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Ivander G, Anggono Y. a comparison of intra-articular hyaluronic acid and platelet-rich plasma for knee osteoarthritis: a systematic review. Orthop Rev (Pavia) 2024; 16:94236. [PMID: 38435440 PMCID: PMC10908594 DOI: 10.52965/001c.94236] [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: 06/21/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Knee osteoarthritis (KOA), the most common chronic degenerative condition in an older population, accounts for many disabilities around the world. One of the most popular treatments is intra-articular injection of hyaluronic acid (HA) and platelet-rich plasma (PRP). Objective Prior studies have found that both HA and PRP had a therapeutic effect on KOA. This study aims to perform a systematic review regarding whether PRP is superior to HA for KOA. Method We conducted a comprehensive literature search using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for prospective randomized control trials (pRCTs) in three international databases PubMed, Google Scholar, and ScienceDirect from 2019-2022. Two researchers independently searched the reviews, extracted, and cross-checked the data. The disparity when choosing the literature was resolved by discussion. The modified Jadad was scale used to assess the quality of the included studies. Cochrane risk of bias 2 tool (RoB-2) was used for determininzg risk of bias. Results Twenty three studies were eligible for inclusion. Four pRCT with the highest Jadad score were selected as best evidence. Risk of bias assesment concluded two studies having a low risk of bias, one is high risk of bias, and the other possesses some concerns.. Three studies found no difference in patient-reported outcomes between PRP and HA group and one study concluded that PRP is more effective than HA in treating KOA. Conclusion Intra-articular injections of PRP and HA are effective interventions for KOA. However, there is not enough evidence of PRP superiority over HA.
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Affiliation(s)
- Gian Ivander
- Orthopedic Universitas Katolik Widya Mandala Surabaya
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2
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Lu J, Li H, Zhang Z, Xu R, Wang J, Jin H. Platelet-rich plasma in the pathologic processes of tendinopathy: a review of basic science studies. Front Bioeng Biotechnol 2023; 11:1187974. [PMID: 37545895 PMCID: PMC10401606 DOI: 10.3389/fbioe.2023.1187974] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.
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Affiliation(s)
- Jialin Lu
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Han Li
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Ziyu Zhang
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Rui Xu
- Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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3
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Foreman M, Foster D, Kioutchoukova I, Lucke-Wold B. The Role of Platelet-Rich Plasma Therapy in Joint Arthroplasty A Mini-Review. JOURNAL OF MEDICAL CLINICAL CASE REPORTS 2023; 5:1-6. [PMID: 37795457 PMCID: PMC10550165 DOI: 10.47485/2767-5416.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Orthobiologics are playing an increasingly large role in the clinical setting across multiple fields of surgery. Particularly, in the field of orthopedic surgery, the employment of platelet-rich plasma (PRP) therapy in total joint arthroscopy (TJA) has become popular for its prompted benefits of controlling pain, blood loss, and increased wound healing. PRP was originally used for thrombolytic conditions, however, the aforementioned potential benefits have led to its increased use across various fields of medicine including dermatology, neurosurgery, orthopedics, and sports medicine. Currently, there is a persisting gap in the literature surrounding the mechanism of action of PRP, as well as its true role in increasing positive patient outcomes in the context of TJA. Thus, this review aims to briefly highlight the physiological mechanisms underlining PRP therapy, evaluate recent preclinical and clinical data about its effects on TJA patient outcomes, and to describe its concomitant use in novel orthopedic-applications.
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Affiliation(s)
- Marco Foreman
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610 USA
| | - Devon Foster
- Herbert Wertheim College of Medicine, Miami, FL, 33199 USA
| | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32610 USA
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4
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Baltzer AW, Casadonte R, Korff A, Baltzer LM, Kriegsmann K, Kriegsmann M, Kriegsmann J. Biological injection therapy with leukocyte-poor platelet-rich plasma induces cellular alterations, enhancement of lubricin, and inflammatory downregulation in vivo in human knees: A controlled, prospective human clinical trial based on mass spectrometry imaging analysis. Front Surg 2023; 10:1169112. [PMID: 37151865 PMCID: PMC10160617 DOI: 10.3389/fsurg.2023.1169112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Objective To investigate the in vivo biological effects of leukocyte-poor platelet-rich plasma (LpPRP) treatment in human synovial layer to establish the cellular basis for a prolonged clinical improvement. Methods Synovial tissues (n = 367) were prospectively collected from patients undergoing arthroscopic surgery. Autologous-conditioned plasma, LpPRP, was injected into the knees of 163 patients 1-7 days before surgery to reduce operative trauma and inflammation, and to induce the onset of regeneration. A total of 204 patients did not receive any injection. All samples were analyzed by mass spectrometry imaging. Data analysis was evaluated by clustering, classification, and investigation of predictive peptides. Peptide identification was done by tandem mass spectrometry and database matching. Results Data analysis revealed two major clusters belonging to LpPRP-treated (LpPRP-1) and untreated (LpPRP-0) patients. Classification analysis showed a discrimination accuracy of 82%-90%. We identified discriminating peptides for CD45 and CD29 receptors (receptor-type tyrosine-protein phosphatase C and integrin beta 1), indicating an enhancement of musculoskeletal stem cells, as well as an enhancement of lubricin, collagen alpha-1-(I) chain, and interleukin-receptor-17-E, dampening the inflammatory reaction in the LpPRP-1 group following LpPRP injection. Conclusions We could demonstrate for the first time that injection therapy using "autologic-conditioned biologics" may lead to cellular changes in the synovial membrane that might explain the reported prolonged beneficial clinical effects. Here, we show in vivo cellular changes, possibly based on muscular skeletal stem cell alterations, in the synovial layer. The gliding capacities of joints might be improved by enhancing of lubricin, anti-inflammation by activation of interleukin-17 receptor E, and reduction of the inflammatory process by blocking interleukin-17.
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Affiliation(s)
- Axel W. Baltzer
- Center for Molecular Orthopaedics, MVZ Ortho Koenigsallee, Düsseldorf, Germany
- Correspondence: Axel W. Baltzer
| | - Rita Casadonte
- Imaging Mass Spectrometry, Proteopath GmbH, Trier, Germany
| | - Alexei Korff
- Center for Molecular Orthopaedics, MVZ Ortho Koenigsallee, Düsseldorf, Germany
| | | | - Katharina Kriegsmann
- Department for Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - Mark Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Germany Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research (DZL), Heidelberg, Germany
| | - Jörg Kriegsmann
- Imaging Mass Spectrometry, Proteopath GmbH, Trier, Germany
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
- Department of Medicine, Faculty of Medicine/Dentistry, Danube Private University, Krems, Austria
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5
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Jorge DDMF, Huber SC, Rodrigues BL, Da Fonseca LF, Azzini GOM, Parada CA, Paulus-Romero C, Lana JFSD. The Mechanism of Action between Pulsed Radiofrequency and Orthobiologics: Is There a Synergistic Effect? Int J Mol Sci 2022; 23:ijms231911726. [PMID: 36233026 PMCID: PMC9570243 DOI: 10.3390/ijms231911726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022] Open
Abstract
Radiofrequency energy is a common treatment modality for chronic pain. While there are different forms of radiofrequency-based therapeutics, the common concept is the generation of an electromagnetic field in the applied area, that can result in neuromodulation (pulsed radiofrequency—PRF) or ablation. Our specific focus relates to PRF due to the possibility of modulation that is in accordance with the mechanisms of action of orthobiologics. The proposed mechanism of action of PRF pertaining to pain relief relies on a decrease in pro-inflammatory cytokines, an increase in cytosolic calcium concentration, a general effect on the immune system, and a reduction in the formation of free radical molecules. The primary known properties of orthobiologics constitute the release of growth factors, a stimulus for endogenous repair, analgesia, and improvement of the function of the injured area. In this review, we described the mechanism of action of both treatments and pertinent scientific references to the use of the combination of PRF and orthobiologics. Our hypothesis is a synergic effect with the combination of both techniques which could benefit patients and improve the life quality.
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Affiliation(s)
| | - Stephany Cares Huber
- Orthoregen International Course—Avenida Presidente Kennedy, 1386, Cidade Nova I, Indaiatuba 13334-170, Brazil
| | - Bruno Lima Rodrigues
- Orthoregen International Course—Avenida Presidente Kennedy, 1386, Cidade Nova I, Indaiatuba 13334-170, Brazil
| | - Lucas Furtado Da Fonseca
- Orthopaedic Department, Universidade Federal de São Paulo, 715 Napoleão de Barros St-Vila Clementino, São Paulo 04024-002, Brazil
| | - Gabriel Ohana Marques Azzini
- Department of Orthopaedics, Brazilian Institute of Regenerative Medicine, Cidade Nova I, Indaiatuba 13334-170, Brazil
| | - Carlos Amilcar Parada
- Laboratory of Study of Pain, Department of Structural and Functional Biology, University of Campinas, Rua Monteiro Lobato, 255, Campinas 13083-862, Brazil
| | - Christian Paulus-Romero
- American Academy of Regenerative Medicine, 14405 West Colfax Avenue, #291, Lakewood, CO 80401, USA
| | - José Fábio Santos Duarte Lana
- Orthoregen International Course—Avenida Presidente Kennedy, 1386, Cidade Nova I, Indaiatuba 13334-170, Brazil
- Department of Orthopaedics, Brazilian Institute of Regenerative Medicine, Cidade Nova I, Indaiatuba 13334-170, Brazil
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6
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Biological Targets of Multimolecular Therapies in Middle-Age Osteoarthritis. Sports Med Arthrosc Rev 2022; 30:141-146. [PMID: 35921596 DOI: 10.1097/jsa.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Knee osteoarthritis (OA) is a common condition, prevalent in middle-agedness, associated with chronic pain and impaired quality of life. Two interrelated biological processes fuel early OA progression: inflammation and structural tissues catabolism. Procatabolic and proinflammatory mediators are interconnected and form part of a self-perpetuating loop. They leverage OA research complexity because of the impossibility to discern certain spatiotemporal tissues' changes from others. Both are shared targets of versatile regenerative multimolecular therapies. In particular, platelet-rich plasma can interfere with inflammation and inflammatory pain. The therapeutic approach is to alter the vicious inflammatory loop by modifying the molecular composition of the synovial fluid, thereby paracrine cellular cross talk. Intra-articular injections of platelet-rich plasma can provide key factors balancing proinflammatory and anti-inflammatory factors, targeting macrophage dysfunction and modulating immune mechanisms within the knee.
