Allogenic platelet-rich plasma for treatment of knee and hip osteoarthritis

Efficacy of decellularized extracellular matrix (dECM) for articular cartilage repair in osteoarthritis (OA): a systematic review and meta-analysis

BACKGROUND

Osteoarthritis (OA) is a common degenerative joint disease causing chronic pain, disability, and mobility limitations, severely affecting quality of life. Traditional treatments like physical therapy and surgery often have limited efficacy due to side effects, incomplete recovery, and disease progression, highlighting the need for innovative therapies.

METHODS

We searched PubMed and Embase from January 1, 2010 to November 1, 2024, preliminary included studies involving animal experiments on the therapeutic effects of decellularized extracellular matrix (dECM) and its derived materials on cartilage defect. After removing duplicates, we conducted a bibliometric analysis. Following the exclusion and evaluation of literature, the random/fixed effects model was employed to perform meta-analysis and obtain Weighted Mean Difference (WMD) of Osteoarthritis Research Society International (OARSI) score and International Cartilage Repair Society (ICRS) score between the dECM treatment group and corresponding control group. We verify the robustness of the results through subgroup analysis and sensitivity analysis, with heterogeneity assessed by Q-test and quantified via I2 values.

RESULTS

We included a total of 10 studies, of which 7 were used for ICRS-based meta-analysis and 3 were used for OARSI-based meta-analysis. The combined mean ICRS of dECM treatment group/control group resulted in an WMD of 2.45 (95% CI: 1.07 to 3.84; I2 = 97.4%); P-value < 0.001). Meanwhile, the combined mean OARSI of dECM treatment group/control group resulted in an WMD of -1.65 (95% CI: -3.63 to 0.34; I2 = 97.3%). The subsequent funnel plot confirmed the low publication bias of the above results.

CONCLUSIONS

Based on the dual-index meta-analysis, the dECM and relative derivatives have been proved to possess significant cartilage repair function in OA, which can be further explored in tissue regeneration filed.

Efficacy of Amniotic Suspension Allografts in the Treatment of Knee Osteoarthritis: A Systematic Review

Knee osteoarthritis significantly impacts mobility and quality of life. This condition is a leading cause of disability in aging populations, with total knee replacement commonly sought in advanced cases. Traditional nonoperative management strategies, including anti-inflammatories, corticosteroid injections, and hyaluronic acid, often provide limited relief, especially in severe cases. Recently, regenerative therapies such as amniotic suspension allografts (ASA) have emerged as promising alternatives due to their anti-inflammatory and regenerative properties, which may counteract the catabolic effects of osteoarthritis. This systematic review evaluated the efficacy and safety of ASA in reducing pain and improving function among knee osteoarthritis patients. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a comprehensive search of PubMed and Embase databases initially identified 1,733 studies pertaining to ASA, of which 1,575 were screened, and 9 studies ultimately met the inclusion criteria for detailed analysis of ASA in the treatment of knee osteoarthritis. Data extraction and narrative synthesis focused on outcomes such as pain reduction and functional improvement using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), as well as safety profiles. The results demonstrated notable improvements in pain scores following ASA treatment, as shown by studies reporting increases in KOOS pain scores over 6 months, which generally outperformed hyaluronic acid and saline treatments in pain reduction. Similarly, ASA treatment was associated with substantial improvements in physical function outcome scores, enhancing patients' ability to perform daily activities. Patient-reported outcomes also indicated higher quality of life and functional status, with most patients experiencing high levels of satisfaction. Additionally, ASA's safety profile was favorable, with adverse events primarily mild to moderate in nature, including a few transient events such as knee stiffness and myalgias. This systematic review highlights ASA as an effective therapeutic option for knee osteoarthritis, although further studies focusing on long-term radiographic outcomes and mechanisms of action are recommended to fully establish its benefits and optimize treatment protocols.

Hyperbaric oxygen potentiates platelet-rich plasma composition and accelerates bone healing

Objective

This study aimed to investigate whether platelet-rich plasma (PRP) obtained from the blood of rats preconditioned with hyperbaric oxygen (HBOP) would enhance the biological activity of PRP and accelerate the healing process of femur fractures in a rat model.

