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Lin HW, Tam KW, Liou TH, Rau CL, Huang SW, Hsu TH. Efficacy of Platelet-Rich Plasma Injection on Range of Motion, Pain, and Disability in Patients With Adhesive Capsulitis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:2109-2122. [PMID: 37119955 DOI: 10.1016/j.apmr.2023.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To investigate the therapeutic effects of platelet-rich plasma (PRP) injection on range of motion, pain, and disability in patients with adhesive capsulitis (AC). DATA SOURCES The authors performed the literature search in the PubMed, Embase, and Cochrane Library databases in February 2023. STUDY SELECTION Prospective studies comparing the outcomes of PRP with other intervention in patients with AC. DATA EXTRACTION The quality of included randomized trials was assessed using the revised Cochrane Risk of Bias (RoB 2.0) tool. The Risk of Bias in Non-Randomized Studies of Interventions tool was applied to assess the quality of nonrandomized trials. The mean difference (MD) or standardized mean difference (SMD) was determined as the effect size for continuous outcomes, and outcome accuracy was determined using 95% confidence intervals (CIs). DATA SYNTHESIS Fourteen studies involving 1139 patients were included. Our meta-analysis revealed that PRP injection can significantly improve passive abduction (MD=3.91; 95% CI, 0.84-6.98), passive flexion (MD=3.90; 95% CI, 0.15-7.84), and disability (SMD=-0.50; 95% CI, -1.29 to -0.74) within 1 month after intervention. Moreover, PRP injection can significantly improve passive abduction (MD=17.19; 95% CI, 12.38-22.01), passive flexion (MD=17.74; 95% CI, 9.89-25.59), passive external rotation (MD=12.95; 95% CI, 10.04-15.87), pain (MD=-8.40; 95% CI, -16.73 to -0.06), and disability (SMD=-1.02; 95% CI, -1.29 to -0.74) 3 months after intervention. PRP injection can also significantly improve pain (MD=-18.98; 95% CI, -24.71 to -13.26), and disability (SMD=-2.01; 95% CI, -3.02 to -1.00) 6 months after intervention. In addition, no adverse effects of PRP injection were reported. CONCLUSIONS PRP injection may serve as an effective and safe treatment for patients with AC.
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Affiliation(s)
- Ho-Wei Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Cochrane Taiwan, Taipei Medical University, Taipei City; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chi-Lun Rau
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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Ghalibafan S, Osei K, Amescua G, Sabater A. Efficacy of Plasma Rich in Growth Factors (PRGF) in Stage 1 Neurotrophic Keratitis. RESEARCH SQUARE 2023:rs.3.rs-3040369. [PMID: 37461454 PMCID: PMC10350222 DOI: 10.21203/rs.3.rs-3040369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Background/Aims Neurotrophic keratitis (NK) is a neurodegenerative disease that can lead to corneal hypoesthesia, decreased tear production, and epitheliopathy. Based on the severity of ocular surface damage, NK is classified into 3 stages. Stage 1 NK is characterized by superficial punctate keratopathy, tear film instability, and reduced corneal sensation. The therapeutic efficacy of PRGF eye drops for NK stages 2 and 3 has been previously reported. In this study, we evaluated the efficacy and safety of autologous PRGF eye drops in improving corneal sensitivity and other ocular surface clinical signs in patients with stage 1 NK. Methods Retrospective chart review. Results 26 eyes of 15 stage 1 NK patients (seven males, eight females), aged 76.3 ± 12.1 years, were included in the study. The mean treatment duration was 2 ± 1.8 months. With PRGF treatment, corneal sensitivity increased from 2.8 to 4.5 cm in 53.8% (14/26) (p < 0.01), TBUT increased from 3.6 to 5.0 s in 69.2% (18/26) (p < 0.01), and Schirmer score increased from 13.7 to 16.8 mm in 80.7% (21/26) of treated eyes (p < 0.01). Similarly, an improvement in corneal staining (punctate epithelial erosions) and MMP-9 levels was seen in 80.7% (n = 21) and 65.4% (n = 17) of treated eyes, respectively. BCVA improvement was seen in 26.9% of treated eyes (n = 7). Conclusions This study demonstrates the effective role of PRGF therapy in recovering corneal sensation and tear film function and in the healing of corneal erosions in stage 1 NK patients.
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Affiliation(s)
| | - Kwaku Osei
- University of Miami Miller School of Medicine
| | - Guillermo Amescua
- Bascom Palmer Eye institute, University of Miami, Miller School of Medicine
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Lozano-Sanroma J, Barros A, Alcalde I, Sánchez-Ávila RM, Queiruga-Piñeiro J, Fernández-Vega Cueto L, Merayo-Lloves J. Impact of Plasma Rich in Growth Factors (PRGF) Eye Drops on Ocular Redness and Symptomatology in Patients with Dry Eye Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050928. [PMID: 37241160 DOI: 10.3390/medicina59050928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Dry eye disease (DED) is a common and very symptomatic pathology that affects normal daily activity. The aim of the study was to evaluate the efficacy of plasma rich in growth factors (PRGF) added to one routine treatment protocol for DED (artificial tears substitutes, lid hygiene, and anti-inflammatory therapy). Materials and Methods: Patients were divided into two groups of treatment: standard treatment group (n = 43 eyes) and PRGF group (n = 59). Patients' symptomatology (inferred from OSDI and SANDE questionnaires), ocular inflammation, tear stability, and ocular surface damage were analyzed at baseline and after 3 months of treatment. Results: OSDI test scores were significantly lower in both groups (p < 0.001). SANDE frequency test scores also improved statistically, with differences between groups (p = 0.0089 SANDE frequency and p < 0.0119 SANDE severity). There was a greater reduction in ocular redness (ocular inflammation) in the PRGF group (p < 0.0001) and fluorescein tear break-up time was significantly improved in the PRGF group (p = 0.0006). No significant changes were found in terms of ocular surface damage. No adverse events were obtained in either group. Conclusions: The addition of PRGF to the standard treatment of DED, according to the results obtained, proved to be safe and produced an improvement in ocular symptomatology and signs of inflammation, particularly in moderate and severe cases, when compared to standard treatment.
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Affiliation(s)
| | - Alberto Barros
- Instituto Oftalmológico Fernández-Vega, 33012 Oviedo, Spain
| | - Ignacio Alcalde
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | | | | | - Luis Fernández-Vega Cueto
- Instituto Oftalmológico Fernández-Vega, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Jesús Merayo-Lloves
- Instituto Oftalmológico Fernández-Vega, 33012 Oviedo, Spain
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, Universidad de Oviedo, 33006 Oviedo, Spain
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Gutierrez-Ontalvilla P, Giner F, Vidal L, Iborra M. The Effect of Lipofilling and Platelet-Rich Plasma on Patients with Moderate-Severe Vulvar Lichen Sclerosus who were Non-Responders to Topical Clobetasol Propionate: A Randomized Pilot Study. Aesthetic Plast Surg 2022; 46:2469-2479. [PMID: 35048150 DOI: 10.1007/s00266-021-02718-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The first-line treatment for vulvar lichen sclerosus (VLS) is 3 months of topical corticosteroid therapy. However, limited evidence is available concerning the use of fat grafting and platelet-rich plasma as a second-line treatment for patients who do not respond to first-line treatment. METHODS This prospective single-center randomized pilot trial included 20 patients with a clinical and histological diagnosis of moderate to severe VLS. The patients in the treatment group (TG) received two infiltrations (at 3-month intervals) of nanofat mixed with platelet-rich plasma (PRP) into the vulvar area, while the control group (CG) received standard topical corticosteroid therapy. Fat was aspirated from the medial thigh or lower abdomen regions. Microfat was obtained after centrifugation and was emulsified to obtain a nanofat suspension. Treatment efficacy was determined by measuring changes in the vulvar skin elasticity, histopathology, and clinical signs, symptoms, and patient quality of life at after 1 year. RESULTS A total of 19 patients were finally assessed (9 TG and 10 CG). At the end of the study (1 year), there had been no significant improvement in vulvar skin elasticity. However, patients in the TG showed a significant improvement in their symptoms (itching, pain, burning, and dyspareunia) and clinical signs (cervical erosions, fissures, stenosis, and leukoderma). Analysis of skin biopsies revealed a significant decrease in all inflammatory cell types in the TG. No adverse events related to the autologous treatment were recorded. CONCLUSIONS Compared with topical corticosteroids, two infiltrations delivered 3 months apart decreased the inflammation of the vulva and improved most of the clinical signs and symptoms associated with VLS. Nonetheless, no improvement in vulvar skin elasticity was derived from the autologous treatment. LEVEL OF EVIDENCE I 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)
- P Gutierrez-Ontalvilla
- Department of Plastic and Reconstructive Surgery, Hospital University La Fe, Avda Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - F Giner
- Department of Histology, Hospital University La Fe, Valencia, Spain
| | - L Vidal
- Fidia Farmacéutica S.L.U, Barcelona, Spain
| | - M Iborra
- Department of Digestive Medicine, Unit of inflammatory bowel disease, Hospital University La Fe, Valencia, Spain
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García-Millan C, Pino A, Rodrigues R, Segurado-Miravalles G, Alegre-Sánchez A, Jaén P, Anitua E. An Autologous Topical Serum Derived from Platelet-Rich Plasma Therapy for the Management of Sensitive Skin Alterations: A Case Series Report. Clin Cosmet Investig Dermatol 2022; 15:2077-2086. [PMID: 36199385 PMCID: PMC9528915 DOI: 10.2147/ccid.s379323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022]
Abstract
Background Although the underlying pathophysiology of sensitive skin remains unknown, it presents clinical symptoms like erythema, burning and dryness associated with other inflammatory dermatoses such as dermatitis or rosacea. Objective The aim of the present report was to provide preliminary data about the efficacy of Endoret-Serum (ES) as an autologous therapy for the topical management of sensitive skin alterations. Materials and Methods Five patients underwent a daily topical ES treatment that was maintained for three months. Clinical assessment was carried out using validated dermatological surveys (DLQI, IGA, Likert, PGI-I). Additionally, skin hydration measurement and high-resolution topographic and reflectance confocal imaging analysis were carried out. Results No adverse events were observed during the treatment. At the end of the follow-up period, surveys highlighted a significant therapeutic effect compared to baseline. Skin hydration was also improved, and topographic images showed a decrease in patient’s underlying inflammatory and vascular condition. Conclusion This preliminary report suggests that Endoret-Serum may be useful in the management of clinical symptoms derived from sensitive skin alterations.