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7
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Orthobiologics for the Management of Early Arthritis in the Middle-Aged Athlete. Sports Med Arthrosc Rev 2022; 30:e9-e16. [PMID: 35533063 DOI: 10.1097/jsa.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article is dedicated to the use of orthobiologic therapies in the management of early osteoarthritis in middle-aged athletes. Understanding a patient's presenting symptoms, physical examination, imaging results, and goals is of critical importance in applying orthobiologic therapies. The field of orthobiologics is expanding at a rapid pace, and the clinical studies examining the utility of each treatment lag behind the direct-to-consumer marketing that leads to these products being used. Here we provide a review of the available treatments, emerging treatments, and the current literature supporting or refuting their use. Currently studied orthobiologics include autologous and allogenic cell therapies, autologous blood products, hyaluronic acid, gene therapies, Wnt inhibitors, and a variety of systemic treatments.
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8
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Zitsch BP, James CR, Crist BD, Stoker AM, Della Rocca GJ, Cook JL. A prospective randomized double-blind clinical trial to assess the effects of leukocyte-reduced platelet-rich plasma on pro-inflammatory, degradative, and anabolic biomarkers after closed pilon fractures. J Orthop Res 2022; 40:925-932. [PMID: 34185333 DOI: 10.1002/jor.25123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/19/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Posttraumatic osteoarthritis (PTOA) significantly affects patients with pilon fractures even after adequate anatomical reduction, and treatment strategies targeting the biologic mediators of PTOA are needed. This study was designed to determine the effects of intra-articular injection of platelet-rich plasma (PRP) on synovial fluid (SF) biomarkers for patients undergoing open reduction and internal fixation (ORIF) of pilon fractures. Patients undergoing staged management of pilon fractures were enrolled in a prospective, double-blinded, randomized, and placebo-controlled clinical trial to determine the effects of a single intra-articular injection of leukocyte-reduced PRP on SF biomarkers. Arthrocentesis of the injured and uninjured ankles was performed at the time of external skeletal fixation (ESF) and ORIF. Patients were randomized to receive either autogenous leukocyte-reduced PRP or saline (control) via intra-articular injection into the injured ankle at the time of ESF. SF biomarker concentrations were compared-uninjured, injured pretreatment, and saline-injected or PRP-injected. Eleven patients (PRP, n = 5; saline, n = 6) completed the study. Twenty-one uninjured, and 11 injured pretreatment, five PRP-treated, and six saline-treated SF samples were analyzed. PRP-treated SF contained significantly higher levels of PDGF-AA (p = 0.046) and significantly lower levels of MMP-3 (p = 0.042), MMP-9 (p = 0.009), IL-1β (p = 0.049), IL-6 (p < 0.01), IL-8 (p = 0.048), and PGE2 (p < 0.04). This study provided mechanistic data to suggest that a single intraarticular injection of leukocyte-reduced PRP is associated with anti-inflammatory, anti-degradative, and anabolic responses compared with saline control. These findings provide the impetus for investigating long-term clinical outcomes after PRP injection as an orthobiologic adjunct to ORIF for mitigating the incidence and severity of PTOA after pilon fractures.
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Affiliation(s)
| | - Christopher R James
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Aaron M Stoker
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | | | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA.,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
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9
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Tramś E, Malesa K, Pomianowski S, Kamiński R. Role of Platelets in Osteoarthritis-Updated Systematic Review and Meta-Analysis on the Role of Platelet-Rich Plasma in Osteoarthritis. Cells 2022; 11:1080. [PMID: 35406644 PMCID: PMC8997794 DOI: 10.3390/cells11071080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 01/15/2023] Open
Abstract
Platelets are an essential component of hemostasis, with an increasing role in host inflammatory processes in injured tissues. The reaction between receptors and vascular endothelial cells results in the recruitment of platelets in the immune response pathway. The aim of the present review is to describe the role of platelets in osteoarthritis. Platelets induce secretion of biological substances, many of which are key players in the inflammatory response in osteoarthritis. Molecules involved in cartilage degeneration, or being markers of inflammation in osteoarthritis, are cytokines, such as tumor necrosis factor α (TNFα), interleukins (IL), type II collagen, aggrecan, and metalloproteinases. Surprisingly, platelets may also be used as a treatment modality for osteoarthritis. Multiple randomized controlled trials included in our systematic review and meta-analyses prove the effectiveness of platelet-rich plasma (PRP) as a minimally invasive method of pain alleviation in osteoarthritis treatment.
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Affiliation(s)
| | | | | | - Rafał Kamiński
- Centre of Postgraduate Medical Education, Department of Orthopaedics and Trauma Surgery, Professor A. Gruca Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland; (E.T.); (K.M.); (S.P.)
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10
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Migliorini F, Cuozzo F, Cipollaro L, Oliva F, Hildebrand F, Maffulli N. Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis. J Orthop Traumatol 2022; 23:8. [PMID: 35129728 PMCID: PMC8821738 DOI: 10.1186/s10195-022-00630-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/25/2022] [Indexed: 01/10/2023] Open
Abstract
Background The efficacy and safety of platelet-rich plasma (PRP) augmentation for arthroscopic meniscal repair is controversial. This meta-analysis compared arthroscopic meniscal repair performed in isolation or augmented with PRP. Methods The present study was conducted according to PRISMA 2020 guidelines. Pubmed, Web of Science, Google Scholar and Embase were accessed in August 2021. All the clinical trials which compared arthroscopic meniscal repair performed in isolation or augmented with PRP were included. Results Eight hundred thirty-seven patients were included: 38% (318 of 837 patients) were women; the mean age of the patients was 35.6 (range, 20.8–64.3) years; the mean follow-up was 26.2 (range, 6–54) months. Similarity was found in analogue scale (VAS) (P = 0.5) and Lysholm (P = 0.9), and International Knee Documentation Committee (IKDC) scores (P = 0.9). Similarity was found in the rate of failure (P = 0.4) and rate of revision (P = 0.07). Conclusion The current published scientific evidence does not support PRP augmentation for arthroscopic meniscal repair.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Lucio Cipollaro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy.,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke on Trent, England.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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11
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Melnikov DV, Kirillova KA, Zakharenko AS, Sinelnikov MY, Ragimov AA, Istranov AL, Startseva OI. Effect of Cryo-Processing on Platelet-Rich Autoplasma Preparations. Sovrem Tekhnologii Med 2021; 12:54-60. [PMID: 34796019 PMCID: PMC8596230 DOI: 10.17691/stm2020.12.6.07] [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] [Received: 05/17/2020] [Indexed: 11/28/2022] Open
Abstract
Platelet-derived growth factor (PDGF) plays an important role in angiogenesis, affects activation of migration and proliferation of mesenchymal stem cells, fibroblasts, smooth muscle cells, osteoblasts; activation of migration of monocytes, macrophages, and neutrophils. The aim of the investigation was to study the effect of cryo-processing on the qualitative properties of platelet-rich autoplasma (PRP) at different time intervals.
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Affiliation(s)
- D V Melnikov
- Associate Professor, Department of Oncology, Radiotherapy and Plastic Surgery; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
| | - K A Kirillova
- Junior Researcher, Department of Oncology, Radiotherapy and Plastic Surgery; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
| | - A S Zakharenko
- Junior Researcher, Department of Oncology, Radiotherapy and Plastic Surgery; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
| | - M Y Sinelnikov
- Junior Researcher, Institute of Regenerative Medicine; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
| | - A A Ragimov
- Professor, Department of Clinical Transfusion Medicine; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
| | - A L Istranov
- Professor, Department of Oncology, Radiotherapy and Plastic Surgery; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
| | - O I Startseva
- Professor, Department of Oncology, Radiotherapy and Plastic Surgery I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., Moscow, 119991, Russia
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12
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Zhang K, Li Z, Lu Y, Xiang L, Sun J, Zhang H. Silencing of Vangl2 attenuates the inflammation promoted by Wnt5a via MAPK and NF-κB pathway in chondrocytes. J Orthop Surg Res 2021; 16:136. [PMID: 33588909 PMCID: PMC7883434 DOI: 10.1186/s13018-021-02268-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Wnt planar cell polarity (PCP) pathway is implicated in osteoarthritis (OA) both in animals and in humans. Van Gogh-like 2 (Vangl2) is a key PCP protein that is required for the orientation and alignment of chondrocytes in the growth plate. However, its functional roles in OA still remain undefined. Here, we explored the effects of Vangl2 on OA chondrocyte in vitro and further elucidated the molecular mechanism of silencing Vangl2 in Wnt5a-overexpressing OA chondrocytes. METHODS Chondrocytes were treated with IL-1β (10 ng/mL) to simulate the inflammatory microenvironment of OA. The expression levels of Vangl2, Wnt5a, MMPs, and related proinflammatory cytokines were measured by RT-qPCR. Small interfering RNA (siRNA) of Vangl2 and the plasmid targeting Wnt5a were constructed and transfected into ATDC5 cells. Then, the functional roles of silencing Vangl2 in the OA chondrocytes were investigated by Western blotting, RT-qPCR, and immunocytochemistry (ICC). Transfected OA chondrocytes were subjected to Western blotting to analyze the relationship between Vangl2 and related signaling pathways. RESULTS IL-1β induced the production of Vangl2, Wnt5a, and MMPs in a time-dependent manner and the significantly increased expression of Vangl2. Vangl2 silencing effectively suppressed the expression of MMP3, MMP9, MMP13, and IL-6 at both gene and protein levels and upregulated the expression of type II collagen and aggrecan. Moreover, knockdown of Vangl2 inhibited the phosphorylation of MAPK signaling molecules (P38, ERK, and JNK) and P65 in Wnt5a-overexpressing OA chondrocytes. CONCLUSIONS For the first time, we demonstrate that Vangl2 is involved in the OA process. Vangl2 silencing can notably alleviate OA progression in vitro by inhibiting the expression of MMPs and increasing the formation of the cartilage matrix and can inhibit the proinflammatory effects of Wnt5a via MAPK and NF-κB pathway. This study provides new insight into the mechanism of cartilage inflammation.