Design

PRP was derived from blood samples of healthy rats subjected to either hyperbaric oxygen (hPRP) or normobaric air (nPRP). A closed femur fracture model was established in male Wistar rats, with treatments of hPRP or nPRP administered around the fracture site immediately post-fracture and on days 7, 14, 21, and 28. Growth factor concentrations in hPRP and nPRP were biochemically quantified. Bone healing was assessed weekly by X-ray, while histological and immunofluorescence analyses evaluated inflammatory status, osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL) expression, and the presence of osteoblasts, osteoclasts, and osteocytes during healing. The effects of hPRP and nPRP on MC3T3-E1 preosteoblast migration and proliferation were also tested in vitro.

Results

hPRP showed significantly higher concentrations of growth factors such as activin-A, brain-derived neurotrophic factor, nerve growth factor, Flt-3 Ligand, granulocyte-macrophage colony-stimulating factor, hepatocyte growth factor, and platelet-derived growth factor, compared to nPRP. In vitro, hPRP demonstrated more significant effects on preosteoblast migration and proliferation. In vivo, hPRP treatment resulted in enhanced bone healing, higher OPG levels in osteoblasts and osteoclasts, and an elevated OPG/RANKL ratio compared to nPRP.

Conclusions

HBOP enhances the biological activity of PRP and accelerates bone healing in a closed femur fracture model in rats. This study highlights the regenerative potential of PRP when preconditioned with hyperbaric oxygen for use in bone fracture therapy.

Significance statement

PRP is widely used in treating bone defects and fractures, but its enhancement through HBOP remains underexplored. Our findings demonstrate that HBOP potentiates the biological activity of PRP, offering promising therapeutic potential for bone fracture healing.

The translational potential of this article

Enriching growth factors in PRP through HBOP could significantly improve tissue regeneration, especially in bone healing. The potential of hPRP in clinical applications is highly promising, particularly in orthopaedic surgery, trauma care, sports medicine, and managing bone healing in compromised patients.

Clinical efficacy of cell-free fat extract and its effects on bone marrow edema in patients with early to mid-stage knee osteoarthritis: a clinical trial in comparison with hyaluronic acid

BACKGROUND

Previous studies have shown that hyaluronic acid can delay the progression of knee osteoarthritis. Existing research has extracted a bright red fluid called cell-free fat extract from human adipose tissue, which may play an important role in delaying the progression of osteoarthritis. By comparing with intra-articular injection of hyaluronic acid, this study aimed to evaluate the effects of intra-articular injection of CEFFE on both clinical efficacy and the reduction of bone marrow edema in patients with early to mid-stage knee osteoarthritis.

METHODS

A total of 48 patients with KOA (Kellgren-Lawrence grade II-III) symptoms were randomly divided into CEFFE group (24 cases) and HA group (24 cases). The patients in the CEFFE group received five injections of CEFFE (2 ml, 1 time/week), and the patients in the HA group received five injections of HA (2 ml, 1 ml/10 mg, 1 time/week). All the patients underwent clinical assessments using rating scales, including VAS, WOMAC and Lysholm Knee Score. These assessments were conducted at pre-treatment and at 3-week, 6-week, 3-month, and 6-month follow-up timepoints post-treatment. The clinical efficacy was evaluated at the 6-month follow-up after the treatment. The changes in subchondral bone marrow edema before and 6 months after treatment were assessed by grading BME on MRI of the affected knees.

RESULTS

A total of 52 knees from 46 patients were included in the final analysis. Comparison of VAS score, WOMAC score, and Lysholm score between the two groups revealed that the differences between pre-treatment and 3 weeks post-treatment were not statistically significant (P > 0.05). For the VAS score and WOMAC score at 6 weeks, 3 months, and 6 months post-treatment, the CEFFE group was lower than the HA group (P < 0.05). For the Lysholm score, the CEFFE group was higher than the HA group (P < 0.05). Compared with pre-treatment, VAS scores and WOMAC scores were lower and Lysholm scores were higher at all post-treatment time points (P < 0.05). At 6 months post-treatment, the clinical efficacy of the CEFFE group was significantly better than that of the HA group (P < 0.05). At 6 months post-treatment, MRI grading showed that subchondral BME was reduced to different degrees in both groups, with the reduction being more pronounced in the CEFFE group (P < 0.05).

CONCLUSION

This study demonstrated that intra-articular injection of CEFFE into the knee joint could enhance the durability of tissue-specific cells (especially chondrocytes) and improve cellular metabolic processes, preventing the continued progression of osteoarthritis. Both CEFFE and HA were found to improve clinical symptoms and reduced subchondral bone marrow edema in the treatment of early to mid-stage knee osteoarthritis. However, CEFFE was more effective than HA in achieving these outcomes.

