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Zhu X, Zhao L, Riva N, Yu Z, Jiang M, Zhou F, Gatt A, Giannoudis PV, Guo JJ. Allogeneic platelet-rich plasma for knee osteoarthritis in patients with primary immune thrombocytopenia: A randomized clinical trial. iScience 2024; 27:109664. [PMID: 38646173 PMCID: PMC11031822 DOI: 10.1016/j.isci.2024.109664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/08/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
The treatment of painful KOA in adult patients with ITP has not been well studied yet. We conducted a prospective, double-blind, randomized, placebo-controlled trial to evaluate the efficacy of intra-articular allogeneic PRP injections on symptoms and joint structure in patients with KOA and ITP. 80 participants were randomly allocated in a 1:1 ratio to allogeneic PRP group or saline group. The primary outcome was the WOMAC total score at 12 months post-injection. The number of patients in each group who achieved MCID of primary outcome showed a statistically significant difference only at 3-month (27/39 vs. 5/39, p = 0.001) and 6-month (15/39 vs. 3/38, p = 0.032). The difference in WOMAC total score exceeded the MCID only at 3 month (mean difference of -15.1 [95% CI -20.7 to -9.5], p < 0.001). Results suggest that allogeneic PRP was superior to placebo only with respect to symptoms at 3-month of follow-up.
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Affiliation(s)
- Xiaohang Zhu
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Lingying Zhao
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
- China-Europe Sports Medicine Belt-and-Road Joint Laboratory, Ministry of Education of PRC, Suzhou, P.R. China
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ziqiang Yu
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
| | - Miao Jiang
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
| | - Feng Zhou
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
| | - Alexander Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Haematology, Mater Dei Hospital, Msida, Malta
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Jiong Jiong Guo
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, P.R. China
- China-Europe Sports Medicine Belt-and-Road Joint Laboratory, Ministry of Education of PRC, Suzhou, P.R. China
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Chen SC, Tsai CF, Wang PH, Lee YT, Chen CC. Auricular acupressure approach for the early stage of knee osteoarthritis. QJM 2023; 116:811-812. [PMID: 37162482 DOI: 10.1093/qjmed/hcad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 05/11/2023] Open
Affiliation(s)
- S-C Chen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C-F Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - P-H Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-T Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - C-C Chen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Vun J, Iqbal N, Jones E, Ganguly P. Anti-Aging Potential of Platelet Rich Plasma (PRP): Evidence from Osteoarthritis (OA) and Applications in Senescence and Inflammaging. Bioengineering (Basel) 2023; 10:987. [PMID: 37627872 PMCID: PMC10451843 DOI: 10.3390/bioengineering10080987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Aging and age-related changes impact the quality of life (QOL) in elderly with a decline in movement, cognitive abilities and increased vulnerability towards age-related diseases (ARDs). One of the key contributing factors is cellular senescence, which is triggered majorly by DNA damage response (DDR). Accumulated senescent cells (SCs) release senescence-associated secretory phenotype (SASP), which includes pro-inflammatory cytokines, matrix metalloproteinases (MMPs), lipids and chemokines that are detrimental to the surrounding tissues. Chronic low-grade inflammation in the elderly or inflammaging is also associated with cellular senescence and contributes to ARDs. The literature from the last decade has recorded the use of platelet rich plasma (PRP) to combat senescence and inflammation, alleviate pain as an analgesic, promote tissue regeneration and repair via angiogenesis-all of which are essential in anti-aging and tissue regeneration strategies. In the last few decades, platelet-rich plasma (PRP) has been used as an anti-aging treatment option for dermatological applications and with great interest in tissue regeneration for orthopaedic applications, especially in osteoarthritis (OA). In this exploration, we connect the intricate relationship between aging, ARDs, senescence and inflammation and delve into PRP's properties and potential benefits. We conduct a comparative review of the current literature on PRP treatment strategies, paying particular attention to the instances strongly linked to ARDs. Finally, upon careful consideration of this interconnected information in the context of aging, we suggest a prospective role for PRP in developing anti-aging therapeutic strategies.
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Affiliation(s)
- James Vun
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (J.V.); (E.J.)
- Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS97TF, UK
| | - Neelam Iqbal
- School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK;
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (J.V.); (E.J.)
| | - Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (J.V.); (E.J.)