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Affiliation(s)
| | - Ander Pino
- BTI Biotechnology Institute, Vitoria, Spain
| | | | | | | | - Pedro Jaén
- Grupo de Dermatología Pedro Jaén, Madrid, Spain
- University Hospital Ramon y Cajal, Madrid, Spain
| | - Eduardo Anitua
- BTI Biotechnology Institute, Vitoria, Spain
- Correspondence: Eduardo Anitua, BTI Biotechnology Institute, Jacinto Quincoces 39, Vitoria, Spain, Email
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Wang M, Yennam S, Pflugfelder S. Initial experiences using plasma rich in growth factors to treat keratoneuralgia. Front Med (Lausanne) 2022; 9:946828. [PMID: 36091697 PMCID: PMC9448984 DOI: 10.3389/fmed.2022.946828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Keratoneuralgia, a clinical diagnosis of sensitized corneal pain without visible ocular surface damage, generally has minimal response to conventional therapies. Causes include refractive surgery and chronic dry eye. We evaluated the efficacy of Plasma Rich in Growth Factors (PRGF), a novel treatment prepared using a commercially available kit, in patients with keratoneuralgia. A retrospective chart review identified patients who had the clinical diagnosis of keratoneuralgia and were treated with PRGF for at least 3 months from October 2015 to April 2020 at a single academic institution. Both objective eye exam findings and concurrent treatments were obtained at baseline, 3 months, and final visit (if available). A questionnaire was administered to identified patients, including symptoms scores measured with a visual analog scale. The results of this survey and other objective findings were compared before and after PRGF treatment. 16 out of 32 patients (50%) with a mean follow-up period of 33 ± 26 months answered the questionnaire. Refractive surgeries were the cause of keratoneuralgia in 14 patients (87.5%), with LASIK the most common procedure (11 patients, 69%). There were no adverse events recorded or reported. Symptom scored by VAS in a modified Symptoms Assessment in Dry Eye questionnaire significantly decreased after PRGF use (85 ± 16 to 45 ± 33, p = 0.0002). Ten patients (63%) reported PRGF is superior to other therapy and would recommend to others. There were no significant trends in visual acuity, objective exam findings, or concurrent treatments after PRGF treatment. PRGF is safe and can potentially alleviate symptoms in patients with keratoneuralgia, a rare but devastating complication after refractive surgery. Prospective trial is indicated to explore PRGF as a potentially useful treatment for keratoneuralgia.
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7
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Soifer M, Tovar A, Wang M, Mousa HM, Yennam S, Sabater AL, Pflugfelder S, Perez VL. A multicenter report of the use of plasma rich in growth factors (PRGF) for the treatment of patients with ocular surface diseases in North America. Ocul Surf 2022; 25:40-48. [PMID: 35489588 DOI: 10.1016/j.jtos.2022.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the efficacy and safety of plasma rich in growth factors (PRGF) eyedrops in the management of patients with ocular surface diseases in North America. METHODS Multicenter interventional case series of patients using PRGF eyedrops for the first time. A cohort of patients was analyzed for corneal staining score at initial visit and at 3 months of therapy with PRGF. Another cohort responded to a 10-item questionnaire that evaluated patients' satisfaction and safety, which included the symptom assessment questionnaire in dry eye (SANDE) score, after 6 months of PRGF treatment. RESULTS A total of 153 patients were analyzed. Of these, 102 were reviewed for corneal epitheliopathy and 99 patients responded to the questionnaire. The mean (±SD) age of the population was 63.7 ± 17 years and 72.5% were female. The clinical indications for PRGF usage were dry eye (60%), neurotrophic keratopathy (15%), dormant corneal ulcers (12%), limbal stem cell deficiency (10%), and cicatrizing conjunctivitis (4%). At the final visit, 74.3% of patients showed an improvement of their corneal staining. Those who had punctate epithelial erosions or epithelial defects were reduced from 76.5% to 47% and 23.5%-7.8% respectively (p < 0.0001). Symptoms, measured via SANDE score, significantly decreased from a median of 90 to 34.6 out of 100 points on follow-up (p < 0.0001). Only one patient (0.98%) complained of ocular burning sensation as a side effect. CONCLUSIONS This multicentric study demonstrates the safety and efficacy of the use of PRGF for treating signs and symptoms in patients with significant ocular surface diseases.
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Affiliation(s)
- Matias Soifer
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Arianna Tovar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret Wang
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sowmya Yennam
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Alfonso L Sabater
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Victor L Perez
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, USA.
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Nunes-Tamashiro JC, Natour J, Ramuth FM, Toffolo SR, Mendes JG, Rosenfeld A, Furtado RNV. Intra-articular injection with platelet-rich plasma compared to triamcinolone hexacetonide or saline solution in knee osteoarthritis: A double blinded randomized controlled trial with one year follow-up. Clin Rehabil 2022; 36:900-915. [PMID: 35379019 DOI: 10.1177/02692155221090407] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To compare the effectiveness of intra-articular injection (IAI) of Platelet-Rich Plasma (PRP) with Triamcinolone Hexacetonide (TH) and Saline Solution (SS), in patients with knee osteoarthritis (OA). DESIGN A randomized controlled trial, with blinded patients and assessor. SETTING Outpatient rheumatology service. SUBJECTS Patients with knee osteoarthritis grades II and III. INTERVENTIONS Patients received IAI with PRP, 40 mg TH, or SS. METHODS Patients were assessed at baseline and after 4, 8, 12 e 52 weeks with: visual analogue scale (VAS) for pain at rest and movement, WOMAC questionnaire, Timed to Up and Go test, 6-min walk test, percentage of improvement, goniometry, quality of life SF-36 questionnaire, Likert scale and Kelgreen & Lawrence (KL) radiographic scale (only at baseline and 52 weeks). RESULTS 100 patients were studied, with a mean age of 67.13(6.56) years. The TH group was superior for: percentage of improvement (versus SS group from 4 to 52 weeks); WOMAC total and pain (versus PRP group at 4 weeks); and WOMAC stiffness (versus SS group at 12 weeks). The SS group was inferior for WOMAC function (from 8 to 52 weeks). The PRP group showed lowest radiographic progression [TH 17 (51.51%) to 24 (72.72%); SS 17 (51.51%) to 30 (90.90%); PRP 20 (58.82%) to 21 (61.76%)]. CONCLUSION The Triamcinolone Hexacetonide group was superior for percentage of improvement and WOMAC, pain and stiffness. For the WOMAC function, the Platelet-Rich Plasma group and Triamcinolone Hexacetonide group were superior to the Saline group. The Platelet-Rich Plasma group showed the lowest radiographic progression at 52 weeks of follow-up.