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Affiliation(s)
- Ke Zhang
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, No.56 Lingyuan West Road, Guangzhou, 510055, Guangdong, People's Republic of China
| | - Zhuoying Li
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, No.56 Lingyuan West Road, Guangzhou, 510055, Guangdong, People's Republic of China
| | - Yunyang Lu
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, No.56 Lingyuan West Road, Guangzhou, 510055, Guangdong, People's Republic of China
| | - Linyi Xiang
- Department of Stomatology, Binhaiwan Central Hospital of Dongguan (also called The Fifth People's Hospital of Dongguan), The Dongguan Affiliated Hospital of Medical College of Jinan University, No.111 Humen Road, Humen Town, Dongguan City, 523905, Guangdong Province, People's Republic of China
| | - Jiadong Sun
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, No.56 Lingyuan West Road, Guangzhou, 510055, Guangdong, People's Republic of China
| | - Hong Zhang
- Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, No.56 Lingyuan West Road, Guangzhou, 510055, Guangdong, People's Republic of China.
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Choi MH, Blanco A, Stealey S, Duan X, Case N, Sell SA, Rai MF, Zustiak SP. Micro-Clotting of Platelet-Rich Plasma Upon Loading in Hydrogel Microspheres Leads to Prolonged Protein Release and Slower Microsphere Degradation. Polymers (Basel) 2020; 12:E1712. [PMID: 32751604 PMCID: PMC7464943 DOI: 10.3390/polym12081712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022] Open
Abstract
Platelet-rich plasma (PRP) is an autologous blood product that contains a variety of growth factors (GFs) that are released upon platelet activation. Despite some therapeutic potential of PRP in vitro, in vivo data are not convincing. Bolus injection of PRP is cleared rapidly from the body diminishing its therapeutic efficacy. This highlights a need for a delivery vehicle for a sustained release of PRP to improve its therapeutic effect. In this study, we used microfluidics to fabricate biodegradable PRP-loaded polyethylene glycol (PEG) microspheres. PRP was incorporated into the microspheres as a lyophilized PRP powder either as is (powder PRP) or first solubilized and pre-clotted to remove clots (liquid PRP). A high PRP loading of 10% w/v was achieved for both PRP preparations. We characterized the properties of the resulting PRP-loaded PEG microspheres including swelling, modulus, degradation, and protein release as a function of PRP loading and preparation. Overall, loading powder PRP into the PEG microspheres significantly affected the properties of microspheres, with the most pronounced effect noted in degradation. We further determined that microsphere degradation in the presence of powder PRP was affected by platelet aggregation and clotting. Platelet aggregation did not prevent but prolonged sustained PRP release from the microspheres. The delivery system developed and characterized herein could be useful for the loading and releasing of PRP to promote tissue regeneration and wound healing or to suppress tissue degeneration in osteoarthritis, and intervertebral disc degeneration.
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Affiliation(s)
- Miran Hannah Choi
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Alexandra Blanco
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Samuel Stealey
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Xin Duan
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, MO 63110, USA; (X.D.); (M.F.R.)
| | - Natasha Case
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Scott Allen Sell
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
| | - Muhammad Farooq Rai
- Department of Orthopedic Surgery, Washington University in St. Louis, School of Medicine, Saint Louis, MO 63110, USA; (X.D.); (M.F.R.)
- Department of Cell Biology & Physiology, Washington University in St. Louis, School of Medicine, Saint Louis, MO 63110, USA
| | - Silviya Petrova Zustiak
- Program of Biomedical Engineering, School of Engineering, Saint Louis University, Saint Louis, MO 63103, USA; (M.H.C.); (A.B.); (S.S.); (N.C.); (S.A.S.)
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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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16
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Rasheed N, Hafeez K, Zaidi IH, Askari R, Rasheed N, Khani GMK. Role of platelet-rich plasma in early osteoarthritis of knee joint: Experience from a tertiary care center in Pakistan. J Orthop Surg (Hong Kong) 2020; 27:2309499019853953. [PMID: 31177908 DOI: 10.1177/2309499019853953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Osteoarthritis is the most common articular disease. The aim of this study was to observe the outcome after intra-articular platelet-rich plasma (PRP) injection in our patients presenting with knee osteoarthritis. METHODS This study was conducted in Dow University of Health Sciences, Karachi, Pakistan, from December 2014 to December 2015. All patients between 35 years and 60 years of age diagnosed with grade I and II arthritis were included in the study. Three PRP injections were injected in the knees at 4-week interval. Patients were followed up in outpatient department (OPD) and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. RESULTS Two hundred fourteen patients with the mean age of 55.15 (±6.93) years were studied. Female to male ratio was 3:1. One hundred fifty-five patients were classified as having Kellgren-Lawrence grade 1 osteoarthritis, while 59 were grade 2. One hundred eighty-nine patients had clinical symptoms for less than 2 years and 25 for more than 2 years. Mean WOMAC score before the start of treatment was 83.05, and after 6 months, it was reduced to 38.84 which was statistically significant ( p = 0.000). WOMAC score was improved more in the subgroup with patients having symptoms less than 2 years ( p = 0.005). Three patients developed minor hyperemia which was managed conservatively with activity limitation and ice application, but none of the patient developed gross infection. CONCLUSION The sequential use of PRP injection for the treatment of early osteoarthritis proved to be effective in our study.
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Affiliation(s)
- Nusrat Rasheed
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
| | - Kamran Hafeez
- 2 Department of Orthopedics, Buraidah Central Hospital, Al Qassim, Saudi Arabia
| | - Itat Hussain Zaidi
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
| | - Raza Askari
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
| | - Naseem Rasheed
- 3 Department of Gynecology and Obstetrics, Sindh Government Hospital, Karachi, Pakistan
| | - Ghulam Mustafa Kaim Khani
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
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Du R, Lei T. Effects of autologous platelet-rich plasma injections on facial skin rejuvenation. Exp Ther Med 2020; 19:3024-3030. [PMID: 32256789 PMCID: PMC7086200 DOI: 10.3892/etm.2020.8531] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022] Open
Abstract
Autologous serum platelet-rich plasma (PRP) has been used to rejuvenate wrinkled and aged skin for years; however, the molecular mechanism for the positive effects of PRP on the skin remains unclear. The present study aimed to clarify the potential molecular mechanisms for the role of PRP in wrinkled and aged skin rejuvenation, and provide evidence for future clinical applications. A total of 30 healthy females were recruited for PRP treatment and signed informed consent was obtained. A total of 3 autologous PRP injections were administered to each patient with 15-day intervals between injections. The effects of PRP injections were evaluated using the VISIA® Complexion Analysis System and skin computed tomography. A human organotypic skin model was established and treated with PBS or PRP before ultraviolet (UV)-B light (10 mJ/cm2) irradiation. The distribution of the epidermal structure and dermal fibers were analyzed by hematoxylin and eosin and Masson's trichome staining. Expression of matrix metalloproteinase-1 (MMP-1), tyrosinase, fibrillin and tropoelastin was detected by reverse transcription-quantitative PCR, western blotting and immunofluorescence. The present results showed that PRP treatment improved skin quality in the participants. In addition, the VISIA® results showed that wrinkles, texture and pores were decreased in the PRP groups compared with the PBS treatment. The in vitro study demonstrated that PRP treatment ameliorated photoaging by inhibiting UV-B-induced MMP-1 and tyrosinase upregulation, and by inducing fibrillin and tropoelastin expression that was downregulated by UV-B. Collectively, it was demonstrated that PRP treatment ameliorated skin photoaging through regulation of MMP-1, tyrosinase, fibrillin and tropoelastin expression.
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Affiliation(s)
- Rina Du
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China.,Department of Dermatology, Inner Mongolia International Mongolian Hospital, Hohhot, Inner Mongolia 010010, P.R. China
| | - Tiechi Lei
- Department of Dermatology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Andia I, Maffulli N. New biotechnologies for musculoskeletal injuries. Surgeon 2019; 17:244-255. [DOI: 10.1016/j.surge.2018.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/12/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022]
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Liu F, Xu H, Huang H. A novel kartogenin-platelet-rich plasma gel enhances chondrogenesis of bone marrow mesenchymal stem cells in vitro and promotes wounded meniscus healing in vivo. Stem Cell Res Ther 2019; 10:201. [PMID: 31287023 PMCID: PMC6615105 DOI: 10.1186/s13287-019-1314-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background The meniscus tear is one of the most common knee injuries particularly seen in athletes and aging populations. Subchondral bone sclerosis, irreparable joint damage, and the early onset of osteoarthritis make the injured meniscus heal difficultly. Methods The study was performed by in vitro and in vivo experiments. The in vitro experiments were carried out using the bone marrow stem cells (BMSCs) isolated from the rabbits, and the stemness of the BMSCs was tested by immunostaining. The BMSCs positively expressed stem cell markers were cultured with various concentrations of kartogenin (KGN) for 2 weeks. The chondrogenesis of BMSCs induced by KGN was examined by histochemical staining and quantitative RT-PCR. The in vivo experiments were completed by a rabbit model. Three holes were created in each meniscus by a biopsy punch. The rabbits were treated with four different conditions in each group. Group 1 was treated with 20 μl of saline (saline); group 2 was treated with 5 μl of 100 μM KGN and 15 μl saline (KGN); group 3 was treated with 5 μl of 100 μM KGN, 5 μl of 10,000 U/ ml thrombin, and 10 μl of PRP (KGN+PRP); group 4 was treated with 10,000 BMSCs in 10 μl of PRP, 5 μl of saline solution, and 5 μl of 10,000 U/ml thrombin (PRP+BMSC); group 5 was treated with 10,000 BMSCs in 10 μl of PRP, 5 μl of 100 μM KGN, and 5 μl of 10,000 U/ml thrombin (KGN+PRP+BMSC). The menisci were collected at day 90 post-surgery for gross inspection and histochemical analysis. Results The histochemical staining showed that KGN induced chondrogenesis of BMSCs in a concentration-dependent manner. The RT-PCR results indicated that chondrocyte-related genes were also increased in the BMSCs cultured with KGN in a dose-dependent manner. The in vivo results showed that large unhealed wound areas were still found in the wounds treated with saline and KGN groups. The wounds treated with BMSCs-containing PRP gel healed much faster than the wounds treated without BMSCs. Furthermore, the wounds treated with BMSCs-containing KGN-PRP gel have healed completely and formed more cartilage-like tissues than the wounds treated with BMSCs-containing PRP gel. Conclusions BMSCs could be differentiated into chondrocytes when they were cultured with KGN-PRP gel in vitro and formed more cartilage-like tissues in the wounded rabbit meniscus when the wounds were treated with BMSCs-containing KGN-PRP gel. The results indicated that the BMSCs-containing KGN-PRP gel is a good substitute for injured meniscus repair and regeneration.