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Oo WM, Linklater J, Bennell KL, Yu SP, Duong V, Hunter DJ. Inflammatory ultrasound features as prognostic factors of pain and functional outcomes following intra-articular platelet-rich plasma in knee osteoarthritis. Int J Rheum Dis 2023; 26:1540-1546. [PMID: 37309612 PMCID: PMC10946528 DOI: 10.1111/1756-185x.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 05/05/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
AIM To explore inflammatory ultrasound predictors of improvements in pain and function over 2, 6, and 12 months following administration of intra-articular platelet-rich plasma (PRP) in knee osteoarthritis (OA). METHOD Patients with painful mild-moderate radiographic knee OA from a subset of the RESTORE RCT underwent ultrasound assessment according to the standardized OMERACT scanning protocol to detect inflammatory features such as synovitis, synovial hypertrophy, and effusion with power Doppler. The study knee was treated with 3 once-weekly PRP injections obtained after centrifugation at 1500 g for 5 min. Numerical Rating Score (NRS), Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) function sub-score were used to measure pain and functional severity. Separate linear regression models were performed to determine whether baseline ultrasound-detected features of inflammation predicted the improvement in pain and function following PRP injection in both unadjusted and adjusted models for confounders. RESULTS Forty-four participants were included, with 25 (56.8%) being female. In an unadjusted model, higher OMERACT scores for inflammatory features such as global synovitis and/or effusion were significantly associated with greater improvement in all outcomes measured at 2 months but not at 6 and 12 months for pain measures. Only global synovitis showed significant association with functional improvement at 2 and 12 months. Similar findings were observed in the adjusted model. CONCLUSION Ultrasound indices of knee inflammation predicted short-term improvements in pain severity and both short- and longer-term improvements in function following intra-articular PRP injection.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Physical Medicine and Rehabilitation, Mandalay General HospitalUniversity of Medicine, MandalayMandalayMyanmar
| | - James Linklater
- Department of Musculoskeletal ImagingCastlereagh Sports Imaging CentreSt. Leonards, SydneyNew South WalesAustralia
| | - Kim L. Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine Dentistry & Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Shirley P. Yu
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
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Li S, Cao P, Chen T, Ding C. Latest insights in disease-modifying osteoarthritis drugs development. Ther Adv Musculoskelet Dis 2023; 15:1759720X231169839. [PMID: 37197024 PMCID: PMC10184265 DOI: 10.1177/1759720x231169839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/29/2023] [Indexed: 05/19/2023] Open
Abstract
Osteoarthritis (OA) is a prevalent and severely debilitating disease with an unmet medical need. In order to alleviate OA symptoms or prevent structural progression of OA, new drugs, particularly disease-modifying osteoarthritis drugs (DMOADs), are required. Several drugs have been reported to attenuate cartilage loss or reduce subchondral bone lesions in OA and thus potentially be DMOADs. Most biologics (including interleukin-1 (IL-1) and tumor necrosis factor (TNF) inhibitors), sprifermin, and bisphosphonates failed to yield satisfactory results when treating OA. OA clinical heterogeneity is one of the primary reasons for the failure of these clinical trials, which can require different therapeutic approaches based on different phenotypes. This review describes the latest insights into the development of DMOADs. We summarize in this review the efficacy and safety profiles of various DMOADs targeting cartilage, synovitis, and subchondral bone endotypes in phase 2 and 3 clinical trials. To conclude, we summarize the reasons for clinical trial failures in OA and suggest possible solutions.
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Affiliation(s)
- Shengfa Li
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peihua Cao
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tianyu Chen
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Changhai Ding
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, 261 Industry Road, Guangzhou 510515, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Clinical Research Center, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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Zhu X, Zhao L, Liu A, Yu Z, Guo JJ. Efficacy of intra-articular injection of allogeneic platelet-rich plasma for knee osteoarthritis combined with hematologic blood dyscrasias with platelet dysfunction: protocol of a randomized, double-blind, placebo-controlled trial. BMC Musculoskelet Disord 2022; 23:1095. [PMID: 36517775 PMCID: PMC9749297 DOI: 10.1186/s12891-022-06073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) has been shown to alleviate the symptoms of patients suffering from knee osteoarthritis (KOA), but for certain patients with hematologic diseases with platelet dysfunction and patients receiving anti-platelet medications, autologous PRP is not an optimum solution. Allogeneic PRP has been proven to be safe and effective in the treatment of osteoarthritis, rotator cuff disease, refractory wounds and other medical fields. However, a well-designed and long-term follow-up prospective randomized controlled trial (RCT) to evaluate the effect of allogeneic PRP intra-articular injections for KOA combined with hematologic blood dyscrasias has not yet been performed. METHODS/ DESIGN We will conduct an allogeneic PRP injection for KOA combined with hematologic blood dyscrasias with platelet dysfunction study: a prospective, randomized, double-blind, placebo-controlled trial. One hundred participants with KOA combined with hematologic blood dyscrasias with platelet dysfunction will be randomly allocated to receive either one allogeneic PRP injection or one saline injection into the knee joint. The primary outcome will be a 12-month change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary outcomes will be the 36-Item Short-Form General Health Survey (SF-36) score, Lysholm score, overall knee pain score and MRI assessment at 1-, 3-, 6- and 12-month. DISCUSSION The results of this study will help determine whether allogeneic PRP could be used as a non-surgical intervention to treat patients with knee OA combined with hematologic blood dyscrasias with platelet dysfunction. TRIAL REGISTRATION Chinese Clinical Trials Registry reference: ChiCTR2100048624. Prospectively registered 11th of July 2021.
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Affiliation(s)
- Xiaohang Zhu
- grid.429222.d0000 0004 1798 0228Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 People’s Republic of China
| | - Lingying Zhao
- grid.429222.d0000 0004 1798 0228Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 People’s Republic of China ,grid.429222.d0000 0004 1798 0228Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, People’s Republic of China
| | - An Liu
- grid.429222.d0000 0004 1798 0228Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 People’s Republic of China ,grid.263761.70000 0001 0198 0694Suzhou Medical College of Soochow University, Suzhou, People’s Republic of China
| | - Ziqiang Yu
- grid.429222.d0000 0004 1798 0228Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 People’s Republic of China ,grid.429222.d0000 0004 1798 0228Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of PR China, Suzhou, People’s Republic of China
| | - Jiong Jiong Guo
- grid.429222.d0000 0004 1798 0228Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 People’s Republic of China ,grid.429222.d0000 0004 1798 0228Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 People’s Republic of China
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McDonald A. Primary Care-Based Interventional Procedures for Chronic Pain. Prim Care 2022; 49:425-437. [DOI: 10.1016/j.pop.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ganguly P, Fiz N, Beitia M, Owston HE, Delgado D, Jones E, Sánchez M. Effect of Combined Intraosseous and Intraarticular Infiltrations of Autologous Platelet-Rich Plasma on Subchondral Bone Marrow Mesenchymal Stromal Cells from Patients with Hip Osteoarthritis. J Clin Med 2022; 11:jcm11133891. [PMID: 35807175 PMCID: PMC9267269 DOI: 10.3390/jcm11133891] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Osteoarthritis (OA) is a debilitating condition that significantly impacts its patients and is closely associated with advancing age and senescence. Treatment with autologous platelet rich plasma (PRP) is a novel approach that is increasingly being researched for its effects. Subchondral bone mesenchymal stromal cells (MSCs) are key progenitors that form bone and cartilage lineages that are affected in OA. This study investigated the changes in subchondral bone MSCs before and after combined intraosseous (IO) and intraarticular (IA) PRP infiltration. Patient bone marrow aspirates were collected from 12 patients (four male, eight female) aged 40–86 years old (median 59.5). MSCs were expanded in standard media containing human serum to passage 1 and analysed for their colony-forming potential, senescence status, and gene expression. Hip dysfunction and Osteoarthritis Outcome Score (HOOS) at baseline and 6 months post second infiltration were used to assess the clinical outcomes; seven patients were considered responders and five non-responders. The number of colony-forming MSCs did not increase in the post treatment group, however, they demonstrated significantly higher colony areas (14.5% higher compared to Pre) indicative of enhanced proliferative capacity, especially in older donors (28.2% higher). Senescence assays also suggest that older patients and responders had a higher resistance to senescent cell accumulation. Responder and non-responder MSCs tended to differ in the expression of genes associated with bone formation and cartilage turnover including osteoblast markers, matrix metalloproteinases, and their inhibitors. Taken together, our data show that in hip OA patients, combined IO and IA PRP infiltrations enhanced subchondral MSC proliferative and stress-resistance capacities, particularly in older patients. Future investigation of the potential anti-ageing effect of PRP infiltrations and the use of next-generation sequencing would contribute towards better understanding of the molecular mechanisms associated with OA in MSCs.