A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA)

INTRODUCTION

KOA, a chronic degenerative joint disease, is commonly treated with intra-articular HA and PRP, used alone or in combination. However, the efficacy and safety of combination therapy (PRP + HA) remain unclear.

AIM

The aim of this systematic review and meta-analysis is to assess the clinical effectiveness and safety profile of PRP + HA versus PRP monotherapy for KOA.

MATERIAL AND METHODS

A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals. The mean difference (MD) and risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I2statistics and the appropriate p-value. The analysis used RevMan 5.4. GRADE system was used for evidence assessment for each outcome parameter.

RESULTS

This meta-analysis of 11 RCTs (n = 1023 KOA patients) revealed that PRP + HA has substantial effectiveness than PRP alone in reducing OMAC total scores [MD -1.77 (95% CI -2.20 to - 1.34); I2 = 10%, and p < 0.001], VAS scores [MD -4.27 (95% CI -4.96 to - 3.58); I2 = 13%, and p < 0.001], and Lequesne index score [MD -5.48 (95% CI -6.56 to - 4.40); I2 = 16%, and p < 0.001], while increasing IKDC scores [MD -2.10 (95% CI -3.70 to - 0.50); I2 = 9%, and p = 0.01], with low risk of adverse events [RR 0.41 (95% CI 0.35 to 0.48); I2 = 12%, and p < 0.001].

CONCLUSION

This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy.

Adipose-derived mesenchymal stem cells combined with platelet-rich plasma are superior options for the treatment of osteoarthritis

BACKGROUND

There is currently no definitive treatment for osteoarthritis. We examined the therapeutic effects and underlying mechanisms of platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cells (ADSCs), individually or in combination, in a rat model of anterior cruciate ligament-induced degenerative osteoarthritis (OA) of the knee. This study seeks to advance clinical approaches to OA treatment.

METHODS

Eight- to nine-week-old male Sprague-Dawley (SD) rats were randomly assigned to two groups: (1) a normal control group (Group A) and (2) a model group. The control group received no treatment. The model group underwent treatment and was further subdivided into six groups: Group B (an injury control group), Group C (high-dose ADSCs), Group D (PRP combined with high-dose ADSCs), Group E (low-dose ADSCs), Group F (PRP combined with low-dose ADSCs), and Group G (PRP alone). PRP and/or ADSCs were administered via intra-articular injection on Days 7, 37, and 67 post-surgery. Daily observations recorded activity levels and behavior, while weight changes were monitored weekly. Digital radiography (DR) was conducted on Days 30, 60, and 90 post-surgery to assess joint surface and contour alterations. Histopathological examination and inflammatory factor analysis were performed on cartilage and synovial tissue.

RESULTS

No abnormal reactions were observed in any rats, and body weights increased as expected (P > 0.05). Significant differences in knee swelling rates and Wakitani scores were observed between Groups A and B (P < 0.01). Knee swelling rates also differed significantly between Group B and Groups C-G (P < 0.01). Wakitani scores decreased on Days 60 and 90 in Groups C-G. TNF-α and IL-1β expression levels were significantly higher in Group B compared to Group A (P < 0.05). Expression levels of these genes were significantly lower in Groups C-G than in Group B (P < 0.05).

CONCLUSIONS

Repeated intra-articular injections of PRP and ADSCs alleviated inflammation and pain, promoted tissue repair, and modulated immune responses in rats with surgically induced OA. The combination of PRP and ADSCs demonstrated enhanced therapeutic efficacy, suggesting its potential as a treatment option for OA.

Autologous Growth Factor-Rich Concentrate (GFC) Injection in Non-union of Fractures: A Quasi-experimental Study

INTRODUCTION

Non-union fractures represent a significant challenge in orthopedic practice, contributing to considerable morbidity and socioeconomic burden. Traditional treatments, such as autologous bone grafting, are effective but have limitations, including donor-site morbidity and limited tissue availability. Autologous peripheral blood-derived orthobiologics, including growth factor-rich concentrate (GFC), have emerged as a minimally invasive alternative, leveraging the body's natural healing mechanisms by concentrating and applying growth factors directly to the fracture site. This study evaluates the safety and efficacy of GFC injections in the treatment of non-union fractures.