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Affiliation(s)
- Feng Liu
- Department of Orthopaedics, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hongyao Xu
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - He Huang
- Department of Sports Medicine and Joint Surgery, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China. .,China Orthopaedic Regeneration Medicine Group, Zhejiang, 310000, Hangzhou, China.
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20
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Yan L, Zhou L, Xie D, Du W, Chen F, Yuan Q, Tong P, Shan L, Efferth T. Chondroprotective effects of platelet lysate towards monoiodoacetate-induced arthritis by suppression of TNF-α-induced activation of NF-ĸB pathway in chondrocytes. Aging (Albany NY) 2019; 11:2797-2811. [PMID: 31089001 PMCID: PMC6535074 DOI: 10.18632/aging.101952] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/02/2019] [Indexed: 12/14/2022]
Abstract
Platelet lysate (PL) contains a cocktail of growth factors that actively participates in cartilage repair. This study was designed to determine the effect and mechanism of PL on osteoarthritis (OA). An arthritis model was established to mimic human OA by intra-articular injection of monoiodoacetate (MIA) to Sprague Dawley (SD) rats. The model was weekly treated with PL by intra-articular injection. Thermal withdrawal latency, mechanical withdrawal threshold, and treadmill gait were tested for pain behavior observation. Histopathological and immunohistochemical analyses were conducted for evaluating cartilage degradation. Real time PCRs and Western blots were conducted to elucidate the mechanism of PL on primary chondrocytes. Results showed that, in vivo, PL significantly attenuated pain symptoms and exerted chondrocyte-protective and extracellular matrix (ECM)-modifying effect on the arthritic cartilage in a dose-dependent manner. The in situ expressions of type II Collagen (Col2) and matrix metalloproteinase 13 (Mmp13) in the arthritic cartilage was abnormal and was restored by PL. In vitro, PL significantly restored tumor necrosis factor α (TNF-α)-suppressed anabolic gene expression (Col2 and aggrecan) and TNF-α-increased catabolic gene expression (Col10, Mmp13, Adamts5, and Adamts9) in chondrocytes. The effects were mediated by TNF-α downstream signaling, including inhibition of NF-κB and c-Jun activities. This study provides certain knowledge of anti-OA effect and TNF signaling-related mechanism of PL, placing it as a promising and alternative option for OA therapy in the future.
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Affiliation(s)
- Li Yan
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
- Center for Stem Cell Translational Research, Zhejiang Chinese Medical University, Hangzhou, China
- Equal contribution
| | - Li Zhou
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
- Center for Stem Cell Translational Research, Zhejiang Chinese Medical University, Hangzhou, China
- Equal contribution
| | - Danting Xie
- Center for Stem Cell Translational Research, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenxi Du
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fangming Chen
- Academy of Chinese Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qiang Yuan
- College of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Peijian Tong
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Letian Shan
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
- Center for Stem Cell Translational Research, Zhejiang Chinese Medical University, Hangzhou, China
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
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Yanasse RH, De Lábio RW, Marques L, Fukasawa JT, Segato R, Kinoshita A, Matsumoto MA, Felisbino SL, Solano B, Dos Santos RR, Payão SLM. Xenotransplantation of human dental pulp stem cells in platelet-rich plasma for the treatment of full-thickness articular cartilage defects in a rabbit model. Exp Ther Med 2019; 17:4344-4356. [PMID: 31186677 PMCID: PMC6507499 DOI: 10.3892/etm.2019.7499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 03/09/2018] [Indexed: 12/15/2022] Open
Abstract
Stem cells in platelet-rich plasma (PRP) scaffolds may be a promising treatment for cartilage repair. Human dental pulp stem cell (hDPSC) subpopulations have been identified to have substantial angiogenic, neurogenic and regenerative potential when compared with other stem cell sources. The present study evaluated the potential of hDPSCs in a PRP scaffold to regenerate full-thickness cartilage defects in rabbits. Full-thickness articular cartilage defects were created in the patellar groove of the femur of 30 rabbits allocated into three experimental groups: Those with an untreated critical defect (CTL), those treated with PRP (PRP) and those treated with stem cells in a PRP scaffold (PRP+SC). The patellar grooves of the femurs from the experimental groups were evaluated macroscopically and histologically at 6 and 12 weeks post-surgery. The synovial membranes were also collected and evaluated for histopathological analysis. The synovial lining cell layer was enlarged in the CTL group compared with the PRP group at 6 weeks (P=0.037) but not with the PRP+SC group. All groups exhibited low-grade synovitis at 6 weeks and no synovitis at 12 weeks. Notably, macroscopic grades for the area of articular cartilage repair for the PRP+SC group were significantly improved compared with those in the CTL (P=0.001) and PRP (P=0.049) groups at 12 weeks. Furthermore, histological scores (modified O'Driscoll scoring system) of the patellar groove articular cartilage in the PRP+SC and PRP groups, in which the articular cartilage was primarily hyaline-like, were significantly higher compared with those in the CTL group at 12 weeks (P=0.002 and P=0.007, respectively). The present results support the therapeutic use of hDPSCs for the treatment of full-thickness articular cartilage defects.
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Affiliation(s)
- Ricardo Hideki Yanasse
- Department of Genetics, Blood Center, Faculdade de Medicina de Marília (FAMEMA), Marília, SP 17519-050, Brazil
| | - Roger William De Lábio
- Department of Genetics, Blood Center, Faculdade de Medicina de Marília (FAMEMA), Marília, SP 17519-050, Brazil
| | - Leonardo Marques
- Department of Health Sciences, Universidade do Sagrado Coração, Bauru, SP 17519-050, Brazil
| | - Josianne Tomazini Fukasawa
- Department of Genetics, Blood Center, Faculdade de Medicina de Marília (FAMEMA), Marília, SP 17519-050, Brazil
| | - Rosimeire Segato
- Department of Genetics, Blood Center, Faculdade de Medicina de Marília (FAMEMA), Marília, SP 17519-050, Brazil
| | - Angela Kinoshita
- Department of Health Sciences, Universidade do Sagrado Coração, Bauru, SP 17519-050, Brazil
| | - Mariza Akemi Matsumoto
- Department of Health Sciences, Universidade do Sagrado Coração, Bauru, SP 17519-050, Brazil
| | - Sergio Luis Felisbino
- Department of Morphology, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP 17519-050, Brazil
| | - Bruno Solano
- Center for Biotechnology and Cell Therapy, Monte Tabor Hospital São Rafael, Salvador, BA 17519-050, Brazil
| | - Ricardo Ribeiro Dos Santos
- Center for Biotechnology and Cell Therapy, Monte Tabor Hospital São Rafael, Salvador, BA 17519-050, Brazil
| | - Spencer Luiz Marques Payão
- Department of Genetics, Blood Center, Faculdade de Medicina de Marília (FAMEMA), Marília, SP 17519-050, Brazil.,Department of Health Sciences, Universidade do Sagrado Coração, Bauru, SP 17519-050, Brazil
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Bianchini E, Mancini F, Di Meo A, Stabile A, Buratta S, Moscati L, Pistilli A, Floridi C, Pepe M, Chiaradia E. Protective effects of platelet-rich plasma against lidocaine cytotoxicity on canine articular chondrocytes. Acta Vet Scand 2018; 60:63. [PMID: 30367652 PMCID: PMC6204030 DOI: 10.1186/s13028-018-0418-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background Lidocaine (LD) is one of the most commonly used local anesthetics for performing arthroscopic surgery and managing of osteoarthritic pain in both human and veterinary medicine. However, over the last years, several studies have focused on the chondrotoxic effects of LD. In order to ensure that intra-articular lidocaine is safe to use, treatments aimed at mitigating chondrocyte death have recently been investigated. The aim of this study is to evaluate the possible protective effects of platelet-rich plasma (PRP) against LD cytotoxicity on canine articular chondrocytes. Results Articular canine chondrocytes, were exposed to 1% or 1.8% LD alone or in co-presence with 10% PRP for 30 min. In order to evaluate the effects of PRP pre-treatments, experiments were carried out on cells cultured in serum-free medium-or in medium supplemented with 10% PRP or 10% fetal bovine serum. Cell viability was evaluated by methyl thiazolyl tetrazolium assay and cell apoptosis was analyzed by flow cytometry using annexin V-fluorescein isothiocyanate/propidium iodide. The results showed that LD significantly reduced canine chondrocytes viability, probably due to apoptosis induction. Pre-treatment or the co-presence of PRP in the media restored the number of viable chondrocytes. The PRP also seemed to protect the cells from LD-induced apoptosis. Conclusions Pre-treatments and/or the simultaneous administration of PRP reduced LD-induced cytotoxicity in canine chondrocytes. Further in vivo studies are required to determine whether PRP can be used as a save protective treatment for dogs receiving intra-articular LD injections.
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Platelet-rich Plasma and Mesenchymal Stem Cells: Exciting, But … are we there Yet? Sports Med Arthrosc Rev 2018; 26:59-63. [PMID: 29722764 DOI: 10.1097/jsa.0000000000000191] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Joint conditions incapacitate free movement driving to a sedentary lifestyle, a major risk factor for chronic diseases. Regenerative procedures, involving the use of mesenchymal stem/stromal cells along with platelet-rich plasma (PRP), can help patients with these conditions. We describe the main characteristics of cellular products (bone marrow concentrate, stromal vascular fraction of adipose tissue, and mesenchymal stem/stromal cells derived from these tissues), and the potential benefits of combination with PRP in 3 scenarios: PRP lysates used during laboratory cell expansion; PRP to prime cellular products or the host tissue before cell implantation; PRP used as a vehicle for cell transplantation and to provide trophic signals. Clinical studies exploring the benefits of combination products are limited to case series and few controlled studies, involving either arthroscopy or percutaneous injections. Combination products are making their way to clinics but further experimental and clinical research is needed to establish protocols and indications.