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Affiliation(s)
- Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK; (P.G.); (H.E.O.)
| | - Nicolás Fiz
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain;
| | - Maider Beitia
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
| | - Heather E. Owston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK; (P.G.); (H.E.O.)
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7JT, UK; (P.G.); (H.E.O.)
- Correspondence: (E.J.); (M.S.)
| | - Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain;
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Beato Tomás de Zumarraga 10, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
- Correspondence: (E.J.); (M.S.)
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Oo WM, Linklater JM, Bennell KL, Daniel MS, Pryke D, Wang X, Yu SP, Deveza L, Duong V, Hunter DJ. Reliability and Convergent Construct Validity of Quantitative Ultrasound for Synovitis, Meniscal Extrusion, and Osteophyte in Knee Osteoarthritis With MRI. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1559-1573. [PMID: 34569080 DOI: 10.1002/jum.15840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 05/25/2023]
Abstract
AIMS To determine: 1) inter-rater reliability of quantitative measurements of ultrasound-detected synovitis, meniscal extrusion, and osteophytes; and 2) construct (convergent) validity via correlations and absolute agreements between ultrasound- and gold-standard magnetic resonance imaging (MRI)-outcomes in knee osteoarthritis. METHODS Dynamic ultrasound images for supra-patellar synovitis, meniscal extrusion, and osteophytes were acquired and quantified by a physician operator, musculoskeletal ultrasonographer, and medical student independently. On the same day, 3T MRI images were acquired. Effusion-synovitis, meniscal extrusion, and osteophytes were quantified on sagittal or coronal proton-density-weighted fat-suppressed noncontrast TSE sequences, respectively. Intra-class correlation coefficients (ICCs), Pearson's correlations (r), and Bland-Altman plots were used to analyze inter-rater reliability, and correlations, and agreements between the two imaging modalities. RESULTS Eighty-nine participants [48 females (53.9%)] with mean (standard deviation) age of 61.5 ± 6.9 years were included. The inter-rater reliability was excellent for osteophytes (ICC range = 0.90-0.96), meniscal extrusion (ICC range = 0.90-0.93), and synovitis (ICC range = 0.86-0.88). The correlations between ultrasound pathologies and their MRI counterparts were very strong (ICC range = 0.85-0.98) except for lateral meniscal extrusion [0.66 (95% CI, 0.52-0.76)]. Bland-Altman plots showed 0.01, 0.05, 0.10, 0.53, and 0.60 mm larger size in ultrasound medial tibial and medial femoral osteophytes, medial meniscal extrusions, synovitis, and lateral meniscal extrusions with 95% limits of agreements [±0.39, ±0.44, ±0.85, ±0.70, and ±0.90 (SDs)] than MRI measures, respectively. The lines of equality were within 95% CI of the mean differences (bias) only for medial osteophytes and medial meniscal extrusion. CONCLUSION The quantitative assessment of synovitis, meniscal extrusion, and osteophytes generally showed excellent inter-rater reliability and strong correlations with MRI-based measurements. Absolute agreement was strong for medial tibiofemoral pathologies.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney, NSW, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia
| | - Matthew S Daniel
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Danielle Pryke
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney, NSW, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Shirley P Yu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Leticia Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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10
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Yu SP, Ferreira ML, Duong V, Caroupapoullé J, Arden NK, Bennell KL, Hunter DJ. Responsiveness of an activity tracker as a measurement tool in a knee osteoarthritis clinical trial (ACTIVe-OA study). Ann Phys Rehabil Med 2021; 65:101619. [PMID: 34879312 DOI: 10.1016/j.rehab.2021.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/03/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In osteoarthritis (OA) clinical trials, reliable and responsive outcome measures to document physical and functional improvements are limited. OBJECTIVE This study aimed to assess whether the use of an activity tracker in an OA clinical trial is a responsive measurement tool. Secondary objectives assessed feasibility and validity. METHODS We recruited 65 participants in a prospective cohort study nested in a placebo-controlled clinical trial of platelet-rich plasma injection in knee OA. Participants wore an activity tracker (Fitbit Flex 2), and a smartphone was preloaded with a mobile application (OApp) designed to monitor load rates as a surrogate of knee loading. Participants used the systems for 7 days at baseline and for 7 days before the 2-month follow-up assessment. Effect size (ES) and standardised response mean (SRM) were calculated for change in step count and knee loading rate and regularly used knee OA outcome measures. Correlation coefficients (r) were calculated to examine the strength of the association between outcome measures. RESULTS Step count showed a trivial ES and SRM and mean knee loading rate measurements a moderate ES and SRM. We found a weak but significant correlation between change in mean steps per day and global improvement overall (r = 0.28) and Western Western Ontario and McMaster Universities Osteoarthritis Index function (r = -0.28). Compliance was high with the activity trackers. CONCLUSIONS Despite good feasibility, this study did not show significant responsiveness or validity of the activity trackers as compared with currently recommended outcome measures in OA clinical trials. The main challenge is the lack of a gold standard outcome measure to validate against, and because of the complex interplay between pain and measured function, a lack of correlation does not necessarily represent a failed validation in this context. Australian New Zealand Clinical Trials Registry: ACTRN12617000853347. This trial is a substudy of the "Platelet-rich plasma as a symptom-and disease-modifying treatment for knee osteoarthritis - the RESTORE trial".