MATERIALS AND METHODS

This quasi-experimental study included 17 patients with non-union fractures of various long bones, treated under fluoroscopic guidance with three doses of 5 mL GFC injections, administered 2 weeks apart at the non-union site. Demographic data, injury characteristics, and comorbid conditions were recorded. Growth factor levels were quantified via enzyme-linked immunosorbent assay (ELISA), and statistical analyses were conducted to explore associations between the amount of growth factors and treatment outcomes. Radiographic assessments and bony callus appearance were evaluated at the baseline and at 1-, 3-, and 6-month follow-up post-last injection.

RESULTS

No adverse effects were reported throughout the duration of the study. The majority of patients (82.4%) showed significant improvement, evidenced by enhanced bony callus formation and reduced non-union signs. No significant correlation was found between the specific growth factor levels and the clinical outcomes of non-union of fractures. However, the presence of comorbid conditions significantly influenced treatment efficacy, underscoring the importance of patient selection in clinical practice.

CONCLUSION

Administration of GFC injection is safe and potentially efficacious for the treatment of non-union fractures, offering an alternative to traditional surgical interventions. These results laid the foundation for prospective, adequately powered, randomized and non-randomized clinical studies with longer follow-up to further establish the efficacy of GFC in patients with non-union fractures. Moreover, formulation protocols need to be optimized while considering patient-specific variables, to ensure reproducibility and repeatability of outcomes from these studies.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-024-01278-1.

Autologous platelet rich plasma injection can be effective in the management of osteoarthritis of the knee: impact on IL-1 β, TNF-α, hs-CRP

OBJECTIVE

To analyze the clinical efficacy of autologous platelet rich plasma (PRP) injection in the treatment of knee osteoarthritis (KOA) and its influence on related biomarkers such as interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP).

METHOD

150 study subjects are randomly selected from KOA patients received treatment in the Third Hospital of Bethune Hospital from January 2022 to January 2023. After enrollment, patients are randomly numbered 1-100. 75 patients with odd and even numbers are included in the control group and the observation group, respectively. The former is cured with etocoxib, while the latter is treated with autologous PRP injection based on this. The clinical efficacy, relevant biomarkers (IL-1β, TNF-α, hs-CRP), and Lysholm knee score scale and Fugl Meyer assessment (FMA) scores are compared and analyzed.

RESULTS

The total effective rate of 94.67% (71/75) in the observation group was higher than 84.00% (63/75) in the other one group (P < 0.05). Before treatment, the comparison in IL-1β, TNF-α, hs-CRP, Lysholm knee joint score, and FMA scale score are with P > 0.05. When the treatment period is at 1 and 2 months, the IL-1β, TNF-α, hs-CRP levels within the group were lower than before treatment, while the Lysholm knee joint score and FMA scale score were higher than before treatment (P < 0.05). When the treatment period is at 1 and 2 months, the IL-1β, TNF-α, hs-CRP levels and the Lysholm knee joint and FMA scale scores in the observation group were lower and higher than those in the other one group, respectively (P < 0.05).

CONCLUSION

The application of autologous PRP injection therapy in KOA patients can significantly improve their levels of related biomarkers, effectively improve knee joint function and motor function, and have good clinical efficacy.

Effects of platelet-rich plasma combined with exercise therapy for one year on knee osteoarthritis: retrospective cohort study

BACKGROUND

Platelet-rich plasma (PRP) is a promising treatment for knee osteoarthritis (OA). However, exercise therapy and activities of daily living (ADL) guidance are recommended as core treatments in the Osteoarthritis Research Society International (OARSI) guidelines. However, the effects of PRP combined with exercise therapy are not fully understood. This study aimed to clarify the effectiveness of this treatment.

METHODS

We assigned patients diagnosed with knee OA and treated between January 2021 and December 2022 to groups who underwent PRP + exercise (PE), PRP (P), or exercise (E) therapy. Outcomes were evaluated using Knee Injury and Osteoarthritis Outcome Scores (KOOS) before, and 1, 3, and 12 months after treatment. Within-group comparisons according to the time of each score were statistically assessed using a one-way analysis of variance, then differences were analyzed using Bonferroni multiple comparisons p < 0.05). Treatment responses were determined using Outcome Measures in Rheumatology (OMERACT)-OARSI Responder criteria.