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Affiliation(s)
- José Carlos Nunes-Tamashiro
- Academic of Rheumatology Division, 58804from Universidade Federal de São Paulo- Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
| | - Jamil Natour
- Professor of Rheumatology Division and Head of Ambulatory of Rheumatology Interventions, 28105from Universidade Federal de São Paul o- Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
| | - Fernando Maier Ramuth
- Academic of Rheumatology Division, 58804from Universidade Federal de São Paulo- Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
| | - Sandra Regina Toffolo
- Academic of Rheumatology Division, 58804from Universidade Federal de São Paulo- Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
| | - Jamile Godoy Mendes
- Academic of Rheumatology Division, 58804from Universidade Federal de São Paulo- Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
| | - André Rosenfeld
- Department of Diagnostic Imaging, 28105from Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
| | - Rita Nely Vilar Furtado
- 28105Rheumatologist and Physiatrist Affiliated Professor from Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp - EPM), Sao Paulo, Brazil
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Anitua E, Muñoz V, Aspe L, Tierno R, García-Salvador A, Goñi-de-Cerio F, Pino A. In vitro and in vivo Effect of Platelet-Rich Plasma-Based Autologous Topical Serum on Cutaneous Wound Healing. Skin Pharmacol Physiol 2021; 35:51-64. [PMID: 34247175 DOI: 10.1159/000517195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Skin injury and wound healing is an inevitable event during lifetime. However, several complications may hamper the regeneration of the cutaneous tissue and lead to a chronic profile that prolongs patient recovery. Platelet-rich plasma is rising as an effective and safe alternative to the management of wounds. However, this technology presents some limitations such as the need for repeated blood extractions and health-care interventions. OBJECTIVE The aim of this study was to assess the use of an endogenous and storable topical serum (ES) derived from plasma rich in growth factors promoting wound healing, and to obtain preliminary data regarding its clinical and experimental effect over ulcerated skin models and patient care. METHODS Human dermal fibroblast and 3D organotypic ulcerated skin models were used to assess ES over the main mechanisms of wound healing including cell migration, edge contraction, collagen synthesis, tissue damage, extracellular matrix remodeling, cell death, metabolic activity, and histomorphometry analysis. Additionally, 4 patients suffering from skin wounds were treated and clinically assessed. RESULTS ES promoted dermal fibroblast migration, wound edge contraction, and collagen synthesis. When topically applied, ES increased collagen and elastin deposition and reduced tissue damage. The interstitial edema, structural integrity, and cell activity were also maintained, and apoptotic levels were reduced. Patients suffering from hard-to-heal wounds of different etiologies were treated with ES, and the ulcers healed completely within few weeks with no reported adverse events. CONCLUSION This preliminary study suggests that ES might promote cutaneous wound healing and may be useful for accelerating the re-epithelization of skin ulcers.
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Affiliation(s)
- Eduardo Anitua
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain.,BTI Biotechnology Institute, Vitoria, Spain
| | | | - Libe Aspe
- University Hospital of Araba (HUA), Vitoria, Spain
| | - Roberto Tierno
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain.,BTI Biotechnology Institute, Vitoria, Spain
| | - Adrian García-Salvador
- GAIKER Technology Centre, Basque Research and Technology Alliance (BRTA), Zamudio, Spain
| | - Felipe Goñi-de-Cerio
- GAIKER Technology Centre, Basque Research and Technology Alliance (BRTA), Zamudio, Spain
| | - Ander Pino
- University Institute for Regenerative Medicine and Oral Implantology (UIRMI), Vitoria, Spain, .,BTI Biotechnology Institute, Vitoria, Spain,
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10
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Orive G, Anitua E. Platelet-rich therapies as an emerging platform for regenerative medicine. Expert Opin Biol Ther 2021; 21:1603-1608. [PMID: 34043484 DOI: 10.1080/14712598.2021.1936495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The combination of human plasma components with the multiple secretome from platelets has provided a new biological tool that is shaping a new future for its direct application in tissue regeneration as well as in cell culture and advanced therapy by means of its use as a clinical-grade supplement. AREAS COVERED Some relevant aspects related to the biology, growth factor delivery and molecular pathways driving the biological effects of platelet-rich therapies are summarized. Their use as clinical-grade cell supplements and advanced therapies is also carefully described. EXPERT OPINION Platelet-rich plasma therapies, and especially PRGF, contain an incredible number of biologically active agents that may exert regenerative and therapeutic potential. Here, we highlight the latest advances in this biological approach for the delivery of autologous growth factors with some of the recent new applications including the development of a clinical-grade supplement for advanced therapy.
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Affiliation(s)
- Gorka Orive
- BTI Biotechnology Institute, Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology - UIRMI (Upv/ehu-fundación Eduardo Anitua), Vitoria, Spain.,Department of Pharmacy, NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Paseo De La Universidad 7, Vitoria-Gasteiz, Spain
| | - Eduardo Anitua
- BTI Biotechnology Institute, Vitoria, Spain.,University Institute for Regenerative Medicine and Oral Implantology - UIRMI (Upv/ehu-fundación Eduardo Anitua), Vitoria, Spain
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11
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Anitua E, Pino A, Aspe L, Martínez M, García A, Goñi F, Troya M. Anti-inflammatory effect of different PRGF formulations on cutaneous surface. J Tissue Viability 2021; 30:183-189. [PMID: 33712331 DOI: 10.1016/j.jtv.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 12/20/2022]
Abstract
Cutaneous autoimmune and inflammatory diseases are a major burden of global disease and many lack effective treatments that can derive in different dermatoses like atopic dermatitis. Despite the increase prevalence and the high health-care costs worldwide, the heterogeniety and multifactoriality of these diseases mean that effective treatment options are scarce. Plasma rich in growth factors (PRGF) technology could be an alternative approach that may help in the management of this cutaneous condition. The aim of this study was to assess the effect of two different PRGF formulations (just activated and autologous topical serum (ATS)) for the management of skin inflammation. Additionally, ATS was assessed over two patients suffering from radiotherapy induced dermatitis. Human organotypic skin explant cultures (hOSECs) were used as human skin models. To induce atopic dermatitis-like conditions, skin explants were treated with both interleukin-4 (IL-4) and interleukin-13 (IL-13). PRGF and ATS were intradermally and topically applied, respectively. Metabolic activity, reactive oxigen species (ROS), necrosis and inflammatory cytokine production were determined. Both PRGF formulations increased tissue viability and significantly reduced the excessive free radical accumulation and the cutaneous cytokine production such as TNF-α and IL-1β. Case reports showed a positive response after ATS treatment in terms of skin quality improvement, local erythema decrease and burning and itching amelioration. The oedema, swelling and desquamation caused by radiation induced dermatitis was also reduced and the patients referred ceased pruritus and pain. This preliminary study suggests that PRGF might aid in the management of inflammatory skin conditions.
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Affiliation(s)
- Eduardo Anitua
- BTI-Biotechnology Institute, Vitoria, Spain; University Institute for Regenerative Medicine & Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain.
| | - Ander Pino
- BTI-Biotechnology Institute, Vitoria, Spain; University Institute for Regenerative Medicine & Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - Libe Aspe
- University Hospital of Araba (HUA), Vitoria, Spain
| | | | - Adrian García
- GAIKER Technology Centre, Basque Research and Technology Alliance (BRTA), Zamudio, Spain
| | - Felipe Goñi
- GAIKER Technology Centre, Basque Research and Technology Alliance (BRTA), Zamudio, Spain
| | - María Troya
- BTI-Biotechnology Institute, Vitoria, Spain; University Institute for Regenerative Medicine & Oral Implantology, UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
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The Management of Postsurgical Wound Complications with Plasma Rich in Growth Factors: A Preliminary Series. Adv Skin Wound Care 2021; 33:202-208. [PMID: 31789622 DOI: 10.1097/01.asw.0000604168.62330.c7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postsurgical wound complications constitute a relevant public health issue because of their frequency. There is growing evidence regarding platelet-based autologous therapies that support their use in promoting cutaneous regeneration. OBJECTIVE To provide preliminary data regarding the potential benefit of plasma rich in growth factors (PRGF) in the management of postsurgical wound complications. DESIGN Three patients suffering from poorly healing severe full-thickness wounds were treated with either one or a combination of different formulations derived from their own blood: autologous clot, fibrin membrane, injectable plasma, or topical ointment. Different treatment protocols are described, and follow-up results are reported. RESULTS Within 4 to 12 months, the treated wounds healed completely with no signs of infection, tissue necrosis, or functional impairment. No adverse events were reported. CONCLUSION Additional clinical trials with long-term follow-up periods and larger patient populations are needed to establish the efficacy of PRGF technology. However, these preliminary findings suggest that PRGF merits further randomized controlled studies exploring its capacity to accelerate re-epithelialization and restore functional integrity to cutaneous ulcers resulting from surgical complications.