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Affiliation(s)
- Shirley P Yu
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
| | - Manuela L Ferreira
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Duong
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jimmy Caroupapoullé
- Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Nigel K Arden
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Bennell KL, Paterson KL, Metcalf BR, Duong V, Eyles J, Kasza J, Wang Y, Cicuttini F, Buchbinder R, Forbes A, Harris A, Yu SP, Connell D, Linklater J, Wang BH, Oo WM, Hunter DJ. Effect of Intra-articular Platelet-Rich Plasma vs Placebo Injection on Pain and Medial Tibial Cartilage Volume in Patients With Knee Osteoarthritis: The RESTORE Randomized Clinical Trial. JAMA 2021; 326:2021-2030. [PMID: 34812863 PMCID: PMC8611484 DOI: 10.1001/jama.2021.19415] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Most clinical guidelines do not recommend platelet-rich plasma (PRP) for knee osteoarthritis (OA) because of lack of high-quality evidence on efficacy for symptoms and joint structure, but the guidelines emphasize the need for rigorous studies. Despite this, use of PRP in knee OA is increasing. OBJECTIVE To evaluate the effects of intra-articular PRP injections on symptoms and joint structure in patients with symptomatic mild to moderate radiographic medial knee OA. DESIGN, SETTING, AND PARTICIPANTS This randomized, 2-group, placebo-controlled, participant-, injector-, and assessor-blinded clinical trial enrolled community-based participants (n = 288) aged 50 years or older with symptomatic medial knee OA (Kellgren and Lawrence grade 2 or 3) in Sydney and Melbourne, Australia, from August 24, 2017, to July 5, 2019. The 12-month follow-up was completed on July 22, 2020. INTERVENTIONS Interventions involved 3 intra-articular injections at weekly intervals of either leukocyte-poor PRP using a commercially available product (n = 144 participants) or saline placebo (n = 144 participants). MAIN OUTCOMES AND MEASURES The 2 primary outcomes were 12-month change in overall average knee pain scores (11-point scale; range, 0-10, with higher scores indicating worse pain; minimum clinically important difference of 1.8) and percentage change in medial tibial cartilage volume as assessed by magnetic resonance imaging (MRI). Thirty-one secondary outcomes (25 symptom related and 6 MRI assessed; minimum clinically important difference not known) evaluated pain, function, quality of life, global change, and joint structures at 2-month and/or 12-month follow-up. RESULTS Among 288 patients who were randomized (mean age, 61.9 [SD, 6.5] years; 169 [59%] women), 269 (93%) completed the trial. In both groups, 140 participants (97%) received all 3 injections. After 12 months, treatment with PRP vs placebo injection resulted in a mean change in knee pain scores of -2.1 vs -1.8 points, respectively (difference, -0.4 [95% CI, -0.9 to 0.2] points; P = .17). The mean change in medial tibial cartilage volume was -1.4% vs -1.2%, respectively (difference, -0.2% [95% CI, -1.9% to 1.5%]; P = .81). Of 31 prespecified secondary outcomes, 29 showed no significant between-group differences. CONCLUSIONS AND RELEVANCE Among patients with symptomatic mild to moderate radiographic knee OA, intra-articular injection of PRP, compared with injection of saline placebo, did not result in a significant difference in symptoms or joint structure at 12 months. These findings do not support use of PRP for the management of knee OA. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617000853347.
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Affiliation(s)
- Kim L. Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kade L. Paterson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ben R. Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jillian Eyles
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Rheumatology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Shirley P. Yu
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David Connell
- Imaging @ Olympic Park, Melbourne, Victoria, Australia
| | | | - Bing Hui Wang
- Monash Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Biomarker Discovery Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Mandalay, Myanmar
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Stem Cells in Autologous Microfragmented Adipose Tissue: Current Perspectives in Osteoarthritis Disease. Int J Mol Sci 2021; 22:ijms221910197. [PMID: 34638538 PMCID: PMC8508703 DOI: 10.3390/ijms221910197] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a chronic debilitating disorder causing pain and gradual degeneration of weight-bearing joints with detrimental effects on cartilage volume as well as cartilage damage, generating inflammation in the joint structure. The etiology of OA is multifactorial. Currently, therapies are mainly addressing the physical and occupational aspects of osteoarthritis using pharmacologic pain treatment and/or surgery to manage the symptomatology of the disease with no specific regard to disease progression or prevention. Herein, we highlight alternative therapeutics for OA specifically considering innovative and encouraging translational methods with the use of adipose mesenchymal stem cells.