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Seuser A, Djambas Khayat C, Negrier C, Sabbour A, Heijnen L. Evaluation of early musculoskeletal disease in patients with haemophilia: results from an expert consensus. Blood Coagul Fibrinolysis 2018; 29:509-520. [PMID: 30020119 PMCID: PMC6125749 DOI: 10.1097/mbc.0000000000000767] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/26/2018] [Accepted: 07/05/2018] [Indexed: 11/25/2022]
Abstract
: Early joint damage in patients with haemarthrosis often escapes diagnosis because of insufficient investigation of biomechanical changes. Arthropathy in haemophilia requires complex assessment with several tools. Considering the increased emphasis on an integrated approach to musculoskeletal (MSK) outcomes, re-evaluation of MSK assessment to address individual patient needs is warranted. To advise on the optimal use of current assessment tools and strategies for tailored MSK evaluation in patients with haemophilia. A panel of experts in haemophilic arthropathy evaluated internationally recognized assessment tools through published literature and personal expertise. Each tool was considered, scored and ranked for their utility in the clinical assessment of MSK damage. Subsequently, a patient evaluation table detailing advice on type and frequency of assessments for different patient populations was constructed. To obtain a complete MSK assessment, multiple tools must be used to ensure each criterion is evaluated. For patients with haemophilia, clinical examination of the joint, disease-specific structure/function scores, and activity/participation scores including quality of life are important, and should be performed on a regular basis according to age and clinical condition. Joint imaging is recommended in the prevention, diagnosis and follow-up of haemophilic arthropathy and should be used in conjunction with joint structure and function scores. An integrated approach to MSK assessment using combinations of tools will allow earlier management of dysfunction and may improve long-term outcomes. This approach could be used in long-term follow-up of all patients independent of age and disease stage, especially in children to prevent arthropathy.
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Affiliation(s)
- Axel Seuser
- Private Practice for Prevention, Rehabilitation and Orthopaedics, Bonn, Germany
| | | | - Claude Negrier
- Centre Régional de Traitement de l’Hémophilie, Louis Pradel, University Claude Bernard, Lyon, France
| | - Adly Sabbour
- Physiotherapy Department, Cairo University, Egypt
| | - Lily Heijnen
- Van Creveldkliniek, UMC, Utrecht, the Netherlands
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Fotouhi A, Maleki A, Dolati S, Aghebati-Maleki A, Aghebati-Maleki L. Platelet rich plasma, stromal vascular fraction and autologous conditioned serum in treatment of knee osteoarthritis. Biomed Pharmacother 2018; 104:652-660. [DOI: 10.1016/j.biopha.2018.05.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 12/16/2022] Open
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Xing D, Wang B, Zhang W, Yang Z, Hou Y, Chen Y, Lin J. Intra-articular platelet-rich plasma injections for knee osteoarthritis: An overview of systematic reviews and risk of bias considerations. Int J Rheum Dis 2017; 20:1612-1630. [PMID: 29210206 DOI: 10.1111/1756-185x.13233] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Numerous systematic reviews investigating the efficacy of platelet-rich plasma (PRP) in treating knee osteoarthritis (OA) have been recently published. The purpose of the present study was (1) to perform an overview of overlapping systematic reviews investigating PRP for knee OA via evaluating methodological quality and risk of bias of systematic reviews and (2) to provide recommendations through the best evidence. METHODS A systematic search of systematic reviews published through Feb 2017 was conducted using the MEDLINE, EMBASE and Cochrane Library. The methodological quality and risk of bias of included systematic reviews were assessed by AMSTAR instrument and ROBIS tool respectively. Best evidence choice procedure was conducted according to the Jadad decision algorithm. The systematic reviews with high quality of methodology and low risk of bias were selected ultimately. RESULTS Ten systematic reviews were eligible for inclusion. The Jadad decision making tool suggested that the reviews with highest AMSTAR score should be selected. According to the ROBIS tool, there were 4 systematic reviews with low risk of bias and 6 with high risk of bias. As a result, two systematic reviews conducted by Dai et al and Meheux et al with highest AMSTAR score and low risk of bias were selected as the best evidence. CONCLUSIONS The present overview demonstrates that PRP is an effective intervention in treating knee OA without increased risk of adverse events. Therefore, the present conclusions may help decision makers interpret and choose PRP with more confidence.
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Affiliation(s)
- Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Bin Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wei Zhang
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Ziyi Yang
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yunfei Hou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Chinese GRADE Center, Gansu, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Beijing, China.,Arthritis Institute, Peking University, Beijing, China
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Lykov AP, Bondarenko NA, Surovtseva MA, Kim II, Poveshchenko OV, Pokushalov EA, Konenkov VI. Comparative Effects of Platelet-Rich Plasma, Platelet Lysate, and Fetal Calf Serum on Mesenchymal Stem Cells. Bull Exp Biol Med 2017; 163:757-760. [PMID: 29063326 DOI: 10.1007/s10517-017-3897-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 12/01/2022]
Abstract
We studied the effects of human platelet-rich plasma and platelet lysate on proliferation, migration, and colony-forming properties of rat mesenchymal stem cells. Platelet-rich plasma and platelet lysate stimulated the proliferation, migration, and colony formation of mesenchymal stem cells. A real-time study showed that platelet-rich plasma produces the most potent stimulatory effect, while both platelet-rich plasma and platelet lysate stimulated migration of cells.
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Affiliation(s)
- A P Lykov
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia. .,E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
| | - N A Bondarenko
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia.,E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - M A Surovtseva
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia.,E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - I I Kim
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia.,E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - O V Poveshchenko
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia.,E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - E A Pokushalov
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia.,E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - V I Konenkov
- Research Institute of Clinical and Experimental Lymphology, Novosibirsk, Russia
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Prządka P, Kiełbowicz Z, Osiński B, Dzimira S, Madej JA, Nowacki W, Kubiak K, Reichert P, Cegielski M. Reconstruction of cranial cruciate ligament in rabbits using polyester implants saturated with PRP, antlerogenic stem cells MIC-1 and their homogenate. Connect Tissue Res 2017; 58:464-478. [PMID: 27791406 DOI: 10.1080/03008207.2016.1251911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM OF THE STUDY The attempt to limit the negative effects of polyester implants on the articular cavity by using preparations containing growth factors. MATERIALS AND METHODS Polyester implants used for the reconstruction of a rabbit's cranial cruciate ligament (CCL) were saturated with autogenic platelet-rich plasma (PRP), antlerogenic stem cells MIC-1 and their homogenate prior to the surgery. Six months after CCL reconstruction, morphological, and biochemical blood tests were carried out, including proteinogram and acute phase proteins. The knee joints were also examined macro- and microscopically. RESULTS The results, compared to the control group, showed a favorable effect of the PRP and homogenate of antlerogenic cells on limiting the inflammation caused by the presence of polyester implant in the knee joint. The addition of growth factors caused covering the implant faster with the recipient's connective tissue, thus contributing to reducing the inflammatory reaction of the articular capsule to the presence of polyester. At the same time, no enhanced local or general reaction of the rabbit organism was observed to the presence of xenogenic antlerogenic stem cells MIC-1 homogenate which, like the PRP, may provide an easily available source of growth factors, increasingly often used in regenerative medicine. CONCLUSIONS Applying antlerogenic stem cells, their homogenate or PRP increases the volume of connective tissue that surrounds and intertwines polyester CCL implant, separating it from synovial cavity environment.
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Affiliation(s)
- Przemysław Prządka
- a Department of Surgery, Faculty of Veterinary Medicine , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Zdzisław Kiełbowicz
- a Department of Surgery, Faculty of Veterinary Medicine , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Bogdan Osiński
- a Department of Surgery, Faculty of Veterinary Medicine , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Stanisław Dzimira
- b Department of Pathology , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Janusz A Madej
- b Department of Pathology , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Wojciech Nowacki
- c Department of Immunology, Pathophysiology and Preventive Medicine , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Krzysztof Kubiak
- d Department of Internal Medicine and Clinic of Disease of Horses, Dogs and Cats , Wroclaw University of Environmental and Life Sciences , Wroclaw , Poland
| | - Paweł Reichert
- e Department and Clinic of Traumatology and Hand Surgery , Medical University of Wroclaw , Wroclaw , Poland
| | - Marek Cegielski
- f Department of Histology and Embryology , Medical University of Wroclaw , Wroclaw , Poland.,g Stem Cells Spin , Wroclaw , Poland
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29
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Rodriguez-Merchan EC. Platelet-rich plasma intra-articular injections for haemophilic synovitis: Scientific knowledge does not support its use. Haemophilia 2017; 23:e486-e487. [DOI: 10.1111/hae.13328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
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30
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Oral Platelet Gel Supernatant Plus Supportive Medical Treatment Versus Supportive Medical Treatment in the Management of Radiation-induced Oral Mucositis. Am J Clin Oncol 2017; 40:336-341. [DOI: 10.1097/coc.0000000000000177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Dernek B, Kesiktas FN, Duymus TM, Aydin T, Isiksacan N, Diracoglu D, Aksoy C. Effect of platelet concentration on clinical improvement in treatment of early stage-knee osteoarthritis with platelet-rich plasma concentrations. J Phys Ther Sci 2017; 29:896-901. [PMID: 28603367 PMCID: PMC5462694 DOI: 10.1589/jpts.29.896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/16/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To compare two platelet-rich plasma kits with different platelet concentrations
for treatment of knee osteoarthritis. [Subjects and Methods] Male and female patients with
knee osteoarthritis who had confirmed diagnosis with X-ray and magnetic resonance imaging
were included in this retrospective study. Eligible patients were divided into two groups:
Group I, which received platelet-rich plasma kit I, and Group II, which received
platelet-rich plasma kit II. Platelet concentrations of both kits were measured by manual
counting. For each group, platelet-rich plasma kit was injected twice with a one-month
interval between injections. The Western Ontario and McMaster Universities Osteoarthritis
Index and the Visual Analog Scale were applied for clinical evaluation before the first
injection and one, three and six months after the second injection. [Results] Kits I and
II contained 1,000,000 and 3,000,000 platelets/µl respectively. In both groups, initial
Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale
scores were significantly higher compared to the latter evaluations. However, no
significant difference was observed between groups in terms of clinical evaluations.