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Sánchez M, Beitia M, Pompei O, Jorquera C, Sánchez P, Knörr J, Soldado F, López L, Oraa J, Miren Bilbao A, Fiz N, Guadilla J, Aizpurua B, Azofra J, Delgado D. Isolation, Activation, and Mechanism of Action of Platelet-Rich Plasma and Its Applications for Joint Repair. Regen Med 2020. [DOI: 10.5772/intechopen.90543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Elksniņš-Finogejevs A, Vidal L, Peredistijs A. Intra-articular platelet-rich plasma vs corticosteroids in the treatment of moderate knee osteoarthritis: a single-center prospective randomized controlled study with a 1-year follow up. J Orthop Surg Res 2020; 15:257. [PMID: 32650801 PMCID: PMC7353717 DOI: 10.1186/s13018-020-01753-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient's mobility and quality of life. Pharmacological treatments for osteoarthritis, such as corticosteroids, produce an immediate reduction of the patient's pain as well as an improvement in the patient's mobility and quality of life, but with a limited long-term efficacy. In this context, platelet-rich plasma (PRP) infiltrations represent a therapeutic tool due to its trophic properties and its ability to control inflammatory processes, especially in musculoskeletal applications. The aim of this study is to evaluate and compare the clinical benefits of PRP when injected intra-articularly vs a commonly used corticosteroid (CS, triamcinolone acetonide, Kenalog®) in patients affected by mild to moderate symptomatic knee osteoarthritis. METHODS Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren-Lawrence grades II-III) were enrolled in this randomized study. Patients randomized in the PRP group (n = 20) received an intra-articular injection of PRP (8 mL) while patients randomized in the CS group (n = 20) received an intra-articular injection of triamcinolone acetonide (1 mL of 40 mg/mL) plus lidocaine (5 mL of 2%). The pain and function of the target knee were evaluated by the VAS, IKDC, and KSS scales at the baseline (V1), 1 week (V2), 5 weeks (V3), 15 weeks (V4), 30 weeks (V5), and 1 year (V6) after treatment. RESULTS No serious adverse effects were observed during the follow-up period. A mild synovitis was registered in 15 patients (75%) in the PRP group within the first week after treatment which resolved spontaneously. Both treatments were effective in relieving pain and improving the knee function in the very short-term follow-up visit (1 week). A high improvement of the subjective scores was observed for both groups up to 5 weeks, with no significative differences between the groups for the VAS, IKDC, or KSS. After 15 weeks of follow-up, the PRP group showed significative improvements in all scores when compared to the CS group. Overall, the patients who received PRP treatment had better outcomes in a longer follow-up visit (up to 1 year) than those who received CS. CONCLUSIONS A single PRP or CS intra-articular injection is safe and improves the short-term scores of pain and the knee function in patients affected by mild to moderate symptomatic knee OA (with no significant differences between the groups). PRP demonstrated a statistically significant improvement over CS in a 1-year follow-up. This study was registered at ISRCTN with the ID ISRCTN46024618.
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Affiliation(s)
- Andrejs Elksniņš-Finogejevs
- Faculty of Continuing Education, Rīga Stradiņš University, Riga, Latvia. .,"ORTO klinika" Ltd., Riga, Latvia.
| | - Luis Vidal
- Laboratorios Fidia Farmacéutica S.L.U, Madrid, Spain
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Raeissadat SA, Gharooee Ahangar A, Rayegani SM, Minator Sajjadi M, Ebrahimpour A, Yavari P. Platelet-Rich Plasma-Derived Growth Factor vs Hyaluronic Acid Injection in the Individuals with Knee Osteoarthritis: A One Year Randomized Clinical Trial. J Pain Res 2020; 13:1699-1711. [PMID: 32753945 PMCID: PMC7354951 DOI: 10.2147/jpr.s210715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/27/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In this study, we aimed at performing a comparison between intra-articular injections of PRP-derived growth factor (PGRF) and hyaluronic acid regarding their effect on pain and patient's function in knee osteoarthritis, as well as their safety profiles. METHODS During our single-masked randomized clinical trial, the candidates with symptomatic knee osteoarthritis received two intra-articular injections of PRGF with 3 weeks apart or received three weekly injections of HA. The mean improvements from before treatment until the second, sixth, and twelfth months post-intervention in scores obtained by visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index were our primary outcomes. RESULTS A total of 102 candidates were finally included in the study. Patients' mean age was 57.08±7.3 years old in the PRGF group compared to the mean age of 58.63±7.09 years old in HA patients. In the PRGF group, total WOMAC index decreased from 41.96±11.71 to 27.10±12.3 (P = 0.02), and from 39.71±10.4 to 32.41±11.8 in the HA group after 12 months (P > 0.05). Regarding the Lequesne index, pain, ADL, and global scores significantly decreased after 12 months in the PRGF group compared to the HA group (P<0.001). There was also a meaningful higher rate of satisfaction in the PRGF group compared to the HA group after 12 months of treatment (P<0.001). CONCLUSION Besides significantly higher satisfaction belonging to the PRGF group, there was a statistically significant improvement in VAS score and global, pain, and ADL score of Lequesne by passing 12 months from injection in PRGF compared to HA.
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Affiliation(s)
- Seyed Ahmad Raeissadat
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Mansoor Rayegani
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Adel Ebrahimpour
- Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pegah Yavari
- Physical Medicine and Rehabilitation Research Center, Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Intraosseous infiltrations of Platelet-Rich Plasma for severe hip osteoarthritis: A pilot study. J Clin Orthop Trauma 2020; 11:S585-S590. [PMID: 32774033 PMCID: PMC7394798 DOI: 10.1016/j.jcot.2019.12.012] [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] [Received: 07/08/2019] [Revised: 10/21/2019] [Accepted: 12/27/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Addressing the subchondral bone through intraosseous infiltrations of Platelet-Rich Plasma (PRP) may improve the effectiveness of this technique for severe hip osteoarthritis (HOA). METHODS Forty patients with HOA degree 2 and 3 according to the Tönnis scale were recruited for this study. They were susceptible to a total hip arthroplasty, without response to previous treatment based on intraarticular infiltrations of PRP. Patients received a combination of intraosseous injections into the acetabulum and the femoral head, as well as intraarticular PRP infiltrations. The clinical outcome was evaluated at 2, 6 and 12 months using the Hip Osteoarthritis Outcome Score (HOOS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index. RESULTS At 2, 6 and 12 months, patients had significant pain improvement according to HOOS pain, WOMAC pain, and VAS scores. After the treatment, the percentage of patients with minimal clinically important improvement was 40% (16 over 40 patients) at 2 months, 37.5% (15 over 40) at 6 months, and 40% (16 over 40) at 12 months. Conclusion: The combination of intra-articular and intra-osseous infiltrations of PRP showed a pain reduction and improvement in hip joint functionality up to 12 months in patients with severe HOA, with no severe adverse effects.
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Boffa A, Previtali D, Altamura SA, Zaffagnini S, Candrian C, Filardo G. Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis. Orthop J Sports Med 2020; 8:2325967120910504. [PMID: 32341925 PMCID: PMC7175068 DOI: 10.1177/2325967120910504] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/01/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Microfracture is the most common first-line option for the treatment of small chondral lesions, although increasing evidence shows that the clinical benefit of microfracture decreases over time. Platelet-rich plasma (PRP) has been suggested as an effective biological augmentation to improve clinical outcomes after microfracture. Purpose: To evaluate the clinical evidence regarding the application of PRP, documenting safety and efficacy of this augmentation technique to improve microfracture for the treatment of cartilage lesions. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed in PubMed, EBSCOhost database, and the Cochrane Library to identify comparative studies evaluating the clinical efficacy of PRP augmentation to microfracture. A meta-analysis was performed on articles that reported results for visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Risk of bias was documented through use of the Cochrane Collaboration Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions assessment tools. The quality assessment was performed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: A total of 7 studies met the inclusion criteria and were included in the meta-analysis: 4 randomized controlled trials, 2 prospective comparative studies, and 1 retrospective comparative study, for a total of 234 patients. Of the 7 studies included, 4 studies evaluated the effects of PRP treatment in the knee, and 3 studies evaluated effects in the ankle. The analysis of all scores showed a difference favoring PRP treatment in knees (VAS, P = .002 and P < .001 at 12 and 24 months, respectively; IKDC, P < .001 at both follow-up points) and ankles (both VAS and AOFAS, P < .001 at 12 months). The improvement offered by PRP did not reach the minimal clinically important difference (MCID). Conclusion: PRP provided an improvement to microfracture in knees and ankles at short-term follow-up. However, this improvement did not reach the MCID, and thus it was not clinically perceivable by the patients. Moreover, the overall low evidence and the paucity of high-level studies indicate further research is needed to confirm the potential of PRP augmentation to microfracture for the treatment of cartilage lesions.
