The use of platelet-rich plasma for the treatment of osteoarthritis

Aging Affects the Efficacy of Platelet-Rich Plasma Treatment for Osteoarthritis

OBJECTIVE

Despite the increased use of platelet-rich plasma in the treatment of osteoarthritis, whether and how age of the platelet-rich plasma donor affects therapeutic efficacy is unclear.

DESIGN

In vitro, male osteoarthritic human chondrocytes were treated with platelet-rich plasma from young (18-35 yrs) or old (≥65 yrs) donors, and the chondrogenic profile was evaluated using immunofluorescent staining for two markers of chondrogenicity, type II collagen and SOX-9. In vivo, we used a within-subjects design to compare Osteoarthritis Research Society International scores in aged mouse knee joints injected with platelet-rich plasma from young or old individuals.

RESULTS

In vitro experiments revealed that platelet-rich plasma from young donors induced a more youthful chondrocyte phenotype, as evidenced by increased type II collagen ( P = 0.033) and SOX-9 expression ( P = 0.022). This benefit, however, was significantly blunted when cells were cultured with platelet-rich plasma from aged donors. Accordingly, in vivo studies revealed that animals treated with platelet-rich plasma from young donors displayed a significantly improved cartilage integrity when compared with knees injected with platelet-rich plasma from aged donors ( P = 0.019).

CONCLUSIONS

Injection of platelet-rich plasma from a young individual induced a regenerative effect in aged cells and mice, whereas platelet-rich plasma from aged individuals showed no improvement in chondrocyte health or cartilage integrity.

Adjunctive platelet-rich plasma and hyaluronic acid injection after arthroscopic debridement in Kellgren-Lawrence grade 3 and 4 knee osteoarthritis

BACKGROUND

Osteoarthritis (OA) is the most common cause of pain and disability, predominantly affecting the knee. The current management of knee OA falls short of completely stopping disease progression, particularly in Kellgren-Lawrence (KL) grade 3 and 4 knee OA. As such, joint replacement is often recommended, although only 15%-33% of candidates accept it. Alternative therapeutic options are still needed to prevent the progression of joint damage and delay the need for knee arthroplasty.

AIM

To investigate the effect of adjunctive platelet rich plasma (PRP) and hyaluronic acid (HA) after arthroscopic debridement in KL grade 3 and 4 knee OA.

METHODS

This retrospective cohort study used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and WOMAC sub-scores (pain, stiffness, and function) to assess 21 patients, grouped according to medical record data of treatment received: Arthroscopic debridement (n = 7); arthroscopic debridement with PRP (n = 7); or arthroscopic debridement with HA (n = 7). WOMAC scores and sub-scores at baseline and at 3 mo and 5 mo posttreatment were recorded. The three-group data were statistically analyzed using the tests of paired t, one-way analysis of variance, and post hoc least significant difference.

RESULTS

All three treatment groups showed significant improvements in WOMAC score and sub-scores from before treatment to 3 mo and 5 mo after treatment. However, the arthroscopic debridement with PRP treatment group, in particular, showed a significantly lower WOMAC pain score than the group who received arthroscopic debridement alone at 5 mo after the procedure (P = 0.03).

CONCLUSION

Compared to arthroscopic debridement alone, adjunctive PRP after arthroscopic debridement significantly lessened the patients’ pain symptom.

Bone marrow aspirate concentrate versus platelet-rich plasma for treating knee osteoarthritis: a one-year non-randomized retrospective comparative study

Background

Knee osteoarthritis (OA) is a debilitating condition affecting human body biomechanics and quality of life. Current standard care for knee OA leads to trivial improvement and entails multiple adverse effects or complications. Recently, investigational cell therapies injected intra-articularly, such as bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP), have shown safety and therapeutic potency providing patients with pain relief. In the current retrospective comparative study, we investigated the differences in pain and functional improvements in patients with symptomatic knee OA receiving intra-articular injections of BMAC vs PRP.

Methods

Pain and functionality scores were measured at baseline and at different time points post-injection over 12 months, using 3 self-administered, clinically validated questionnaires: the visual analogue scale (VAS) for assessing pain intensity, the knee injury and osteoarthritis outcome score (KOOS) for evaluating functionality and knee-related quality of life, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) for evaluating physical function. The repeated-measures general linear model with Sidak test for pairwise comparisons was used to investigate the influence of the treatment on the score evolution within groups (between baseline and each time point) and between groups (overall).

Results

The BMAC group (n = 26 knees) significantly improved in VAS, KOOS, and WOMAC scores between baseline and 12 months (57.4, 75.88, and 73.95% mean score improvement, respectively). In contrast, the PRP group (n = 13 knees) witnessed nonsignificant improvement in all scores. BMAC, in comparison to PRP, induced significant improvement in outcomes by 29.38% on the VAS scale, 53.89% on the KOOS scale, and 51.71% on the WOMAC scale (P < .002, P < .01, P < .011, respectively).

Conclusions

Intra-articular autologous BMAC injections are safe, effective in treating pain, and ameliorate functionality in patients with symptomatic knee OA to a greater extent than PRP injections.