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13
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Drummer D, McAdam J, Seay R, Ferrando A, Bridges SL, Singh JA, Bamman M. Osteoarthritis Progression: Mitigation and Rehabilitation Strategies. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:724052. [PMID: 36188773 PMCID: PMC9397730 DOI: 10.3389/fresc.2021.724052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 01/22/2023]
Abstract
Osteoarthritis is the most common form of arthritis and is a substantial burden for patients with the disease. Currently, there is no cure for osteoarthritis, but many emerging therapies have been developed to aid in the mitigation of disease progression. When osteoarthritis reaches the end-stage of disease many patients undergo total joint arthroplasty to improve quality of life, yet some experience persistent pain and mobility limitations for extended periods following surgery. This review highlights recent therapeutic advancements in osteoarthritis treatment consisting of pharmacologics, nutraceuticals, biologics, and exercise while emphasizing the current state of post-arthroplasty rehabilitation.
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Affiliation(s)
- Devin Drummer
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jeremy McAdam
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Regina Seay
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Arny Ferrando
- Department of Geriatrics and Center for Translational Research in Aging and Longevity, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - S Louis Bridges
- Department of Medicine, Hospital for Special Surgery, New York, NY, United States.,Division of Rheumatology, Weill Cornell Medical Center, New York, NY, United States
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States.,Veterans Affairs Medical Center, Birmingham, AL, United States
| | - Marcas Bamman
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, United States.,Florida Institute for Human and Machine Cognition, Pensacola, FL, United States
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14
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Hayashi D, Roemer FW, Guermazi A. How to effectively utilize imaging in disease-modifying treatments for osteoarthritis clinical trials: the radiologist's perspective. Expert Rev Mol Diagn 2021; 21:673-684. [PMID: 34015975 DOI: 10.1080/14737159.2021.1933444] [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] [Indexed: 01/03/2023]
Abstract
Introduction: One of the reasons for failures of disease-modifying osteoarthritis drug clinical trials has been the radiography-based definition of structural eligibility criteria. Imaging, particularly MRI, has a critical role in planning and conducting clinical trials of osteoarthritis.Areas covered: A literature search was performed using keywords including 'osteoarthritis,' 'knee,' 'MRI,' 'intra-articular injection,' 'semiquantitative scoring,' 'clinical trial,' and other specific terms where relevant. The core concepts of using MRI in osteoarthritis clinical trials are explained focusing on knee osteoarthritis, including its role in determining patient eligibility and inclusion/exclusion criteria as well as outcome measures from the expert musculoskeletal radiologist's perspective. A brief overview of statistical analyses that should be deployed in clinical trials utilizing semiquantitative MRI analyses is discussed.Expert opinion: In order to increase chances to detect measurable efficacy effects, investigators should consider utilizing MRI from screening to outcome assessment. Recognition of several phenotypes of osteoarthritis helps in participant stratification and will lead to more targeted clinical trials. Inclusion and exclusion criteria need to be defined using not only radiography but also MRI. Correct intra-articular injection of investigational compounds is critically important if intra-articular drug delivery is required, and such procedure should be performed and documented using appropriate imaging guidance.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Stony Brook University, Renaissance School of Medicine, State University of New York, Stony Brook, NY, USA
| | - Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Veterans Affairs Boston Healthcare System, Boston, MA, USA
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15
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Ren H, Zhang S, Wang X, Li Z, Guo W. Role of platelet-rich plasma in the treatment of osteoarthritis: a meta-analysis. J Int Med Res 2021; 48:300060520964661. [PMID: 33111611 PMCID: PMC7645400 DOI: 10.1177/0300060520964661] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The clinical efficacy of platelet-rich plasma (PRP) in the treatment of osteoarthritis remains controversial. In this paper, we evaluated the clinical efficacy of PRP in the treatment of osteoarthritis using meta-analysis, providing evidence for the selection of clinical treatment options. METHODS We performed a computer-based search of PubMed, Embase, and the Cochrane Library databases to retrieve articles using the search terms "platelet-rich plasma", "osteoarthrosis", and "knee joint". Quality evaluation and data extraction were performed. The combined effect was assessed using RevMan 5.3 software. RESULTS Five randomized controlled trials, involving 320 patients, were included in this study. No significant differences were observed in the International Knee Documentation Committee score, visual analog scale (VAS) score, or the absolute value of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between the experimental and control groups. The absolute value of the VAS score and change in the WOMAC score were significantly decreased and patient satisfaction was increased in the experimental group, as compared with the control group. CONCLUSION The findings of this meta-analysis suggest that intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.
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Affiliation(s)
- Haijiang Ren
- School of Physical Education, Northeast Normal University, Changchun, Jilin Province, China
| | - Shouwei Zhang
- School of Physical Education, Northeast Normal University, Changchun, Jilin Province, China
| | - Xuejie Wang
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zehui Li
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Wenlai Guo
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, China
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16
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El-Gohary R, Diab A, El-Gendy H, Fahmy H, Gado KH. Using intra-articular allogenic lyophilized growth factors in primary knee osteoarthritis: a randomized pilot study. Regen Med 2021; 16:113-115. [PMID: 33754800 DOI: 10.2217/rme-2020-0104] [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: 11/21/2022] Open
Abstract
Objective: Investigating the safety in addition to clinical and structural efficacy of allogenic lyophilized growth factors (L-GFs) in patients with symptomatic primary knee osteoarthritis. Design: A prospective, open-label pilot study. A total of 31-patients randomized into non-intervention and intervention groups. Materials & methods: The intervention group received two intra-articular doses at baseline and after 2-months. Post-injection complications were documented, and the efficacy was assessed by Western Ontario and McMaster Universities Osteoarthritis Index scores and ultrasonography. Results: One dropout from the intervention group. The percentage of improvement of mean Western Ontario and McMaster Universities Osteoarthritis Index-scores and ultrasonography-detected effusion were statistically significant in the intervention group compared with the non-intervention. A brief, mild, post-injection pain was reported by all intervention group. Conclusion: This study provides the safety of intra-articular injection of allogenic L-GFs in knee osteoarthritis. The conclusion of efficacy was limited by small sample size and lack of control injection. Clinical trial registration: NCT04331327 (ClinicalTrials.gov, retrospectively registered).