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Affiliation(s)
- Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Previtali
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | | | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Stefano Zaffagnini, MD, Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy ()
| | - Christian Candrian
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Mautner K, Bowers R, Easley K, Fausel Z, Robinson R. Functional Outcomes Following Microfragmented Adipose Tissue Versus Bone Marrow Aspirate Concentrate Injections for Symptomatic Knee Osteoarthritis. Stem Cells Transl Med 2019; 8:1149-1156. [PMID: 31328447 PMCID: PMC6811695 DOI: 10.1002/sctm.18-0285] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/17/2019] [Indexed: 01/05/2023] Open
Abstract
This study aimed to determine whether autologous orthobiologic tissue source affects pain and functional outcomes in patients with symptomatic knee osteoarthritis (OA) who received microfragmented adipose tissue (MFAT) or bone marrow aspirate concentrate (BMAC) injection. We retrospectively reviewed prospectively collected data from patients who received BMAC or MFAT injection for symptomatic knee OA. Patients completed baseline and follow-up surveys. Each survey included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, Emory Quality of Life (EQOL) questionnaire, and Visual Analog Scale (VAS) for pain. The follow-up responses were compared with baseline for all patients and between BMAC and MFAT groups. A total of 110 patients met inclusion criteria, with 76 patients (BMAC 41, MFAT 35) and 106 knees (BMAC 58, MFAT 48) having appropriate follow-up data. The BMAC group included 17 females and 24 males, with a mean age of 59 ± 11 years. The MFAT group included 23 females and 12 males, with a mean age of 63 ± 11 years. Minimum follow-up time was 0.5 years. Mean follow-up time was 1.80 ± 0.88 years for BMAC and 1.09 ± 0.49 years for MFAT. Both groups had significant improvement in EQOL, VAS, and all KOOS parameters preprocedure versus postprocedure (p < .001). There was not a significant difference when comparing postprocedure scores between groups (p = .09, .38, .63, .94, .17, .15, .70, respectively). These data demonstrate significant improvement in pain and function with both MFAT and BMAC injections in patients with symptomatic knee OA without a significant difference in improvement when comparing the two autologous tissue sources. Stem Cells Translational Medicine 2019;8:1149-1156.
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Affiliation(s)
- Kenneth Mautner
- Department of Orthopaedics, Emory University, Atlanta, Georgia, USA.,Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Robert Bowers
- Department of Orthopaedics, Emory University, Atlanta, Georgia, USA.,Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University, Atlanta, Georgia, USA
| | - Zachary Fausel
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Ryan Robinson
- Department of Orthopaedics, Emory University, Atlanta, Georgia, USA
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Barman A, Mukherjee S, Sahoo J, Maiti R, Rao PB, Sinha MK, Sahoo D, Tripathy SK, Patro BK, Bag ND. Single Intra-articular Platelet-Rich Plasma Versus Corticosteroid Injections in the Treatment of Adhesive Capsulitis of the Shoulder: A Cohort Study. Am J Phys Med Rehabil 2019; 98:549-557. [PMID: 30676339 DOI: 10.1097/phm.0000000000001144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients with adhesive capsulitis of the shoulder. DESIGN Patients aged 18-70 yrs of either sex, diagnosed with adhesive capsulitis of shoulder, with less than 6-mo duration, were included. In intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection (4 ml) of IA-CS and in IA-PRP (test) group, 30 patients received single IA-PRP injection (4 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 12 wks. RESULTS Twenty-eight patients in IA-PRP group and 27 in IA-CS group finished the entire 12-wk study period. At 12 wks, decrements in visual analog scale and total shoulder pain and disability index scores, in IA-PRP group, were 58.4 and 55.1, compared with 48.7 and 45.8 in IA-CS group. In range of movement, IA-PRP group showed significant improvement in passive abduction (-50.4 vs. -39.4), internal (-36.8 vs. -25.8), and external rotations (-35.4 vs. -25.9) compared with IA-CS group, respectively. No major complications were observed in any patients. CONCLUSIONS At 12-wk follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection, in terms of improving pain, disability, and shoulder range of movement in patients with adhesive capsulitis of the shoulder.
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Affiliation(s)
- Apurba Barman
- From the Departments of Physical Medicine and Rehabilitation (AB, JS), Transfusion Medicine (SM, DS), Pharmacology (RM), Anesthesia and Intensive Care (PBR), General Surgery (MKS), Orthopaedics (SKT), Community and Family Medicine (BKP), and Radiodiagnosis (NDB), All India Institute of Medical Sciences, Bhubaneswar, India
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Whittle SL, Johnston RV, McDonald S, Paterson KL, Buchbinder R. Autologous blood product injections including platelet-rich plasma for osteoarthritis of the knee. Hippokratia 2019. [DOI: 10.1002/14651858.cd013341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Samuel L Whittle
- Queen Elizabeth Hospital; Rheumatology Unit; 28 Woodville Road Woodville South South Australia Australia 5011
| | - Renea V Johnston
- Cabrini Institute; Monash Department of Clinical Epidemiology; Malvern Australia
| | - Steve McDonald
- School of Public Health & Preventive Medicine; Cochrane Australia; Monash University 553 St Kilda Road Melbourne Victoria Australia 3004
| | - Kade L Paterson
- The University of Melbourne; Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy; Melbourne Australia 3010
| | - Rachelle Buchbinder
- Cabrini Institute; Monash Department of Clinical Epidemiology; Malvern Australia
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Sánchez M, Delgado D, Pompei O, Pérez JC, Sánchez P, Garate A, Bilbao AM, Fiz N, Padilla S. Treating Severe Knee Osteoarthritis with Combination of Intra-Osseous and Intra-Articular Infiltrations of Platelet-Rich Plasma: An Observational Study. Cartilage 2019; 10:245-253. [PMID: 29448817 PMCID: PMC6425546 DOI: 10.1177/1947603518756462] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Assessing the therapeutic effects of a combination of intra-articular and intra-osseous infiltrations of platelet-rich plasma (PRP) to treat severe knee osteoarthritis (KOA) using intra-articular injections of PRP as the control group. DESIGN In this observational study, 60 patients suffering from severe KOA were treated with intra-articular infiltrations of PRP (IA group) or with a combination of intra-osseous and intra-articular infiltrations of PRP (IO group). Both groups were matched for sex, age, body mass index, and radiographic severity (III and IV degree according to Ahlbäck scale). Clinical outcome was evaluated at 2, 6, and 12 months, using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires. RESULTS At 2, 6 and 12 months after treatment, IO group had a significant improvement in all KOOS and WOMAC subscales ( P < 0.05). On the contrary, patients of the IA group did not improve in any of the scores. Sixteen out of 30 IO group patients showed minimal clinically important improvement (MCII) whereas 8 out of 30 IA group patients showed this response at 6 months (26.7%; 95% CI -0.4 to 49.9; P = 0.037). At 12 months, 14 patients of IO group and 5 patients of the IA group showed MCII (30%; 95% CI 4.3 to 51.9; P = 0.013). No differences between groups were observed at 2 months. CONCLUSIONS PRP intra-articular injections in severe KOA were not effective and did not provide any benefit. Combination of intra-articular and intra-osseous infiltrations of PRP was not clinically superior at 2 months, but it showed superior clinical outcomes at 6 and 12 months when compared with intra-articular injections of PRP.
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Affiliation(s)
- Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
- Advanced Biological Therapy Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
- Mikel Sánchez, Arthroscopic Surgery Unit Research, Hospital Vithas San Jose, C/Beato Tomás de Zumárraga 10, Vitoria-Gasteiz, 01008, Spain.
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Orlando Pompei
- Arthroscopic Surgery Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Juan Carlos Pérez
- Arthroscopic Surgery Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Pello Sánchez
- Advanced Biological Therapy Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Ane Garate
- Advanced Biological Therapy Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Ane Miren Bilbao
- Arthroscopic Surgery Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Nicolás Fiz
- Arthroscopic Surgery Unit, Hospital Vithas San José, Vitoria-Gasteiz, Spain
| | - Sabino Padilla
- University Institute for Regenerative Medicine & Oral Implantology – UIRMI (UPV/EHU-Fundacion Eduardo Anitua), C/Jacinto Quincoces, Vitoria–Gasteiz, Álava, Spain
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Tóth KF, Ádám D, Bíró T, Oláh A. Cannabinoid Signaling in the Skin: Therapeutic Potential of the "C(ut)annabinoid" System. Molecules 2019; 24:E918. [PMID: 30845666 PMCID: PMC6429381 DOI: 10.3390/molecules24050918] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
The endocannabinoid system (ECS) has lately been proven to be an important, multifaceted homeostatic regulator, which influences a wide-variety of physiological processes all over the body. Its members, the endocannabinoids (eCBs; e.g., anandamide), the eCB-responsive receptors (e.g., CB₁, CB₂), as well as the complex enzyme and transporter apparatus involved in the metabolism of the ligands were shown to be expressed in several tissues, including the skin. Although the best studied functions over the ECS are related to the central nervous system and to immune processes, experimental efforts over the last two decades have unambiguously confirmed that cutaneous cannabinoid ("c[ut]annabinoid") signaling is deeply involved in the maintenance of skin homeostasis, barrier formation and regeneration, and its dysregulation was implicated to contribute to several highly prevalent diseases and disorders, e.g., atopic dermatitis, psoriasis, scleroderma, acne, hair growth and pigmentation disorders, keratin diseases, various tumors, and itch. The current review aims to give an overview of the available skin-relevant endo- and phytocannabinoid literature with a special emphasis on the putative translational potential, and to highlight promising future research directions as well as existing challenges.