Graphical abstract

Intra-articular autologous BMAC therapy is safe and provides more relief to patients with symptomatic knee osteoarthritis compared to PRP therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04910-5.

Assessment of wound healing efficacy of Growth Factor Concentrate (GFC) in non-diabetic and diabetic Sprague Dawley rats

Backgrounds

The investigation of wound healing potential of human GFC (growth factor concentrate) was undertaken in diabetic and non-diabetic rats. Primarily, GFC is the combination of several growth factors present in blood which has potential of wound healing. In present study, WCK-GFC kit, a single step optimized kit was used for obtaining human GFC.

Methods

Diabetes in rats was induced by intraperitoneal single injection of 40 mg/kg streptozotocin (STZ). The full thickness circular wounds of 2 cm² area were created using sterilized stainless steel biopsy punch. Non-diabetic wounds were topically treated with 100µL and 300µL of GFC, while diabetic wounds were treated with 300µL of GFC. The standard of care treatment groups were included, wherein the non-diabetic and diabetic wound were topically treated with Nadoxin and Z-AD-G skin cream, respectively. The percentage of wound contraction was measured on weekly intervals. At the end of study duration, tissues from wound were collected for histopathological evaluation.

Results

Both diabetic and non-diabetic GFC treated rats exhibited a significantly higher rate of wound contraction on day 8 and 15 compared to normal untreated control group and standard-of-care treated rats. Wound healing was induced by GFC through rapid re-epithelialization. On comparing wound healing with standard-of care agent, the GFC treated wounds demonstrated a faster remodeling phase, a better organization and lower inflammation.

Conclusions

The current study demonstrates that topically applied GFC promotes healing of wounds, with enhanced wound contraction in both non-diabetic and diabetic rats.

Cell Therapy: Types, Regulation, and Clinical Benefits

Cell therapy practices date back to the 19th century and continue to expand on investigational and investment grounds. Cell therapy includes stem cell- and non-stem cell-based, unicellular and multicellular therapies, with different immunophenotypic profiles, isolation techniques, mechanisms of action, and regulatory levels. Following the steps of their predecessor cell therapies that have become established or commercialized, investigational and premarket approval-exempt cell therapies continue to provide patients with promising therapeutic benefits in different disease areas. In this review article, we delineate the vast types of cell therapy, including stem cell-based and non-stem cell-based cell therapies, and create the first-in-literature compilation of the different "multicellular" therapies used in clinical settings. Besides providing the nuts and bolts of FDA policies regulating their use, we discuss the benefits of cell therapies reported in 3 therapeutic areas-regenerative medicine, immune diseases, and cancer. Finally, we contemplate the recent attention shift toward combined therapy approaches, highlighting the factors that render multicellular therapies a more attractive option than their unicellular counterparts.

Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses

OBJECTIVE

The purpose of this study was (1) to perform a summary of meta-analyses comparing platelet-rich plasma (PRP) injection with hyaluronic acid (HA) and placebo injection for KOA patients, (2) to determine which meta-analysis provides the best available evidence to making proposals for the use of PRP in the treatment of KOA patients, and (3) to highlight gaps in the literature that require future investigation.

MATERIAL AND METHODS

PubMed, EMBASE, and Cochrane databases search were performed for meta-analyses which compared PRP injection with HA or placebo. Clinical outcomes and adverse events were extracted from these meta-analyses. Meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses (QUOROM) systems and the Oxman-Guyatt quality appraisal tool. The Jadad decision algorithm was also used to determine which meta-analysis provided the best available evidence.

RESULTS

Four meta-analyses were included in our study, and all of these articles were Level I evidence. The QUOROM score of each included meta-analysis range from 14 to 17 points (mean score 15, maximum score 18), and the Oxman-Guyatt score range from 4 to 6 points (mean score 5, maximum score 7). Three meta-analyses indicated PRP showed more benefit in pain relief and functional improvement than the control group, and the other one suggested no difference between these groups. All included meta-analyses found no statistical difference in adverse events between these groups. In addition, a meta-analysis conducted by Shen et al. got the highest methodological quality score and suggested that PRP provided better pain relief and function improvement in the treatment of KOA.

CONCLUSIONS

For short-term follow-up (≤1 year), intra-articular PRP injection is more effective in terms of pain relief and function improvement in the treatment of KOA patients than HA and placebo, and there is no difference in the risk of an adverse event between PRP and HA or placebo.

LEVEL OF EVIDENCE

Level I evidence, a summary of meta-analyses TRIAL REGISTRATION: PROSPERO ID CRD42018116168.