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Affiliation(s)
- Rasmia El-Gohary
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
| | - Amany Diab
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
| | - Hala El-Gendy
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
| | - Hossam Fahmy
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Kamel Heshmat Gado
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
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17
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Hegaze AH, Hamdi AS, Alqrache A, Hegazy M. Efficacy of Platelet-Rich Plasma on Pain and Function in the Treatment of Knee Osteoarthritis: A Prospective Cohort Study. Cureus 2021; 13:e13909. [PMID: 33868853 PMCID: PMC8049383 DOI: 10.7759/cureus.13909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Osteoarthritis (OA) is a degenerative disease commonly affecting the knee joints. It affects patients socially, psychologically and economically and rates of the disease have been increasing due to obesity and old age. Regardless of choosing a medically conservative approach, it is a challenge in the long term to provide OA patients efficient treatment with minimal side effects and long-term efficiency. Platelet-rich plasma (PRP) is a convenient, low-cost and affordable treatment technique used in treating knee OA with encouraging efficient and safe outcomes. In this study we will investigate the effect of PRP on knee OA. Methods This is a prospective cohort study involving 252 patients with different OA grades. The Kellgren and Lawrence (K&L) system was used in classifying the affected knee by degenerative cartilage lesions as well as early and severe OA. All patients with a diagnosis of knee OA were screened in every visit before the injection, the pain was assessed by the 0-10 Numeric Rating Scale (NRS), and knee range of motion including flexion and extension was assessed by goniometer. Follow-up appointments were done on three-month intervals for a total of three visits for evaluation. Injection of PRP was given to all the patients with a maximum of four injections. The results were evaluated statistically according to the total number of follow-up visits. Results In grade II patients, the pain improved with the visits and the maximum improvement in flexion degree was noticed in patients who came for a total of three follow-up visits. In grade III patients, the most improvement in pain was in patients who came for three follow-up visits, while the most improvement in flexion degree was in patients who came for a total of two follow-up visits. Patients with grade IV who came for three follow-up visits showed the most improvement in pain and degree of flexion. Conclusions Intra-articular injections gave significant pain and flexion improvement in grades II, III and IV in OA patients, especially with multiple injection in the short-term follow-up. As a result, recommendation of repeated multiple injections up to four times is efficient in providing long time relief in knee OA.
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Affiliation(s)
- Adel H Hegaze
- Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Amre S Hamdi
- Department of Orthopedics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Mohamed Hegazy
- Trauma and Orthopedics, Independent Researcher, Private Sector, Heidelberg, DEU
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18
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Gilat R, Haunschild ED, Knapik DM, Evuarherhe A, Parvaresh KC, Cole BJ. Hyaluronic acid and platelet-rich plasma for the management of knee osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2020; 45:345-354. [PMID: 32935198 DOI: 10.1007/s00264-020-04801-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Symptomatic knee osteoarthritis (OA) remains a substantial cause of pain and disability worldwide and effective management in young patients without indications for total knee arthroplasty remains challenging. Intra-articular injections represent a viable option in the non-operative treatment of knee OA. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two commonly utilized intra-articular treatment modalities that are of particular clinical interest in the current literature. The purpose of this manuscript is to provide a concise review of the current literature on the use of HA, PRP, and HA-PRP conjugates for the treatment of symptomatic knee OA. METHODS A review of the literature utilizing PubMed, OVID/Medline, and Cochrane databases on basic science and clinical literature pertaining to preparation, composition, and outcomes of HA, PRP, and HA-PRP conjugates in patients with symptomatic knee OA. RESULTS Both HA and PRP have been shown to be efficacious for the treatment of symptomatic knee OA, with HA injections providing limited short-term improvement, while PRP may provide greater therapeutic relief, particularly with the use of leukocyte-poor (LP-PRP) formulations. Despite limited data, the combination of different formulations of HA-PRP conjugates may provide a synergistic effect, resulting in a clinically significant improvement in both pain and function. CONCLUSION In patients with symptomatic knee OA, intra-articular HA and PRP provide short-term improvement in pain and function, while the efficacy of HA-PRP conjugates warrants further study.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aghogho Evuarherhe
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
| | - Kevin C Parvaresh
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA.
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Acanfora C, Bruno F, Palumbo P, Arrigoni F, Natella R, Mazzei MA, Carotti M, Ruscitti P, Di Cesare E, Splendiani A, Giacomelli R, Masciocchi C, Barile A. Diagnostic and interventional radiology fundamentals of synovial pathology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:107-115. [PMID: 32945285 PMCID: PMC7944671 DOI: 10.23750/abm.v91i8-s.9993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/11/2020] [Indexed: 01/15/2023]
Abstract
The synovial membrane is a specialized mesenchymal tissue that lines the diarthrodial joints surfaces, bursae, and tendon sheaths of the body. This article aims to provide an overview of the fundamentals of synovial tissue, with particular regard to the imaging findings of the main pathologic processes that can affect the synovia and the role of image-guided interventions. (www.actabiomedica.it)
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Affiliation(s)
- Chiara Acanfora
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Pierpaolo Palumbo
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Raffaele Natella
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Marina Carotti
- Department of Radiology - Division of Special and Pediatric Radiology, University Hospital "Umberto I - Lancisi - Salesi", Ancona, Italy.