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Affiliation(s)
- Kinga Fanni Tóth
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
| | - Dorottya Ádám
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
| | - Tamás Bíró
- Department of Immunology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
- HCEMM Nonprofit Ltd., 6720 Szeged, Hungary.
| | - Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary.
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Saif DS, Serag DM, El Tabl MA. Comparative study between platelet-rich plasma injection and steroid injection in mild–moderate shoulder osteoarthritis and their relation to quality of life. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_17_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Autologous fibrin scaffolds: When platelet- and plasma-derived biomolecules meet fibrin. Biomaterials 2018; 192:440-460. [PMID: 30500725 DOI: 10.1016/j.biomaterials.2018.11.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 02/06/2023]
Abstract
The healing of vascularized mammalian tissue injuries initiate with hemostasis and clotting as part of biological defense system leading to the formation of a fibrin clot in which activated platelets are trapped to quickly stop bleeding and destroy microbials. In order to harness the therapeutic potential of biomolecules secreted by platelets and stemmed from plasma, blood deconstruction has allowed to yield autologous platelet-and plasma-derived protein fibrin scaffold. The autologous growth factors and microparticles stemmed from platelets and plasma, interact with fibrin, extracellular matrix, and tissue cells in a combinatorial, synergistic, and multidirectional way on mechanisms governing tissue repair. This interplay will induce a wide range of cell specifications during inflammation and repair process including but not limited to fibrogenesis, angiogenesis, and immunomodulation. As biology-as-a-drug approach, autologous platelet-and plasma-derived protein fibrin scaffold is emerging as a safe and efficacious natural human-engineered growth factor delivery system to repair musculoskeletal tissues, and skin and corneal ulcers and burns. In doing so, it acts as therapeutic agent not perfect but close to biological precision. However, this autologous, biocompatible, biodegradable, and long in vivo lasting strategy faces several challenges, including its non-conventional single dose-response effect, the lack of standardization in its preparation and application, and the patient's biological features. In this review, we give an account of the main events of tissue repair. Then, we describe the procedure to prepare autologous platelet-and plasma-derived protein fibrin scaffolds, and the rationale behind these biomaterials, and finally, we highlight the significance of strategic accuracy in their application.
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Two cycles of plasma rich in growth factors (PRGF-Endoret) intra-articular injections improve stiffness and activities of daily living but not pain compared to one cycle on patients with symptomatic knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2018; 26:2615-2621. [PMID: 28526995 DOI: 10.1007/s00167-017-4565-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/03/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess the clinical efficacy and safety of a treatment based on one cycle versus two cycles of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) on patients with knee osteoarthritis (OA). METHODS Ninety patients with knee OA were included and evaluated. A total of 48 patients received one cycle (OC group) (3 injections on a weekly basis), while 42 patients received two cycles of PRGF-Endoret (TC group) spaced 6 months between them. Patients were evaluated with LEQUESNE and WOMAC scores before treatment and after 48 weeks. Safety assessment was also performed. RESULTS A significant reduction of all assessed outcome measures was shown for both groups at 48 weeks compared with baseline values (P < 0.001). Patients of TCs group showed a significantly higher reduction (P < 0.05) in WOMAC stiffness subscales. Regarding LEQUESNE INDEX, a significantly higher reduction was observed in the TC group in all subscales except in pain score. In the maximum walking distance subscale (MCD), the improvement rate was 31.8% higher for the TCs group compared with the OC group (P < 0.01). In addition, the TC group showed a significant improvement in LEQUESNE activities of daily living (ADV) and global subscales of 14.7 and 11.8% (P < 0.05) higher, respectively, than the OC group. CONCLUSIONS Treatment with two cycles of PRGF did not show a significantly higher pain reduction compared with one cycle treatment. However, two cycles of PRGF showed a significant improvement in WOMAC stiffness, LEQUESNE MCD, LEQUESNE ADV and LEQUESNE global subscales. Therefore, patients treated with two cycles present an improvement in quality of life. LEVEL OF EVIDENCE II.
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Ferraciolli E, Laposy C, Nogueira M, Justulin Júnior L, Camargo Filho J, Moreira V, Marques M, Nai G, Ozaki G. Avaliação das fibras colágenas de feridas dérmicas de coelhos tratadas com diferentes fontes de plasma rico em plaquetas. ARQ BRAS MED VET ZOO 2018. [DOI: 10.1590/1678-4162-9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Para comparar a regeneração tecidual de feridas dérmicas em coelhos tratados e não tratados, de forma seriada, com diferentes fontes de plasma rico em plaquetas (PRP) gel, biópsias dérmicas foram feitas na região dorsal, com auxílio de um punch de 8mm, em que o lado direito foi tratado com NaCl 0,9%® e o lado esquerdo recebeu aplicação de diferentes fontes de PRPs (autóloga, heteróloga e homóloga), nos dias zero, três, sete, 10, 14, tendo sido acompanhadas durante 17 dias. Ao final do 17º dia, foi realizada avaliação histopatológica das feridas. Do total de 24 animais, seis coelhos (três machos e três fêmeas) foram utilizados somente como doadores para obtenção do PRP homólogo gel. Um cão adulto, saudável, foi utilizado como doador durante o experimento para o preparo do PRP gel do grupo heterólogo. As médias das fibras dos grupos autólogo e homólogo foram muito semelhantes (75,0±13,7 e 73,1±10,2, respectivamente), quando comparadas às médias obtidas no grupo controle (71,5±10,8). Já as fibras colágenas do grupo heterólogo foram inferiores (P<0,05) às dos demais grupos (59,4±11,3). Conclui-se que a fonte heteróloga produz fibras colágenas menos organizadas e menos homogêneas, sendo o último recurso a ser utilizado para promover uma cicatrização de boa qualidade.
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Affiliation(s)
| | | | | | | | | | | | | | - G. Nai
- Universidade do Oeste Paulista, Brazil
| | - G. Ozaki
- Universidade Estadual Paulista, Brazil
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Jaimes Suarez J, Vidal Conde L, Collazos Robles R, Grande Gomez J, Martin Díaz V, Parra Rodriguez O, Pérez-González YC. Zoon Vulvitis Treated Successfully With Platelet-Rich Plasma: First Case Reported. J Low Genit Tract Dis 2017; 21:e48-e51. [PMID: 28857965 PMCID: PMC5625965 DOI: 10.1097/lgt.0000000000000330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic Zoon vulvitis was successfully treated with platelet-rich plasma achieving a considerable reduction of the clinical symptoms and signs of an evident lesion.
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Affiliation(s)
- July Jaimes Suarez
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Luis Vidal Conde
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Rafael Collazos Robles
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Joaquin Grande Gomez
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Victor Martin Díaz
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Oscar Parra Rodriguez
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Yosmar Carolina Pérez-González
- Gynecology Department, Hospital San Rafael, Madrid, Spain, Soluciones Bioregenerativas SL, Barcelona, Spain; and Hospital Fundación Jiménez Díaz, Madrid, Spain
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Cancedda R, Bollini S, Descalzi F, Mastrogiacomo M, Tasso R. Learning from Mother Nature: Innovative Tools to Boost Endogenous Repair of Critical or Difficult-to-Heal Large Tissue Defects. Front Bioeng Biotechnol 2017; 5:28. [PMID: 28503549 PMCID: PMC5408079 DOI: 10.3389/fbioe.2017.00028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/10/2017] [Indexed: 12/16/2022] Open
Abstract
For repair of chronic or difficult-to-heal tissue lesions and defects, major constraints exist to a broad application of cell therapy and tissue engineering approaches, i.e., transplantation of “ex vivo” expanded autologous stem/progenitor cells, alone or associated with carrier biomaterials. To enable a large number of patients to benefit, new strategies should be considered. One of the main goals of contemporary regenerative medicine is to develop new regenerative therapies, inspired from Mother Nature. In all injured tissues, when platelets are activated by tissue contact, their released factors promote innate immune cell migration to the wound site. Platelet-derived factors and factors secreted by migrating immune cells create an inflammatory microenvironment, in turn, causing the activation of angiogenesis and vasculogenesis processes. Eventually, repair or regeneration of the injured tissue occurs via paracrine signals activating, mobilizing or recruiting to the wound site cells with healing potential, such as stem cells, progenitors, or undifferentiated cells derived from the reprogramming of tissue differentiated cells. This review, largely based on our studies, discusses the identification of new tools, inspired by cellular and molecular mechanisms overseeing physiological tissue healing, that could reactivate dormant endogenous regeneration mechanisms lost during evolution and ontogenesis.