Topical effect of allogenous serum rich in growth factors (SRGF) on diabetic skin wound in rat

Diabetic foot ulcer is a major complication of diabetes mellitus with negative effects on the life quality. Management of diabetic foot ulcers is a big challenge with poor and low sufficient outcome management. Therefore, achievement to effective treatments may treat these ulcers. Nowdays, platelet products are used as an effective and safe agent for promotion of healing proposes in regenerative medicine. Serum rich in growth factors (SRGF) is a source of released growth factors from the platelets. In the present study, effect of allogenous SRGF was investigated on the streptozotocin (STZ)-induced diabetic wounds in rats. STZ (50 mg/kh, SC) caused significant increase in blood glucose and weight loss in rats. Full thickness cutaneous wounds (8 mm diameter) were created bilaterally on the dorsal of the diabetic rats. SRGF was injected at the edges of the wounds of one side only on the first day, and the contrary sides were considered as the control group. The percentage of wound contraction was demonstrared on day 3, 7, 11 after surgery. Tissue specimens were collected for microscopic study on days 7 and 14. Results showed a significant higher rate of wound contraction on days 5 and 7 in the treated group. Histopathologic findings displayed acceleration of re-epithelialization, increased angiogenesis and dense collagen fibers with better organization in the treated group. Current study suggests that SRGF was efficient because facilate wound healing and showed rapid re-epithelialization and increased angiogenesis.

The effect of intraarticular serum rich in growth factors (SRGF) on knee osteoarthritis in the rat model

Osteoarthritis (OA) is a degenerative joint disease with high incidence in world. Various treatments have been used for decreasing pain and improving physical function without clearly beneficial evidences. Nowadays, platelet-rich therapy is used as a novel approach in field of regenerative medicine. The present study evaluated the effect of intraarticular serum rich in growth factors (SRGF) on the monosodium iodoacetate induced-osteoarthritis in rat model. SRGF was injected 3 times weekly. Femorotibial joints were examined 2 weeks after last injection. Histopathologic results showed remarkable articular regeneration in the SRGF treated rats. Our findings were less surface irregularities and articular clefts, proliferation of chondrocytes and increasing synthesis of matrix proteoglycan with toluidine blue staining. Destroyed articular cartilage was repaired by fibro-hyaline cartilage in contrast to the OA rats that filled with fibrovascular tissues. The microscopic score had decreased in the treatment group. We concluded that SRGF, as a source of growth factors, have chondroinductive capacity with regard to enhancement of cartilage regeneration.

Identification of Novel Chondroprotective Mediators in Resolving Inflammatory Exudates

We hypothesized that exudates collected at the beginning of the resolution phase of inflammation might be enriched for tissue protective molecules; thus an integrated cellular and molecular approach was applied to identify novel chondroprotective bioactions. Exudates were collected 6 h (inflammatory) and 24 h (resolving) following carrageenan-induced pleurisy in rats. The resolving exudate was subjected to gel filtration chromatography followed by proteomics, identifying 61 proteins. Fractions were added to C28/I2 chondrocytes, grown in micromasses, ions with or without IL-1β or osteoarthritic synovial fluids for 48 h. Three proteins were selected from the proteomic analysis, α1-antitrypsin (AAT), hemopexin (HX), and gelsolin (GSN), and tested against catabolic stimulation for their effects on glycosaminoglycan deposition as assessed by Alcian blue staining, and gene expression of key anabolic proteins by real-time PCR. In an in vivo model of inflammatory arthritis, cartilage integrity was determined histologically 48 h after intra-articular injection of AAT or GSN. The resolving exudate displayed protective activities on chondrocytes, using multiple readouts: these effects were retained in low m.w. fractions of the exudate (46.7% increase in glycosaminoglycan deposition; ∼20% upregulation of COL2A1 and aggrecan mRNA expression), which reversed the effect of IL-1β. Exogenous administration of HX, GSN, or AAT abrogated the effects of IL-1β and osteoarthritic synovial fluids on anabolic gene expression and increased glycosaminoglycan deposition. Intra-articular injection of AAT or GSN protected cartilage integrity in mice with inflammatory arthritis. In summary, the strategy for identification of novel chondroprotective activities in resolving exudates identified HX, GSN and AAT as potential leads for new drug discovery programs.

How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts

The objectives of osteoarthritis (OA) management are to reduce pain and inflammation, slow cartilage degradation, improve function and reduce disability. Current strategies for managing knee OA include nonpharmacological interventions, oral pharmacological treatments, localized intra-articular injections, and surgery. It has become evident that the inflammatory response is a key contributor to the development and progression of knee OA. Signaling pathways involving growth factors and cytokines are being investigated for the development of new therapies that target the underlying biological processes causing the disease. This concept of 'molecular orthopedics' enables more patient-centered diagnostic and treatment strategies. In contrast to other conservative therapies, which ultimately only address OA symptoms, intra-articular injections, in particular autologous conditioned serum (ACS), provide benefits that have the potential to outweigh those of established pharmacological treatments and surgery. Surgery has historically been considered the final solution for treatment of knee OA, both by treating physicians and by patients; however, there are increasing concerns regarding the lack of randomized clinical trials providing evidence to support this opinion. Intra-articular injection of ACS has demonstrated efficacy as a treatment for knee OA in a number of studies, with a very low rate of adverse events and side effects, compared with surgery. Treatment with ACS utilizes the release of anti-inflammatory cytokines and regenerative growth factors to support the natural healing processes in the knee, and has the potential to provide a valuable alternative to surgical intervention.

Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study

[Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5±6.6, 54.9±5.3, and 55.1±5.6 years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.