| | - Piero Ruscitti
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Roberto Giacomelli
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Antonio Barile
- Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
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20
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Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Are OMERACT Knee Osteoarthritis Ultrasound Scores Associated With Pain Severity, Other Symptoms, and Radiographic and Magnetic Resonance Imaging Findings? J Rheumatol 2020; 48:270-278. [PMID: 32414954 DOI: 10.3899/jrheum.191291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the associations of Outcome Measures in Rheumatology (OMERACT) ultrasound scores for knee osteoarthritis (OA) with pain severity, other symptoms, and OA severity on radiographs and magnetic resonance imaging (MRI). METHODS Participants with symptomatic and mild to moderate radiographic knee OA underwent baseline dynamic ultrasound (US) assessment according to standardized OMERACT scanning protocol. Using the published US image atlas, a physician operator obtained semiquantitative or binary scores for US pathologies. Clinical severity was measured on numerical rating scale (NRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscores. OA severity was assessed using the Kellgren-Lawrence (KL) grade on radiographs and MRI Osteoarthritis Knee Score (MOAKS) on noncontrast-enhanced MRI. Separate linear regression models were used to determine associations of US OA pathologies with pain and KOOS subscores, and Spearman correlations were used for US scores with KL grade and MOAKS. RESULTS Eighty-nine participants were included. Greater synovial hypertrophy, power Doppler (PD), and meniscal extrusion scores were associated with worse NRS pain [β 0.92 (95% CI 0.25-1.58), β 0.73 (95% CI 0.11-1.35), and β 1.01 (95% CI 0.22-1.80), respectively]. All greater US scores, except for cartilage grade, demonstrated significant associations with worse KOOS symptoms, whereas only PD and meniscal extrusion were associated with worse KOOS pain. All US scores, except for PD, were significantly correlated with KL grade. US pathologies, except for cartilage, revealed moderate to good correlation with their MOAKS counterparts, with US synovitis having the greatest correlation (0.69, 95% CI 0.60-0.78). CONCLUSION OMERACT US scores revealed significant associations with pain severity, KL grade, and MOAKS.
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Affiliation(s)
- Win Min Oo
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney;
| | - James M Linklater
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Kim L Bennell
- K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Danielle Pryke
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Shirley Yu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Kai Fu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Xia Wang
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Vicky Duong
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - David J Hunter
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
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21
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Kydd ASR, Hart DA. Efficacy and Safety of Platelet-Rich Plasma Injections for Osteoarthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00142-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Oo WM, Linklater JM, Bennell KL, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Superb Microvascular Imaging in Low-Grade Inflammation of Knee Osteoarthritis Compared With Power Doppler: Clinical, Radiographic and MRI Relationship. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:566-574. [PMID: 31917042 DOI: 10.1016/j.ultrasmedbio.2019.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
We compared the assessment of active synovitis in knee osteoarthritis (OA) by utilising superb microvascular imaging (SMI) and conventional power Doppler (cPD) techniques, and then correlated each technique with paients' symptoms, radiographic features and magnetic resonance imaging (MRI)-detected synovitis. A subgroup of participants with symptomatic knee OA underwent dynamic ultrasound assessment for semi-quantitative scores for SMI and cPD in the suprapatellar, medial and lateral parapatellar knee recesses. Knee pain and other symptoms were evaluated with the knee injury and osteoarthritis outcome score (KOOS). OA severity was assessed using the Kellgren and Lawrence grade (KLG) on radiograph and effusion-synovitis and Hoffa's synovitis score of MRI osteoarthritis knee score on non-contrast-enhanced MRI sequences. The χ2 test and κ statistics were conducted to compare detectability of SMI and cPD for low-grade inflammation, and the Spearman's correlation and Fisher's r to z transformation were conducted to compare correlations of both techniques with symptoms and imaging severity. A total of 89 participants were included in the analyses. SMI increased the detection rate by 25.5% for grade 0 cPD, by 35.4% for grade 1 cPD and by 9% for grade 2 cPD. SMI showed significant correlations with KOOS symptoms, KLG, MRI effusion-synovitis and Hoffa's synovitis scores (r = -0.24 [-0.45, -0.01]; r = 0.31 [0.10, 0.50]; r = 0.49 [0.33, 0.63]; and r = 0.54 [0.37, 0.68]). The cPD was significantly correlated with KOOS pain, other symptoms, MRI effusion-synovitis and Hoffa's synovitis (r = -0.23 [-0.44, -0.01]; r = -0.29 [-0.49, -0.06]; r = 0.46 [0.28, 61], r = 0.46 [0.25, 0.63]). However, no significant differences were detected in their extent of correlations. SMI can detect low-grade inflammation implicated in OA disease better than cPD and reveal a significant correlation with symptoms, radiographic features and MRI synovitis. The added clinical value of SMI over cPD is still not clear.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia.
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St. Leonards, Sydney, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Shirley Yu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
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23
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The Use of Higher Proportions of Platelet-Rich Plasma to Enrich Microfat Has Negative Effects. Plast Reconstr Surg 2020; 145:130-140. [DOI: 10.1097/prs.0000000000006406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Fang D, Jin P, Huang Q, Yang Y, Zhao J, Zheng L. Platelet-rich plasma promotes the regeneration of cartilage engineered by mesenchymal stem cells and collagen hydrogel via the TGF-β/SMAD signaling pathway. J Cell Physiol 2019; 234:15627-15637. [PMID: 30768719 DOI: 10.1002/jcp.28211] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 01/24/2023]
Abstract
The tissue engineering technique using mesenchymal stem cells (MSCs) and scaffolds is promising. Transforming growth factor-β1 (TGF-β1) is generally accepted as an chondrogenic agent, but immunorejection and unexpected side effects, such as tumorigenesis and heterogeneity, limit its clinical application. Autogenous platelet-rich plasma (PRP), marked by low immunogenicity, easy accessibility, and low-cost, may be favorable for cartilage regeneration. In our study, the effect of PRP on engineered cartilage constructed by MSCs and collagen hydrogel in vitro and in vivo was investigated and compared with TGF-β1. The results showed that PRP promoted cell proliferation and gene and protein expressions of chondrogenic markers via the TGF-β/SMAD signaling pathway. Meanwhile, it suppressed the expression of collagen type I, a marker of fibrocartilage. Furthermore, PRP accelerated cartilage regeneration on defects with engineered cartilage, advantageous over TGF-β1, as evaluated by histological analysis and immunohistochemical staining. Our work demonstrates that autogenous PRP may substitute TGF-β1 as a potent and reliable chondrogenic inducer for therapy of cartilage defect.