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Affiliation(s)
- Ranieri Cancedda
- Biorigen Srl, Genova, Italy.,Department of Experimental Medicine, University of Genova, Genova, Italy
| | - Sveva Bollini
- Department of Experimental Medicine, University of Genova, Genova, Italy
| | | | | | - Roberta Tasso
- IRCCS AOU San Martino-IST National Institute of Cancer Research, Genova, Italy
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Mancò A, Goderecci R, Rughetti A, DE Giorgi S, Necozione S, Bernardi A, Calvisi V. Microfracture versus microfracture and platelet-rich plasma: arthroscopic treatment of knee chondral lesions. A two-year follow-up study. JOINTS 2016; 4:142-147. [PMID: 27900305 DOI: 10.11138/jts/2016.4.3.142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the aim of this study was to describe and compare the clinical results obtained in patients affected by chondral lesions of the knee submitted to an arthroscopic treatment with the microfracture technique or microfracture + intraoperative autologous platelet-rich plasma (PRP) injection. METHODS a prospective observational study was performed in patients affected by chondral lesions of the knee (classed as grade III-IV according to Outer-bridge's classification) and early osteoarthritis (classed as grade 1-2 according to the Kellgren-Lawrence classification). Their mean age was 52.4 years. Thirteen patients were treated with the microfracture technique according to Steadman (Group A), while 14 were treated with microfracture + PRP injection (Group B). Both groups were assessed using series of measures (a visual analog scale for pain, the 36-Item Short Form Health Survey and the International Knee Documentation Committee Subjective Knee Form) to compare pre-operative and postoperative values at 3, 6, 12 and 24 months. Statistical analysis was conducted using a two-factor ANOVA for repeated measures. RESULTS the VAS score decreased from a pre-operative value of 6.62±1.26 to 3.54 ±2.26 at 24 months in Group A (p<0.001), and from 6.43±1.91 to 3.36±2.84 in Group B (p<0.001). The IKDC subjective score increased from a pre-operative value of 37.02±12.00 to 62.13±19.00 at two years in Group A (p<0.001) and from 34.63±15.00 to 67.11±26.74 in Group B (p<0.001); the SF-36 scores showed a similar trend. Although an improvement was recorded over time in both groups, in the short term the IKDC subjective score improvement seemed to be better in Group B; a similar trend was shown by the SF-36 and VAS scores. At two years, the IKDC Subjective Scale, VAS and SF-36 scores seemed to be similar in the two groups. Over time, no significant differences were found between the two groups in any of the three outcomes. CONCLUSIONS the use of autologous PRP in association with the microfracture technique seems to give better clinical and functional results in short-term follow-up, above all as regards pain. At two-year follow-up, however, the clinical results of the two groups were similar. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Annalisa Mancò
- MESVA Department, Postgraduate School of Orthopaedics and Traumatology, University of L'Aquila, Italy
| | - Remo Goderecci
- MESVA Department, Postgraduate School of Orthopaedics and Traumatology, University of L'Aquila, Italy
| | - Anna Rughetti
- Immunotrasfusional Unit, San Salvatore Hospital, ASL 1, L'Aquila, Italy
| | - Silvana DE Giorgi
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari, Italy
| | - Stefano Necozione
- MESVA Department, Clinical Epidemiology Unit, University of L'Aquila, Italy
| | - Alfredo Bernardi
- MESVA Department, Postgraduate School of Orthopaedics and Traumatology, University of L'Aquila, Italy
| | - Vittorio Calvisi
- MESVA Department, Postgraduate School of Orthopaedics and Traumatology, University of L'Aquila, Italy
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Sampson S, Smith J, Vincent H, Aufiero D, Zall M, Botto-van-Bemden A. Intra-articular bone marrow concentrate injection protocol: short-term efficacy in osteoarthritis. Regen Med 2016; 11:511-20. [PMID: 27527808 DOI: 10.2217/rme-2016-0081] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM Evaluate intra-articular injection of bone marrow concentrate (BMC), followed by platelet-rich plasma (PRP) injection at 8 weeks follow-up in moderate/severe osteoarthritis. DESIGN Single center, retrospective Case Series (n = 125). METHODS Bone marrow was aspirated/concentrated using a standardized technique. Patients received a single intra-articular injection of BMC, with follow-up injection of PRP at 8 weeks. RESULTS Median absolute pain reduction in all joints was five points (71.4%) on visual analog scale. Median patient satisfaction was 9.0/10, while 91.7% indicated that they would repeat the procedure and 94% said that they would recommend the procedure to a friend. CONCLUSION Intra-articular injection of BMC, followed by a PRP injection, can provide short-term benefits in moderate-to-severe osteoarthritis.
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Affiliation(s)
- Steven Sampson
- David Geffen School of Medicine at UCLA; 10833 Le Conte Ave, Los Angeles, CA 90095, USA.,Western University of Health Sciences; 309 E 2nd St, Pomona, CA 91766, USA.,Touro College of Osteopathic Medicine, 230 W 125th St #1, NY 10027, USA.,The Orthobiologic Institute (TOBI), Woodland Hills, CA 91365, USA
| | - Jay Smith
- Departments of PM&R, Radiology & Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic College of Medicine; 200 1st St SW, Rochester, MN 55905, USA
| | - Hunter Vincent
- UC Davis Medical Center, Department of Physical Medicine & Rehabilitation; 4860 Y St, Med Center, Sacramento, CA 95817, USA
| | - Danielle Aufiero
- David Geffen School of Medicine at UCLA; 10833 Le Conte Ave, Los Angeles, CA 90095, USA.,Western University of Health Sciences; 309 E 2nd St, Pomona, CA 91766, USA.,Touro College of Osteopathic Medicine, 230 W 125th St #1, NY 10027, USA.,The Orthobiologic Institute (TOBI), Woodland Hills, CA 91365, USA
| | - Mona Zall
- Greater Los Angeles VA Medical Center, Department of Physical Medicine & Rehabilitation; 11301 Wilshire Blvd, Los Angeles, CA 90073, USA
| | - Angie Botto-van-Bemden
- Musculoskeletal Research International, Clinical Research Experts; 1004 Avocado Isle, Ft. Lauderdale, FL 33315, USA
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Platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cells: stimulatory effects on proliferation and migration of fibroblasts and keratinocytes in vitro. Arch Dermatol Res 2016; 308:511-20. [PMID: 27394438 DOI: 10.1007/s00403-016-1676-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/28/2016] [Accepted: 07/01/2016] [Indexed: 12/26/2022]
Abstract
The clinical use of tissue engineering associated with cell therapy is considered a new alternative therapy for the repair of chronic lesions with potential application in different medical areas, mostly in orthopedic and dermatological diseases. Platelet-rich plasma (PRP) is a rich source of growth factors and cytokines important for wound healing. Adipose-derived mesenchymal stem cells (ADSCs) have shown potential to accelerate the resolution of ulcers, to stimulate cell proliferation, and to benefit the quality of skin repair. This study aims to determine the effect of PRP and conditioned medium (CM) from ADSC on fibroblast and keratinocyte proliferation in vitro. Migration and proliferation assays were performed to evaluate the growth of fibroblasts and keratinocytes in the presence of PRP, CM, and CM + PRP. Significant proliferative stimulation was observed after 48 h of culture (p < 0.05) on mean absorbance of fibroblasts cultured with 10 and 25 % PRP, 100 % CM, and 25 % PRP + 25 % CM, if compared with control. Keratinocyte proliferation was stimulated after 48 h in cultures with 25, 50, and 100 % CM, and growth was compared with controls. The migration assay detected a significant migratory stimulus in fibroblasts cultured with 10 % PRP + 10 % CM after 48 h. These in vitro results suggest that PRP and ADSC have therapeutic potential for healing and re-epithelialization of chronic wounds in vivo.