[Conclusion] Similar clinical results were found in groups receiving different platelet
concentrations, therefore, a concentration of 1,000,000 platelet/µl is considered
sufficient for pain relief and functional recovery.
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Affiliation(s)
- Bahar Dernek
- Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Physical Therapy and Rehabilitation Clinic, Turkey
| | | | - Tahir Mutlu Duymus
- Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Orthopedics and Traumatology Clinic, Turkey
| | - Tugba Aydin
- Okmeydani Training and Research Hospital, Physical Therapy and Rehabilitation Clinic, Turkey
| | - Nilgun Isiksacan
- Department of Biochemistry, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey
| | - Demirhan Diracoglu
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Turkey
| | - Cihan Aksoy
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Turkey
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Russo F, D’Este M, Vadalà G, Cattani C, Papalia R, Alini M, Denaro V. Platelet Rich Plasma and Hyaluronic Acid Blend for the Treatment of Osteoarthritis: Rheological and Biological Evaluation. PLoS One 2016; 11:e0157048. [PMID: 27310019 PMCID: PMC4911091 DOI: 10.1371/journal.pone.0157048] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 05/24/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction Osteoarthritis (OA) is the most common musculoskeletal disease. Current treatments for OA are mainly symptomatic and inadequate since none results in restoration of fully functional cartilage. Hyaluronic Acid (HA) intra-articular injections are widely accepted for the treatment of pain associated to OA. The goal of HA viscosupplementation is to reduce pain and improve viscoelasticity of synovial fluid. Platelet-rich plasma (PRP) has been also employed to treat OA to possibly induce cartilage regeneration. The combination of HA and PRP could supply many advantages for tissue repair. Indeed, it conjugates HA viscosupplementation with PRP regenerative properties. The aim of this study was to evaluate the rheological and biological properties of different HA compositions in combination with PRP in order to identify (i) the viscoelastic features of the HA-PRP blends, (ii) their biological effect on osteoarthritic chondrocytes and (iii) HA formulations suitable for use in combination with PRP. Materials and Methods HA/PRP blends have been obtained mixing human PRP and three different HA at different concentrations: 1) Sinovial, 0.8% (SN); 2) Sinovial Forte 1.6% (SF); 3) Sinovial HL 3.2% (HL); 4) Hyalubrix 1.5% (HX). Combinations of phosphate buffered saline (PBS) and the four HA types were used as control. Rheological measurements were performed on an Anton PaarMCR-302 rheometer. Amplitude sweep, frequency sweep and rotational measurements were performed and viscoelastic properties were evaluated. The rheological data were validated performing the tests in presence of Bovine Serum Albumin (BSA) up to ultra-physiological concentration (7%). Primary osteoarthritic chondrocytes were cultured in vitro with the HA and PRP blends in the culture medium for one week. Cell viability, proliferation and glycosaminoglycan (GAG) content were assessed. Results PRP addition to HA leads to a decrease of viscoelastic shear moduli and increase of the crossover point, due to a pure dilution effect. For viscosupplements with HA concentration below 1% the viscoelasticity is mostly lost. Results were validated also in presence of proteins, which in synovial fluid are more abundant than HA. Chondrocytes proliferated overtime in all different culture conditions. The proliferation rate was higher in chondrocytes cultured in the media containing PRP compared to the cultures with different HA alone. GAG content was significantly higher in chondrocytes cultured in PRP and HL blend. Discussion We investigated the rheological and biological properties of four different HA concentrations when combined with PRP giving insights on viscoelastic and biological properties of a promising approach for future OA therapy. Our data demonstrate that PRP addition is not detrimental to the viscosupplementation effect of HA. Viscosupplements containing low HA concentration are not indicated for combination with PRP, as the viscoelastic properties are lost. Although having the same rheological behavior of SF and HX, HL was superior in stimulating extracellular matrix production in vitro.
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Affiliation(s)
- Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Matteo D’Este
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
- * E-mail:
| | - Caterina Cattani
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Mauro Alini
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Knezevic NN, Candido KD, Desai R, Kaye AD. Is Platelet-Rich Plasma a Future Therapy in Pain Management? Med Clin North Am 2016; 100:199-217. [PMID: 26614728 DOI: 10.1016/j.mcna.2015.08.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Platelet-rich plasma (PRP) has the potential to regenerate tissues and decrease pain through the effects of bioactive molecules and growth factors present in alpha granules. Several PRP preparation systems are available with varying end products, doses of growth factors, and bioactive molecules. This article presents the biology of PRP, the preparation of PRP, and the effects PRP-related growth factors have on tissue healing and repair. Based on available evidence-based literature, the success of PRP therapy depends on the method of preparation and composition of PRP, the patient's medical condition, anatomic location of the injection, and the type of tissue injected.
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Affiliation(s)
- Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA; Department of Anesthesiology, University of Illinois, 1740 W. Taylor St, Chicago, IL 60612, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA; Department of Anesthesiology, University of Illinois, 1740 W. Taylor St, Chicago, IL 60612, USA
| | - Ravi Desai
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 West Wellington Avenue, Suite 4815, Chicago, IL 60657, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University School of Medicine, LSU Health Science Center, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA; Department of Pharmacology, Louisiana State University School of Medicine, 1901 Perdido St, New Orleans, LA 70112, USA.
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Safety and Efficacy of Autologous Intra-articular Platelet Lysates in Early and Intermediate Knee Osteoarthrosis in Humans: A Prospective Open-Label Study. Clin J Sport Med 2015; 25:524-8. [PMID: 25387167 DOI: 10.1097/jsm.0000000000000166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore the safety and benefit from intra-articular autologous platelet lysate (PL) injection in early and intermediate knee osteoarthritis. DESIGN Open-label prospective study. SETTING Laboratory. PATIENTS Adult patients, aged 35 to 70 years, with a history of chronic pain or swelling on one or both knees and imaging findings (radiograph or magnetic resonance imaging) of degenerative changes in the joint of grade I or II on the Kellgren scale were included. INTERVENTIONS Autologous PL was given in the knee joint by percutaneous intra-articular route every 3 weeks for a total of 3 injections. MAIN OUTCOME MEASURES Response was evaluated by nonnormalized Knee Osteoarthritis and Disability Outcome Score (KOOS). RESULTS There was a significant improvement in the 5 aspects evaluated at weeks 32 and 52 compared with baseline. Symptoms score significantly improved at weeks 32 and 52 from a mean of 11.1 at baseline to 9.0 (P < 0.0001) and 8.7 (P < 0.0001). Stiffness score significantly improved at weeks 32 and 52 from 2.2 at baseline to 1.7 (P < 0.022) and 1.6 (P < 0.016). Pain score improved at 32 weeks and at 52 weeks from a baseline of 14.2 to 9.8 (P < 0.0001) and 9.2 (P < 0.0001). Daily Living score improved from 25.0 to 18.7 at 32 weeks (P < 0.0001) and to 15.6 at 52 weeks (P < 0.0001). Sport score improved from 10.7 to 8.4 at 32 weeks (P < 0.0001) and to 8.1 at 52 weeks (P < 0.0001). CONCLUSIONS Intra-articular PL significantly improved score of all aspects evaluated by KOOS. Platelet lysate seems to be a safe product. CLINICAL RELEVANCE To the best of our knowledge, this is the first clinical study addressing the use of autologous PL as a treatment measure for knee osteoarthrosis (KOA). There are no studies published regarding the treatment of KOA by intra-articular injections of PL. The previous studies were on the use of platelet-rich plasma (PRP) treatment for KOA. Platelet-rich plasma use has been in place for several years, however, a standardized protocol has not yet been established. Platelet lysate represents a safe, economical, easy to prepare, and easy to apply source of growth factors in the treatment of KOA. A head-to-head study is needed to compare PRP with PL in KOA.
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Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR, Cole BJ. Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthroscopy 2015; 31:2213-21. [PMID: 26033459 DOI: 10.1016/j.arthro.2015.03.041] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/16/2015] [Accepted: 03/24/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) injection in the treatment of knee joint cartilage degenerative pathology, (2) to provide a framework for analysis and interpretation of the best available evidence to provide recommendations for use (or lack thereof) of PRP in the setting of knee osteoarthritis (OA), and (3) to identify literature gaps where continued investigation would be suggested. METHODS Literature searches were performed for meta-analyses examining use of PRP versus corticosteroids, hyaluronic acid, oral nonsteroidal anti-inflammatory drugs, or placebo. Clinical data were extracted, and meta-analysis quality was assessed. The Jadad algorithm was applied to determine meta-analyses that provided the highest level of evidence. RESULTS Three meta-analyses met the eligibility criteria and ranged in quality from Level II to Level IV evidence. All studies compared outcomes of treatment with intra-articular platelet-rich plasma (IA-PRP) versus control (intra-articular hyaluronic acid or intra-articular placebo). Use of PRP led to significant improvements in patient outcomes at 6 months after injection, and these improvements were seen starting at 2 months and were maintained for up to 12 months. It is unclear if the use of multiple PRP injections, the double-spinning technique, or activating agents leads to better outcomes. Patients with less radiographic evidence of arthritis benefit more from PRP treatment. The use of multiple PRP injections may increase the risk of self-limited local adverse reactions. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected and all showed that IA-PRP provided clinically relevant improvements in pain and function compared with the control treatment. CONCLUSIONS IA-PRP is a viable treatment for knee OA and has the potential to lead to symptomatic relief for up to 12 months. There appears to be an increased risk of local adverse reactions after multiple PRP injections. IA-PRP offers better symptomatic relief to patients with early knee degenerative changes, and its use should be considered in patients with knee OA. LEVEL OF EVIDENCE Level IV, systematic review of Level II through IV studies.