RESULTS

Pre-treatment KOOS did not significantly differ among the groups. Pain in the PE group improved within 1 month, symptoms, ADL, and quality of life (QOL) improved after 3, months and continued for 12 months. Pain and symptoms improved in the P group within 1 month, but ADLs and the QOL did not significantly change. Pain improved after 3 months in the E group and ADL, and QOL improved by 12 months. The response among the groups was the highest for the PE, with 50.0% at 1 and 3 months, and 65.0% at 12 months.

CONCLUSIONS

Therapy with PRP immediately relieved pain, whereas exercise conferred late, but enduring effects. Combining PRP with exercise conferred synergistic advantages that persisted for up to 12 months.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Hip Osteoarthritis: A Systematic Review of Current Clinical Evidence

Osteoarthritis (OA) of the hip affects millions of people with a sizable health-related economic burden. Conventional treatment modalities are prioritized, turning to surgical intervention only when they have failed. Nevertheless, these approaches have flaws, regularly trying to provide symptomatic pain relief instead of focusing on the underlying etiology. The last two decades have seen a significant increase in the use of autologous peripheral blood-derived orthobiologics (APBOs) for managing musculoskeletal disorders, including OA of the hip. Platelet-rich plasma (PRP) is the most regularly used APBO. Yet, studies have shown its inefficacy in improving pain and function along with a high incidence of reporting bias in systematic reviews and meta-analyses involving PRP injections for hip OA. Thus, the potential of using other APBOs, including platelet lysate (PL), autologous conditioned serum (ACS), gold-induced cytokine (GOLDIC), plasma rich in growth factors (PRGF), autologous protein solution (APS), and hyperacute serum (HS), for managing OA of the hip was investigated. This review summarizes the results of clinical studies involving the mentioned APBOs to manage OA of the hip. Multiple databases (Scopus, Embase, PubMed, and Web of Science) were searched employing terms for these 'APBOs' and 'OA of the hip' for articles published in the English language till September 21, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only two articles fit the scope of our study, and both included articles involved the use of ACS. No clinical studies involving the use of PL, GOLDIC, PRGF, APS, and HS were identified. No ongoing clinical trials were listed on any of the searched registers involving the use of the aforesaid APBOs. Intra-articular administration of ACS is safe and can reduce pain in patients with OA of the hip. Nonetheless, given the dearth of pertinent literature and limitations of included articles, more adequately powered, prospective, multicenter, controlled, open-label or blinded, randomized, and non-randomized trials with extended follow-up are necessary to determine the efficacy of various APBOs for managing hip OA. Further comparative studies to assist clinicians in finding the ideal APBO for the treatment of OA of the hip are needed.

Growth Factor Concentrate (GFC) for the Management of Osteoarthritis of the Knee: A Systematic Review

Introduction

The knee is the most commonly affected joint in osteoarthritis (OA), affecting millions of people worldwide. Knee OA significantly impacts the activities of daily living (ADL) along with affecting overall quality of life of patients (QoL), thereby leading to substantial socio-economic burden. Conservative therapies are prioritized, resorting to surgery only when needed. However, these traditional approaches have limitations. Regenerative medicine, involving the use of orthobiologics, including autologous peripheral blood-derived orthobiologics such as growth factor concentrate (GFC), has evolved and shown potential for managing knee OA. The primary goal of this review is to summarize the results of in vitro, preclinical and clinical studies involving GFC for the management of knee OA.

Methods

Multiple databases (PubMed, Scopus, Google Scholar, Web of Science and Embase) were searched applying terms for the intervention 'GFC' and treatment 'knee OA' for the studies published in the English language to March 10, 2024.

Results

Only three clinical studies met our pre-defined criteria and were included in this review.

Conclusion

Intra-articular administration of GFC is safe and potentially efficacious to manage OA of the knee. More, adequately powered, multi-center, prospective, RCTs are warranted to demonstrate the long-term effectiveness of GFC in patients suffering from mild-to-moderate knee OA and to justify its routine clinical use. Further studies evaluating the efficacy of GFC compared to other orthobiologics are also required to allow physicians/surgeons to choose the optimal orthobiologic for the treatment of OA of the knee.