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Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4868613. [PMID: 27462609 PMCID: PMC4947638 DOI: 10.1155/2016/4868613] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 01/15/2023]
Abstract
The aim of this study was to assess a novel approach to treating severe knee osteoarthritis by targeting synovial membrane, superficial articular cartilage, synovial fluid, and subchondral bone by combining intra-articular injections and intraosseous infiltrations of platelet rich plasma. We explored a new strategy consisting of intraosseous infiltrations of platelet rich plasma into the subchondral bone in combination with the conventional intra-articular injection in order to tackle several knee joint tissues simultaneously. We assessed the clinical outcomes through osteoarthritis outcome score (KOOS) and the inflammatory response by quantifying mesenchymal stem cells in synovial fluid. There was a significant pain reduction in the KOOS from baseline (61.55 ± 14.11) to week 24 (74.60 ± 19.19), after treatment (p = 0.008), in the secondary outcomes (symptoms, p = 0.004; ADL, p = 0.022; sport/rec., p = 0.017; QOL, p = 0.012), as well as VAS score (p < 0.001) and Lequesne Index (p = 0.008). The presence of mesenchymal stem cells in synovial fluid and colony-forming cells one week after treatment decreased substantially from 7.98 ± 8.21 MSC/μL to 4.04 ± 5.36 MSC/μL (p = 0.019) and from 601.75 ± 312.30 to 139.19 ± 123.61 (p = 0.012), respectively. Intra-articular injections combined with intraosseous infiltrations of platelet rich plasma reduce pain and mesenchymal stem cells in synovial fluid, besides significantly improving knee joint function in patients with severe knee osteoarthritis. This trial is registered on EudraCT with the number 2013-003982-32.
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Merayo-Lloves J, Sanchez-Avila RM, Riestra AC, Anitua E, Begoña L, Orive G, Fernandez-Vega L. Safety and Efficacy of Autologous Plasma Rich in Growth Factors Eye Drops for the Treatment of Evaporative Dry Eye. Ophthalmic Res 2016; 56:68-73. [DOI: 10.1159/000444496] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 02/07/2016] [Indexed: 11/19/2022]
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Sánchez M, Anitua E, Delgado D, Sanchez P, Prado R, Goiriena JJ, Prosper F, Orive G, Padilla S. A new strategy to tackle severe knee osteoarthritis: Combination of intra-articular and intraosseous injections of Platelet Rich Plasma. Expert Opin Biol Ther 2016; 16:627-43. [PMID: 26930117 DOI: 10.1517/14712598.2016.1157162] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a mechanically induced, cytokine and enzyme-mediated disorder involving all the joint tissue of the knee. Rebuilding a physiological-homeostatic network at the tissue level following knee organ failure, such as in severe KOA, is a daunting task with therapeutic targets encompassing the articular cartilage, synovium and subchondral bone. Intraarticular infiltration of plasma rich in growth factors (PRP) has emerged as a promising symptomatic approach, although it is insufficient to reach the subchondral bone. AREAS COVERED This review addresses current molecular and cellular data in joint homeostasis and osteoarthritis pathophysiology. In particular, it focuses on changes that subchondral bone undergoes in knee osteoarthritis and evaluates recent observations on the crosstalk among articular cartilage, subchondral bone and synovial membrane. In addition, we review some mechanistic aspects that have been proposed and provide the rationale for using PRP intraosseously in KOA. EXPERT OPINION The knee joint is a paradigm of autonomy and connectedness of its anatomical structures and tissues from which it is made. We propose an innovative approach to the treatment of severe knee osteoarthritis consisting of a combination of intraarticular and intraosseous infiltrations of PRP, which might offer a new therapeutic tool in KOA therapy.
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Affiliation(s)
- Mikel Sánchez
- a Arthroscopic Surgery Unit , Hospital Vithas San José , Vitoria-Gasteiz , Spain
| | - Eduardo Anitua
- b Department of Regenerative Medicine, Laboratory of Regenerative Medicine, BTI Biotechnology Institute , Vitoria , Spain
| | - Diego Delgado
- c Arthroscopic Surgery Unit Research , Hospital Vithas San José , Vitoria-Gasteiz , Spain
| | - Peio Sanchez
- c Arthroscopic Surgery Unit Research , Hospital Vithas San José , Vitoria-Gasteiz , Spain
| | - Roberto Prado
- b Department of Regenerative Medicine, Laboratory of Regenerative Medicine, BTI Biotechnology Institute , Vitoria , Spain
| | | | - Felipe Prosper
- e Cell Therapy Program, Foundation for Applied Medical Research , University of Navarra , Pamplona , Spain.,f Hematology and Cell Therapy Department , Clínica Universidad de Navarra, University of Navarra , Pamplona , Spain
| | - Gorka Orive
- b Department of Regenerative Medicine, Laboratory of Regenerative Medicine, BTI Biotechnology Institute , Vitoria , Spain.,g Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy , University of the Basque Country , Vitoria , Spain.,h Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine , CIBER-BBN, SLFPB-EHU , Vitoria-Gasteiz , Spain
| | - Sabino Padilla
- b Department of Regenerative Medicine, Laboratory of Regenerative Medicine, BTI Biotechnology Institute , Vitoria , Spain
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Merayo-Lloves J, Sanchez RM, Riestra AC, Anitua E, Bego�a L, Orive G, Fernandez-Vega L. Autologous Plasma Rich in Growth Factors Eyedrops in Refractory Cases of Ocular Surface Disorders. Ophthalmic Res 2015; 55:53-61. [DOI: 10.1159/000439280] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/07/2015] [Indexed: 11/19/2022]
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Barrionuevo DV, Laposy CB, Abegão KGB, Nogueira RMB, Nai GA, Bracale BN, Delfim IG. Comparison of experimentally-induced wounds in rabbits treated with different sources of platelet-rich plasma. Lab Anim 2015; 49:209-14. [PMID: 25586936 DOI: 10.1177/0023677214567747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the years, autologous platelet-rich plasma (PRP) has been used to great advantage in the healing of acute and chronic wounds. However, it is impossible to use in some situations so alternative PRPs need to be considered, such as homologous or heterologous PRPs. In order to evaluate the effects of PRP in the form of autologous, heterologous and homologous gels on in vivo cutaneous wound healing, 18 animals divided into three groups of six, were used for the study, with another six animals used as PRP donors. For the heterologous group an adult, mixed breed dog was used to obtain the PRP. The wounds were induced using an 8 mm punch. The left side was treated with NaCl 0.9%® (A) and a PRP gel was applied (GA = autologous; GHE = heterologous and GHO = homologous) on the right side (B). The wounds were evaluated for a period of 17 days. On the 17th day biopsies were taken for histopathological assessment of the wounds. The percentage of contraction was evident in side B (treated), which was confirmed in the microscopic analysis of the histological sections. Thus, it was concluded that PRP, regardless of the source, improves and accelerates the healing process, demonstrating its therapeutic potential on cutaneous lesions and its use in patients with impaired wound healing.
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Affiliation(s)
- D V Barrionuevo
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - C B Laposy
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - K G B Abegão
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - R M B Nogueira
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - G A Nai
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - B N Bracale
- Oeste Paulista University, Veterinary Medicine, Presidente Prudente, São Paulo, Brazil
| | - I G Delfim
- Oeste Paulista University, Veterinary Medicine, Presidente Prudente, São Paulo, Brazil
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Anitua E, Sánchez M, Aguirre JJ, Prado R, Padilla S, Orive G. Efficacy and safety of plasma rich in growth factors intra-articular infiltrations in the treatment of knee osteoarthritis. Arthroscopy 2014; 30:1006-17. [PMID: 24996872 DOI: 10.1016/j.arthro.2014.05.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of this study was to systematically review the efficacy and safety of plasma rich in growth factors (PRGF) as a treatment for reducing symptoms in patients with knee osteoarthritis. METHODS A comprehensive and systematic literature search was conducted for PRGF treatment of knee osteoarthritis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All the studies had to include a PRGF group and a control group. Pre- and post-treatment measures of joint pain, reduced function, and stiffness were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lequesne index, or number of Outcome Measures for Rheumatology Committee and Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative (OMERACT-OARSI) responders, with a follow-up period of at least 4 weeks. An assessment of both the quality and risk of bias of the studies was conducted. RESULTS The literature search yielded 91 citations, but only 5 were eligible publications that met the inclusion criteria (2 randomized controlled trials, 2 prospective studies, and 1 retrospective analysis). Two studies were rated as having a low risk of bias whereas 3 had a high risk. In both randomized controlled trials, it was observed that after 6 months of treatment, the number of patients with a pain reduction of more than 50% was significantly higher in the PRGF group. In 2 other studies, the patients treated with PRGF showed a significant pain reduction compared with the control group. The remaining variables (Western Ontario and McMaster Universities Osteoarthritis Index scale for pain, function, and stiffness; Lequesne index; Knee Injury and Osteoarthritis Outcome Score scale; and number of OMERACT-OARSI responders) showed a statistically significant superiority of the group treated with PRGF. CONCLUSIONS The current clinical evidence suggests that PRGF intra-articular infiltrations in patients with knee osteoarthritis reduce pain and therefore are clinically efficacious in osteoarthritis treatment. LEVEL OF EVIDENCE Level III, systematic review of Level I, II, and III studies.
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Affiliation(s)
- Eduardo Anitua
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain.
| | - Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas San Jose, Vitoria-Gasteiz, Spain
| | | | - Roberto Prado
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain
| | - Sabino Padilla
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain
| | - Gorka Orive
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain
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