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Affiliation(s)
- Kirk A Campbell
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Bryan M Saltzman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Randy Mascarenhas
- Division of Sports Medicine, Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
| | - M Michael Khair
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Zheng C, Zhu Q, Liu X, Huang X, He C, Jiang L, Quan D. Improved peripheral nerve regeneration using acellular nerve allografts loaded with platelet-rich plasma. Tissue Eng Part A 2015; 20:3228-40. [PMID: 24901030 DOI: 10.1089/ten.tea.2013.0729] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acellular nerve allografts (ANAs) behave in a similar manner to autografts in supporting axonal regeneration in the repair of short peripheral nerve defects but fail in larger defects. The objective of this article is to evaluate the effect of ANA supplemented with platelet-rich plasma (PRP) to improve nerve regeneration after surgical repair and to discuss the mechanisms that underlie this approach. Autologous PRP was obtained from rats by double-step centrifugation and was characterized by determining platelet numbers and the release of growth factors. Forty-eight Sprague-Dawley rats were randomly divided into 4 groups (12/group), identified as autograft, ANA, ANA loaded with PRP (ANA+PRP), and ANA loaded with platelet-poor plasma (PPP, ANA+PPP). All grafts were implanted to bridge long-gap (15 mm) sciatic nerve defects. We found that PRP with a high platelet concentration exhibited a sustained release of growth factors. Twelve weeks after surgery, the autograft group displayed the highest level of reinnervation, followed by the ANA+PRP group. The ANA+PRP group showed a better electrophysiology response for amplitude and conduction velocity than the ANA and ANA+PPP groups. Based on histological evaluation, the ANA+PRP and autograft groups had higher numbers of regenerating nerve fibers. Quantitative real-time polymerase chain reaction (qRT-PCR) demonstrated that PRP boosted expression of neurotrophins in the regenerated nerves. Moreover, the ANA+PRP and autograft groups showed excellent physiological outcomes in terms of the prevention of muscle atrophy. In conclusion, ANAs loaded with PRP as tissue-engineered scaffolds can enhance nerve regeneration and functional recovery after the repair of large nerve gaps nearly as well as autografts.
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Affiliation(s)
- Canbin Zheng
- 1 Department of Orthopedic and Microsurgery, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou, China
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Ornetti P, Nourissat G, Berenbaum F, Sellam J, Richette P, Chevalier X. Does platelet-rich plasma have a role in the treatment of osteoarthritis? Joint Bone Spine 2015; 83:31-6. [PMID: 26162636 DOI: 10.1016/j.jbspin.2015.05.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 01/27/2023]
Abstract
Platelet-rich plasma (PRP) has been generating considerable attention as an intra-articular treatment to alleviate the symptoms of osteoarthritis. Activated platelets release a host of soluble mediators such as growth factors and cytokines, thereby inducing complex interactions that vary across tissues within the joint. In vivo, PRP may promote chondrocyte proliferation and differentiation. The available data are somewhat conflicting regarding potential effects on synovial cells and angiogenesis modulation. PRP probably exerts an early anti-inflammatory effect, which may be chiefly mediated by inhibition of the NF-κB pathway, a hypothesis that requires confirmation by proof-of-concept studies. It is far too early to draw conclusions about the efficacy of PRP as a treatment for hip osteoarthritis. The only randomized trial versus hyaluronic acid showed no significant difference in effects, and no placebo-controlled trials are available. Most of the randomized trials in knee osteoarthritis support a slightly greater effect in alleviating the symptoms compared to visco-supplementation, most notably at the early stages of the disease, although only medium-term data are available. Many uncertainties remain, however, regarding the best administration regimen. Serious adverse effects, including infections and allergies, seem rare, although post-injection pain is more common than with other intra-articular treatments for osteoarthritis.
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Affiliation(s)
- Paul Ornetti
- CIC-P Inserm 803, plateforme d'investigation technologique, Dijon University Hospital, 21000 Dijon, France; Département de rhumatologie, hôpital universitaire de Dijon, Bocage Central, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - Geoffroy Nourissat
- Département de chirurgie orthopédique, groupe Maussins, 75019 Paris, France; UPMC Paris VI, Inserm UMR-S938, université de la Sorbonne, 75012 Paris, France
| | - Francis Berenbaum
- UPMC Paris VI, Inserm UMR-S938, université de la Sorbonne, 75012 Paris, France; Département de rhumatologie, hôpital Saint-Antoine, 75012 Paris, France
| | - Jérémie Sellam
- UPMC Paris VI, Inserm UMR-S938, université de la Sorbonne, 75012 Paris, France; Département de rhumatologie, hôpital Saint-Antoine, 75012 Paris, France
| | - Pascal Richette
- Département de rhumatologie, université Paris VII, hôpital Lariboisière, 75010 Paris, France
| | - Xavier Chevalier
- Département de rhumatologie, université Paris XII, hôpital Henri-Mondor, 94000 Créteil, France
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Kuffler DP. Platelet-Rich Plasma Promotes Axon Regeneration, Wound Healing, and Pain Reduction: Fact or Fiction. Mol Neurobiol 2015; 52:990-1014. [PMID: 26048672 DOI: 10.1007/s12035-015-9251-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Indexed: 11/25/2022]
Abstract
Platelet-rich plasma (PRP) has been tested in vitro, in animal models, and clinically for its efficacy in enhancing the rate of wound healing, reducing pain associated with injuries, and promoting axon regeneration. Although extensive data indicate that PRP-released factors induce these effects, the claims are often weakened because many studies were not rigorous or controlled, the data were limited, and other studies yielded contrary results. Critical to assessing whether PRP is effective are the large number of variables in these studies, including the method of PRP preparation, which influences the composition of PRP; type of application; type of wounds; target tissues; and diverse animal models and clinical studies. All these variables raise the question of whether one can anticipate consistent influences and raise the possibility that most of the results are correct under the circumstances where PRP was tested. This review examines evidence on the potential influences of PRP and whether PRP-released factors could induce the reported influences and concludes that the preponderance of evidence suggests that PRP has the capacity to induce all the claimed influences, although this position cannot be definitively argued. Well-defined and rigorously controlled studies of the potential influences of PRP are required in which PRP is isolated and applied using consistent techniques, protocols, and models. Finally, it is concluded that, because of the purported benefits of PRP administration and the lack of adverse events, further animal and clinical studies should be performed to explore the potential influences of PRP.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, University of Puerto Rico, Medical Sciences Campus, 201 Blvd. Del Valle, San Juan, 00901, Puerto Rico,
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Andia I, Maffulli N. Meeting current musculoskeletal health demand through deeper insights into tissue homeostasis and regeneration. Expert Opin Biol Ther 2015; 15:767-71. [DOI: 10.1517/14712598.2015.1026324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abdallah AN, Shamaa AA, Tookhy OSE, Mottaleb EMAE. Evaluation of Low Level Laser-Activated Stromal Vascular Fraction as a Single Procedure for Treatment of Experimental Chondral Defects. ACTA ACUST UNITED AC 2015. [DOI: 10.3923/ajas.2016.15.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sánchez M, Fiz N, Guadilla J, Padilla S, Anitua E, Sánchez P, Delgado D. Intraosseous infiltration of platelet-rich plasma for severe knee osteoarthritis. Arthrosc Tech 2014; 3:e713-7. [PMID: 25685680 PMCID: PMC4314556 DOI: 10.1016/j.eats.2014.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/12/2014] [Indexed: 02/03/2023] Open
Abstract
We describe a new technique of platelet-rich plasma (PRP) infiltration for the treatment of severe knee osteoarthritis. PRP intra-articular infiltration is a promising treatment for knee osteoarthritis, but it still has some limitations in high-degree osteoarthritis. Diagnosis of osteoarthritis is based on clinical and radiographic findings, and patients with grade III or IV knee tibiofemoral osteoarthritis based on the Ahlbäck scale are considered candidates for this technique. The technique consists of performing intraosseous infiltration of PRP into the subchondral bone, which acts on this tissue and consequently on cartilage-bone communication. Although the intraosseous injection hinders the conventional knee intra-articular infiltration, it allows an extension of the range of action of the PRP, which acts directly on the subchondral bone, which is involved in the progression of osteoarthritis. Thus this technique involves a new administration of PRP that can delay knee arthroplasty; moreover, it can be applied for not only severe osteoarthritis but also other pathologies in which the subchondral bone is critical in the etiology, such as necrosis and osteochondral lesions.
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Affiliation(s)
- Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas San Jose, Vitoria-Gasteiz, Spain
| | - Nicolás Fiz
- Arthroscopic Surgery Unit, Hospital Vithas San Jose, Vitoria-Gasteiz, Spain,Biotechnology Institute, Vitoria-Gasteiz, Spain
| | - Jorge Guadilla
- Arthroscopic Surgery Unit, Hospital Vithas San Jose, Vitoria-Gasteiz, Spain
| | - Sabino Padilla
- Biotechnology Institute, Vitoria-Gasteiz, Spain,Foundation Eduardo Anitua, Vitoria-Gasteiz, Spain
| | - Eduardo Anitua
- Biotechnology Institute, Vitoria-Gasteiz, Spain,Foundation Eduardo Anitua, Vitoria-Gasteiz, Spain
| | - Pello Sánchez
- Arthroscopic Surgery Unit Research, Hospital Vithas San Jose, Vitoria-Gasteiz, Spain
| | - Diego Delgado
- Arthroscopic Surgery Unit Research, Hospital Vithas San Jose, Vitoria-Gasteiz, Spain,Address correspondence to Diego Delgado, Ph.D., Arthroscopic Surgery Unit Research, Hospital Vithas San Jose, Calle del Beato Tomás de Zumárraga 10, 01008 Vitoria-Gasteiz, Spain.
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Laudy ABM, Bakker EWP, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 2014; 49:657-72. [PMID: 25416198 DOI: 10.1136/bjsports-2014-094036] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effectiveness of platelet-rich plasma (PRP) injections for osteoarthritis (OA) is still controversial. We investigated the effect of PRP injections in patients with knee OA based on decreasing pain, improving function, global assessment and changes regarding joint imaging. METHODS We performed a comprehensive, systematic literature search in computerised databases (MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science and PEDro) until June 2014 for randomised or non-randomised controlled trials. These were graded for risk of bias and a level of evidence was provided. If possible, meta-analysis was performed. RESULTS Ten trials were included. In these, intra-articular PRP injections were more effective for pain reduction (mean difference (MD) -2.45; 95% CI -2.92 to -1.98; p value <0.00001 and MD -2.07; 95% CI -2.59 to -1.55; p value <0.00001, single and double PRP injections, respectively) compared with placebo at 6 months postinjection. Intra-articular PRP injections were compared with hyaluronic acid and showed a statistically significant difference in favour of PRP on pain reduction based on the visual analogue scale and numeric rating scale (standardised mean difference -0.92; 95% CI -1.20 to -0.63; p value <0.00001) at 6 months postinjection. Almost all trials revealed a high risk of bias. CONCLUSIONS On the basis of the current evidence, PRP injections reduced pain more effectively than did placebo injections in OA of the knee (level of evidence: limited due to a high risk of bias). This significant effect on pain was also seen when PRP injections were compared with hyaluronic acid injections (level of evidence: moderate due to a generally high risk of bias). Additionally, function improved significantly more when PRP injections were compared with controls (limited to moderate evidence). More large randomised studies of good quality and low risk of bias are needed to test whether PRP injections should be a routine part of management of patients with OA of the knee.
