of the VAS score (r = 0.392; P = .040). Significant improvements were achieved in reducing pain and ameliorating quality of life and functional recovery. CONCLUSION Results indicated that intra-articular PRP injections offer a significant clinical improvement in patients with hip OA without relevant side effects. The benefit was significantly more stable up to 12 months as compared with the other tested treatments. The addition of PRP+HA did not lead to a significant improvement in pain symptoms.
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Affiliation(s)
- Dante Dallari
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Cesare Stagni
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Nicola Rani
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Giacomo Sabbioni
- Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Patrizia Pelotti
- Radiology and Diagnostic Imaging Department, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Paola Torricelli
- Preclinical and Surgical Studies Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Matilde Tschon
- Preclinical and Surgical Studies Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Gianluca Giavaresi
- Preclinical and Surgical Studies Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
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