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Affiliation(s)
- Depeng Fang
- Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, People's Republic of China.,Orthopaedics, Langdong Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, People's Republic of China
| | - Pan Jin
- Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Key Laboratory of Regenerative Medicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China
| | - Quanxin Huang
- Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Key Laboratory of Regenerative Medicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China
| | - Yuan Yang
- Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Orthopaedics, Langdong Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Key Laboratory of Regenerative Medicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China
| | - Jinmin Zhao
- Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Key Laboratory of Regenerative Medicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China
| | - Li Zheng
- Guangxi Engineering Center in Biomedical Material for Tissue and Organ Regeneration, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China.,Guangxi Key Laboratory of Regenerative Medicine, Life Sciences Institute, Guangxi Medical University, Nanning, People's Republic of China
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25
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Comprehensive Treatment of Noninfectious Uveitis Accompanied by Macular Edema with the Use of Autologous Platelet-Rich Plasma. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.4.12] [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
Background. A common cause of visual impairment in patients with non-infectious uveitis is macular edema, developing in 38–84 % of cases. Plasma enriched with platelets is widely used in various branches of medicine, the effectiveness of its use in the treatment of non-infectious uveitis, accompanied by macular edema, has not been sufficiently investigated. Aim: To evaluate the effectiveness of autologous platelet-rich plasma in the complex treatment of non-infectious uveitis accompanied by macular edema.Material and methods. The study was conducted on the basis of the academician S.N. Fyodorov Eye Microsurgery Federal State Institution in the period from 2016 to 2018, which included 123 people (176 eyes) from 18 to 50 years with non-infectious uveitis, accompanied by macular edema: 46 men, 77 women. Patients were divided into 2 groups. The main group consisted of patients receiving autologous platelet-rich plasma and anti-inflammatory treatment; the comparison group consisted of patients receiving anti-inflammatory treatment. The results of visual acuity, intraocular pressure, biomicroophthalmoscopy, optical coherence tomography of the macular zone, microperimetry, ultrasound examination on the side of the affected eye were evaluated. Statistical processing of the data was carried out in the program Statistica 10.Results. Maintenance of autologous platelet-rich plasma contributes to a statistically significant improvement in visual acuity on the 10th day of treatment by 64.2 %, a decrease in the thickness of the retina in fovea by 36.3 % and an increase in retinal photosensitivity by 34.6 % compared to the group of patients receiving only anti-inflammatory treatment. Conclusions. The use of autologous platelet-rich plasma in the complex treatment of non-infectious uveitis allows to accelerate the natural mechanisms of tissue regeneration, contributing to the reduction of macular edema, and improve visual performance.
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Chondrogenic effect of liquid and gelled platelet lysate on canine adipose-derived mesenchymal stromal cells. Res Vet Sci 2019; 124:393-398. [PMID: 31077967 DOI: 10.1016/j.rvsc.2019.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 11/21/2022]
Abstract
Osteoarthritis associated with hip dysplasia is one of the most common orthopedic abnormalities in dogs, with an incidence of up to 40% in some breeds. Tissue therapy of cartilage has received great attention, with use of mesenchymal stromal cells and different types of biomaterials. The present study aimed to evaluate the effect of platelet lysate (PL) on the proliferation and differentiation of canine adipose tissue-derived mesenchymal stromal cells (ASCs), in liquid culture or hydrogels. PL was prepared from blood collected from healthy dogs and submitted to freezing-thawing cycles, and hydrogel was formed with canine thrombin. The effect of PL on the proliferation and differentiation of canine ASCs was evaluated in liquid and hydrogel systems, with microscopy, quantification of dsDNA, histology and quantification of glycosaminoglycans. The addition of 5% or 10% PL to the culture medium induced a greater proliferation rate than the presence of 10% fetal bovine serum. The cultivation of ASCs in PL gel, with normal or chondrogenic medium, resulted in maintenance of proliferation level similar to the conventional 2D cultivation, and induction of chondrogenic differentiation, especially in the presence of the chondrogenesis induction medium.
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Efficacy of Platelet-Rich Plasma Containing Xenogenic Adipose Tissue-Derived Stromal Cells on Restoring Intervertebral Disc Degeneration: A Preclinical Study in a Rabbit Model. Pain Res Manag 2019; 2019:6372356. [PMID: 31149318 PMCID: PMC6501249 DOI: 10.1155/2019/6372356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/08/2019] [Accepted: 03/05/2019] [Indexed: 01/08/2023]
Abstract
Objective Platelet-rich plasma (PRP) containing multiple growth factors is a promising strategy for disc degeneration. Thus, this study hypothesizes that the combination of PRP and adipose tissue-derived stromal cells (ADSCs) may repair degenerative disc more effectively than using each one of them alone. Methods The model of early intervertebral disc degeneration was induced by annular puncture in the New Zealand rabbit. Autologous PRP was extracted from fresh arterial blood by using two centrifugation techniques. ADSC was offered by the Center for Clinic Stem Cell Research. Four weeks after the first experiment, PRP or ADSCs or a combination of PRP and ADSCs was injected into the punctured intervertebral disc. Four weeks later, disc height and signal intensity on T2-weighted magnetic resonance imaging (MRI) were assessed. Results One month after puncture, we detected relatively narrow discs and lower signal intensity in MRI T2-weighted images. At four weeks after injection, the PRP-ADSC group statistically significantly restored discs, compared with PRP, ADSCs, or negative control group. Conclusions The combination of PRP and ADSCs shows an effective potential to restore degenerated intervertebral discs in the rabbit.
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