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Affiliation(s)
- Augustinus B M Laudy
- Department of Physiotherapy, Meander Medical Centre, Amersfoort, The Netherlands Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amersfoort, The Netherlands
| | - Eric W P Bakker
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amersfoort, The Netherlands
| | - Mark Rekers
- Department of Sport Medical Care, FC Utrecht, Utrecht, The Netherlands
| | - Maarten H Moen
- Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands The Sportsphysician Group, Saint Lucas Hospital, Amsterdam, The Netherlands
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Burnouf T, Goubran HA, Seghatchian J. Multifaceted regenerative lives of expired platelets in the second decade of the 21st century. Transfus Apher Sci 2014; 51:107-12. [PMID: 25189105 DOI: 10.1016/j.transci.2014.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A traditional concept in transfusion medicine is the expiration of platelet concentrates 5-7 days after collection due to storage conditions that favor the risks of bacterial contamination and may lead to a gradual alteration of platelet hemostatic power. Newer findings are strongly suggesting that, after their supposed expiration date, platelet concentrates still contain multiple functional growth factors and cytokines and actually have unaltered power for application in regenerative medicine and cell therapy. Expired platelets can be a valuable source of growth factors to promote the healing of wounds, and can be used for ex vivo expansion of stem cells. There is also preliminary evidence that infusible platelet membrane (IPM) from outdated platelet concentrates and thrombosomes have potential clinical applications as hemostatic products. Experimental work is certainly needed to further validate and standardize the clinical potential of "expired" platelet blood products in human clinical medicine. However, strong evidence accumulates toward a potential for further manufacturing avenues of expired platelet concentrates into valuable therapeutic and clinically relevant products.
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Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Hadi Alphonse Goubran
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety and DDR Strategy, London, UK.
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Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acid treatments in early-stage gonarthrosis patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:509-13. [DOI: 10.1007/s00590-014-1517-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/21/2014] [Indexed: 12/20/2022]
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Cuervo B, Rubio M, Sopena J, Dominguez JM, Vilar J, Morales M, Cugat R, Carrillo JM. Hip osteoarthritis in dogs: a randomized study using mesenchymal stem cells from adipose tissue and plasma rich in growth factors. Int J Mol Sci 2014; 15:13437-60. [PMID: 25089877 PMCID: PMC4159804 DOI: 10.3390/ijms150813437] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/18/2014] [Accepted: 07/21/2014] [Indexed: 02/06/2023] Open
Abstract
Purpose: The aim of this study was to compare the efficacy and safety of a single intra-articular injection of adipose mesenchymal stem cells (aMSCs) versus plasma rich in growth factors (PRGF) as a treatment for reducing symptoms in dogs with hip osteoarthritis (OA). Methods: This was a randomized, multicenter, blinded, parallel group. Thirty-nine dogs with symptomatic hip OA were assigned to one of the two groups, to receive aMSCs or PRGF. The primary outcome measures were pain and function subscales, including radiologic assessment, functional limitation and joint mobility. The secondary outcome measures were owners’ satisfaction questionnaire, rescue analgesic requirement and overall safety. Data was collected at baseline, then, 1, 3 and 6 months post-treatment. Results: OA degree did not vary within groups. Functional limitation, range of motion (ROM), owner’s and veterinary investigator visual analogue scale (VAS), and patient’s quality of life improved from the first month up to six months. The aMSCs group obtained better results at 6 months. There were no adverse effects during the study. Our findings show that aMSCs and PRGF are safe and effective in the functional analysis at 1, 3 and 6 months; provide a significant improvement, reducing dog’s pain, and improving physical function. With respect to basal levels for every parameter in patients with hip OA, aMSCs showed better results at 6 months.
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Affiliation(s)
- Belen Cuervo
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| | - Monica Rubio
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| | - Joaquin Sopena
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
| | - Juan Manuel Dominguez
- Department of Animal Medicine and Surgery, University of Cordoba, 14071 Cordoba, Spain.
| | - Jose Vilar
- Department of Animal Medicine and Surgery, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain.
| | - Manuel Morales
- Department of Animal Medicine and Surgery, University of Las Palmas de Gran Canaria, 35413 Las Palmas de Gran Canaria, Spain.
| | - Ramón Cugat
- Garcia Cugat Foundation CEU UCH Chair of Medicine and Regenerative Surgery, 08006 Barcelona, Spain.
| | - Jose Maria Carrillo
- Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca, Valencia, Spain.
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Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 2014; 5:351-361. [PMID: 25035839 PMCID: PMC4095029 DOI: 10.5312/wjo.v5.i3.351] [Citation(s) in RCA: 237] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/09/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a complex “whole joint” disease pursued by inflammatory mediators, rather than purely a process of “wear and tear”. Besides cartilage degradation, synovitis, subchondral bone remodeling, degeneration of ligaments and menisci, and hypertrophy of the joint capsule take parts in the pathogenesis. Pain is the hallmark symptom of OA, but the extent to which structural pathology in OA contributes to the pain experience is still not well known. For the knee OA, intraarticular (IA) injection (corticosteroids, viscosupplements, blood-derived products) is preferred as the last nonoperative modality, if the other conservative treatment modalities are ineffective. IA corticosteroid injections provide short term reduction in OA pain and can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with OA. IA hyaluronic acid (HA) injections might have efficacy and might provide pain reduction in mild OA of knee up to 24 wk. But for HA injections, the cost-effectiveness is an important concern that patients must be informed about the efficacy of these preparations. Although more high-quality evidence is needed, recent studies indicate that IA platelet rich plasma injections are promising for relieving pain, improving knee function and quality of life, especially in younger patients, and in mild OA cases. The current literature and our experience indicate that IA injections are safe and have positive effects for patient satisfaction. But, there is no data that any of the IA injections will cause osteophytes to regress or cartilage and meniscus to regenerate in patients with substantial and irreversible bone and cartilage damage.
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Andia I, Abate M. Platelet-rich plasma: underlying biology and clinical correlates. Regen Med 2014; 8:645-58. [PMID: 23998756 DOI: 10.2217/rme.13.59] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Platelet-rich plasma (PRP) has recently become the focus of intensive interest and discussion, in part because of the expanding understanding of platelet function. Anucleate platelets within PRP release a myriad of growth factors and cytokines while contributing to plasma coagulation and fibrin development; the latter acts as vehicle for the local delivery. The biological effects of PRP are largely attributed to the platelet secretome and plasma signaling proteins. Clinical data suggest that PRPs may exploit different regenerative mechanisms under diverse disease conditions, including hemostasis, inflammation, angiogenesis and the synthesis of extracellular matrix. The success of PRP therapies depends on current tissue healing research and the translation of this knowledge into clinical developments.
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Affiliation(s)
- Isabel Andia
- BioCruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Bizkaia, Spain.
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Anitua E, Zalduendo MM, Prado R, Alkhraisat MH, Orive G. Morphogen and proinflammatory cytokine release kinetics from PRGF-Endoret fibrin scaffolds: evaluation of the effect of leukocyte inclusion. J Biomed Mater Res A 2014; 103:1011-20. [PMID: 24890049 DOI: 10.1002/jbm.a.35244] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/22/2014] [Accepted: 05/30/2014] [Indexed: 12/21/2022]
Abstract
The potential influence of leukocyte incorporation in the kinetic release of growth factors from platelet-rich plasma (PRP) may explain the conflicting efficiency of leukocyte platelet-rich plasma (L-PRP) scaffolds in tissue regeneration. To assess this hypothesis, leukocyte-free (PRGF-Endoret) and L-PRP fibrin scaffolds were prepared, and both morphogen and proinflammatory cytokine release kinetics were analyzed. Clots were incubated with culture medium to monitor protein release over 8 days. Furthermore, the different fibrin scaffolds were morphologically characterized. Results show that leukocyte-free fibrin matrices were homogenous while leukocyte-containing ones were heterogeneous, loose and cellular. Leukocyte incorporation produced a significant increase in the contents of proinflammatory cytokines interleukin (IL)-1β and IL-16 but not in the platelet-derived growth factors release (<1.5-fold). Surprisingly, the availability of vascular endothelial growth factor suffered an important decrease after 3 days of incubation in the case of L-PRP matrices. While the release of proinflammatory cytokines was almost absent or very low from PRGF-Endoret, the inclusion of leukocytes induced a major increase in these cytokines, which was characterized by the presence of a latent period. The PRGF-Endoret matrices were stable during the 8 days of incubation. The inclusion of leukocytes alters the growth factors release profile and also increased the dose of proinflammatory cytokines.
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Affiliation(s)
- E Anitua
- Foundation Eduardo Anitua, Vitoria, Spain
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Andia I, Maffulli N. Anti-inflammatory and Matrix Restorative Mechanisms of Platelet-Rich Plasma in Osteoarthritis: Letter to the Editor. Am J Sports Med 2014; 42:NP32. [PMID: 24879673 DOI: 10.1177/0363546514536690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Tucker JD, Ericksen JJ, Goetz LL, Elmore LW. Should clinical studies involving "regenerative injection therapy," strive to incorporate a triad of outcome measures instead of only including clinical outcome measures? Osteoarthritis Cartilage 2014; 22:715-7. [PMID: 24769241 DOI: 10.1016/j.joca.2014.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 03/19/2014] [Accepted: 04/09/2014] [Indexed: 02/02/2023]
Affiliation(s)
- J D Tucker
- Virginia Commonwealth University, Department of Physical Medicine and Rehabilitation, United States.
| | | | - L L Goetz
- Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Department of Physical Medicine and Rehabilitation, United States
| | - L W Elmore
- Virginia Commonwealth University, Department of Pathology, United States
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