Proteomics of human platelet lysates and insight from animal studies on platelet protein diffusion to hippocampus upon intranasal administration

Human platelet lysates (HPLs) from allogeneic platelet concentrates (PCs) are biomaterials, which are rich in various trophic factors, increasingly used in regenerative medicine and biotherapy. Understanding how preparation methods influence the HPL protein profile, biological function, and clinical outcomes is crucial. Our study sheds light on the proteomes and functionality of different HPLs, with the aim of advancing their scientifically grounded clinical applications. To achieve this, PCs suspended in plasma underwent three distinct processing methods, resulting in seven HPL types. We used three characterization techniques: label-free proteomics and tandem mass tag (TMT)-based quantitative proteomics, both before and after the immunodepletion of abundant plasma proteins. Bioinformatic tools assessed the proteome, and western blotting validated our quantitative proteomics data. Subsequent pre-clinical studies with fluorescent labeling and label-free proteomics were used as a proof of concept for brain diffusion. Our findings revealed 1441 proteins detected using the label-free method, 952 proteins from the TMT experiment before and after depletion, and 1114 proteins from the subsequent TMT experiment on depleted HPLs. Most detected proteins were cytoplasmic, playing key roles in catalysis, hemostasis, and immune responses. Notably, the processing methodologies significantly influenced HPL compositions, their canonical pathways, and, consequently, their functionality. Each HPL exhibited specific abundant proteins, providing valuable insight for tailored clinical applications. Immunoblotting results for selected proteins corroborated our quantitative proteomics data. The diffusion and differential effects to the hippocampus of a neuroprotective HPL administered intranasally to mice were demonstrated. This proteomics study advances our understanding of HPLs, suggesting ways to standardize and customize their production for better clinical efficacy in regenerative medicine and biotherapy. Proteomic analyses also offered objective evidence that HPPL, upon intranasal delivery, not only effectively diffuses to the hippocampus but also alters protein expression in mice, bolstering its potential as a treatment for memory impairments.

Management of rotator cuff injuries using allogenic platelet-rich plasma

Rotator cuff injuries are a major cause of shoulder pain, affecting the quality of life and producing a significant burden on healthcare systems. Conservative management modalities are prioritized, resorting to surgery only when required. The field of regenerative medicine involving the use of biologics, such as platelet-rich plasma (PRP), has evolved and shown potential for managing rotator cuff injuries. Nonetheless, limitations including subpar outcomes have led clinicians to question the efficacy of autologous PRP. To circumvent this, the possibility of utilizing a standardized and well-characterized allogenic PRP for RCI has been explored. In this manuscript, we qualitatively present the evidence from in vitro, pre-clinical, clinical and ongoing studies investigating the applications of allogenic PRP in the context of rotator cuff disorders. Administration of allogenic PRP is safe and potentially efficacious to manage rotator cuff injuries, though more adequately powered randomized controlled trials with longer follow-ups are warranted to further establish the efficacy of allogenic PRP and justify its routine clinical use.

Autologous Protein Solution (APS) and Osteoarthritis of the Knee: A Scoping Review of Current Clinical Evidence

Knees are the most regularly affected weight-bearing joints in osteoarthritis (OA), impacting millions of individuals across the globe. The incidence of knee OA will further rise with increasing rates of obesity and lifespan, resulting in a significant increase in the worldwide socioeconomic burden. Conventional therapies used to manage the symptoms associated with knee OA have limitations. Lately, there has been an increased interest in the use of autologous peripheral blood-derived orthobiologics (APBO), including autologous protein solution (APS), for the management of knee OA. Here, the primary objective is to summarize the outcomes of clinical studies involving APS for the treatment of knee OA. Several databases (Embase, Scopus, PubMed, and Web of Science) were searched using terms for the intervention "APS" and treatment "knee OA" for articles published in English until January 21, 2024. All clinical studies using APS as an intervention for the treatment of knee OA were included. Studies not utilizing APS alone or not aiming at the management of knee OA were excluded. Six clinical studies that met our predefined search terms and inclusion and exclusion criteria were included in this study. The results demonstrated that the intra-articular administration of APS is safe and efficacious in reducing pain and/or improving function in patients suffering from knee OA. However, more multicenter, randomized controlled trials involving active comparators, with adequate power and long-term follow-up along with post-market real-world studies in clinical practice are required to further assess the efficacy of APS and justify its regular clinical use for the management of knee OA.

Hyperacute Serum and Knee Osteoarthritis

The knees are the most frequently affected weight-bearing joints in osteoarthritis (OA), impacting millions of people globally. With increasing life spans and obesity rates, the prevalence of knee OA will further mount, leading to a significant increase in the economic burden. The usual treatment modalities utilized to manage knee OA have shortcomings. Over the last decade, the field of regenerative medicine involving the use of biologics, such as autologous peripheral blood-derived orthobiologics, including hyperacute serum (HS), has evolved and shown potential for managing knee OA. In this manuscript, we qualitatively present the in vitro, pre-clinical, clinical, and ongoing studies investigating the applications of HS in the context of knee OA. Seven in vitro studies and one clinical study fit the scope of our manuscript. The results demonstrated that the administration of HS is potentially safe and efficacious in terms of increasing the viability of osteoarthritic chondrocytes, reducing pain and inflammation, and improving function in patients with knee OA. However, due to insufficient literature, pre-clinical studies to better understand the mechanism of action are required. In addition, adequately powered, multi-center, non-randomized, and randomized controlled trials with longer follow-up are warranted to establish the safety and efficacy of HS for the management of knee OA and to justify its clinical use.

StemOneTM/Stempeucel®: CDSCO Approved, Adult Human Bone Marrow-Derived, Cultured, Pooled, Allogenic Mesenchymal Stem Cells for Knee Osteoarthritis

The knee, the most likely joint to present osteoarthritis (OA), is accountable for approximately 80% of the global burden of the OA [...].

Allogenic Platelet-Rich Plasma for the Treatment of Adhesive Capsulitis

Adhesive capsulitis (AC) is a common shoulder disorder leading to pain and restricted range of motion (ROM) and affects the patient's activities of daily living (ADL) and overall quality of life (QoL). Conservative therapies are prioritized, resorting to surgical intervention only when necessary. Unfortunately, these modalities have limitations and do not address the underlying pathological cause of AC. The use of autologous biologics, such as platelet-rich plasma (PRP), has evolved and shown promise for managing musculoskeletal (MSK) injuries, including AC. However, subpar functional outcomes have led clinicians to question the long-term efficacy of autologous PRP. To circumvent this, the possibility of utilizing a standardized and well-characterized allogenic PRP for AC has been explored. In this manuscript, we qualitatively present in vitro, pre-clinical, clinical, and ongoing studies investigating the varied applications of allogenic PRP for the management of AC. The results demonstrated that allogenic PRP acts in a pleiotropic manner and decreases pro-inflammatory cytokines only in the inflammatory condition. In addition, the administration of allogenic PRP is safe and potentially efficacious, in terms of reducing pain and improving range of motion, shoulder strength, and function, in non-surgical management of AC. Nonetheless, more pre-clinical studies and adequately powered, multicenter, prospective, non-randomized, and randomized controlled trials with longer follow-up are warranted to further establish the safety and efficacy of allogenic PRP and justify its routine clinical use.

Expanding applications of allogeneic platelets, platelet lysates, and platelet extracellular vesicles in cell therapy, regenerative medicine, and targeted drug delivery

Platelets are small anucleated blood cells primarily known for their vital hemostatic role. Allogeneic platelet concentrates (PCs) collected from healthy donors are an essential cellular product transfused by hospitals to control or prevent bleeding in patients affected by thrombocytopenia or platelet dysfunctions. Platelets fulfill additional essential functions in innate and adaptive immunity and inflammation, as well as in wound-healing and tissue-repair mechanisms. Platelets contain mitochondria, lysosomes, dense granules, and alpha-granules, which collectively are a remarkable reservoir of multiple trophic factors, enzymes, and signaling molecules. In addition, platelets are prone to release in the blood circulation a unique set of extracellular vesicles (p-EVs), which carry a rich biomolecular cargo influential in cell-cell communications. The exceptional functional roles played by platelets and p-EVs explain the recent interest in exploring the use of allogeneic PCs as source material to develop new biotherapies that could address needs in cell therapy, regenerative medicine, and targeted drug delivery. Pooled human platelet lysates (HPLs) can be produced from allogeneic PCs that have reached their expiration date and are no longer suitable for transfusion but remain valuable source materials for other applications. These HPLs can substitute for fetal bovine serum as a clinical grade xeno-free supplement of growth media used in the in vitro expansion of human cells for transplantation purposes. The use of expired allogeneic platelet concentrates has opened the way for small-pool or large-pool allogeneic HPLs and HPL-derived p-EVs as biotherapy for ocular surface disorders, wound care and, potentially, neurodegenerative diseases, osteoarthritis, and others. Additionally, allogeneic platelets are now seen as a readily available source of cells and EVs that can be exploited for targeted drug delivery vehicles. This article aims to offer an in-depth update on emerging translational applications of allogeneic platelet biotherapies while also highlighting their advantages and limitations as a clinical modality in regenerative medicine and cell therapies.