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Gupta A, Maffulli N. Growth Factor Concentrate (GFC) for the Management of Osteoarthritis of the Knee: A Systematic Review. Indian J Orthop 2024; 58:829-834. [PMID: 38948375 PMCID: PMC11208381 DOI: 10.1007/s43465-024-01172-w] [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: 03/27/2024] [Accepted: 04/24/2024] [Indexed: 07/02/2024]
Abstract
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.
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Affiliation(s)
- Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043 USA
- Regenerative Orthopaedics, Noida, 201301 India
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA
- BioIntegrate, Lawrenceville, GA 30043 USA
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185 Rome, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke On Trent, ST4 7QB UK
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Baird HBG, Ashy CC, Kodali P, Myer GD, Murray IR, Pullen WM, Slone HS. Most Publications Regarding Platelet-Rich Plasma Use in the Knee Are From Asia, Investigate Injection for Osteoarthritis, and Show Outcome Improvement: A Scoping Review. Arthroscopy 2024:S0749-8063(24)00252-4. [PMID: 38537725 DOI: 10.1016/j.arthro.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To evaluate and synthesize the available literature related to platelet-rich plasma (PRP) treatment of knee pathologies and to provide recommendations to inform future research in the field. METHODS PubMed, CINAHL, and Scopus databases were queried on October 6, 2023. All identified citations were collated and uploaded into Covidence for screening and data extraction. Studies were included if they were human studies published in English with adult cohorts that received PRP as a procedural injection or surgical augmentation for knee pathologies with patient-reported outcome measures (PROMs) and level of evidence Levels I-IV. RESULTS Our search yielded 2,615 studies, of which 155 studies from 2006 to 2023 met the inclusion criteria. Median follow-up was 9 months (±11.2 months). Most studies (75.5%) characterized the leukocyte content of PRP, although most studies (86%) did not use a comprehensive classification scheme. In addition, most studies were from Asia (50%) and Europe (32%) and were from a single center (96%). In terms of treatment, 74% of studies examined PRP as a procedural injection, whereas 26% examined PRP as an augmentation. Most studies (68%) examined treatment of knee osteoarthritis. Many studies (83%) documented significant improvements in PROMs, including 93% of Level III/IV evidence studies and 72% of Level I/II evidence studies, although most studies (70%) failed to include minimal clinically important difference values. The visual analog scale was the most-used PROM (58% of studies), whereas the Short Form Health Survey 36-item was the least-used PROM (5% of studies). CONCLUSIONS Most published investigations of knee PRP are performed in Asia, investigate procedural injection for osteoarthritis, and show significant outcome improvements. In addition, this review highlights the need for better classification of PRP formulations. LEVEL OF EVIDENCE Level IV, scoping Review of level I-IV studies.
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Affiliation(s)
- Henry B G Baird
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A..
| | - Cody C Ashy
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Prudhvi Kodali
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, U.S.A.; Emory Sports Medicine Center, Atlanta, Georgia, U.S.A.; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A.; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A.; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, United Kingdom
| | - Iain R Murray
- The University of Edinburgh, Edinburgh, United Kingdom
| | - W Michael Pullen
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Harris S Slone
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Saraf A, Hussain A, Bishnoi S, Habib H, Garg A. Serial intraarticular injections of growth factor concentrate in knee osteoarthritis: A placebo controlled randomized study. J Orthop 2023; 37:46-52. [PMID: 36974096 PMCID: PMC10039117 DOI: 10.1016/j.jor.2023.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
Objective To evaluate and compare clinical efficacy and effect on specific serum biomarker with serial injections of growth factor concentrate (GFC) for knee osteoarthritis (KOA) in a randomized triple blinded placebo controlled interventional study. Methods Final assessment was done on 58 patients. Patients with Kellgren-Lawrence grade II, III knee osteoarthritis were administered monthly intraarticular injections(3 injections) of GFC(n = 31) or saline(n = 27) and evaluated clinically with visual analogue scale(VAS) and Western Ontario and McMaster Universities Arthritis Index(WOMAC) at 3,6 and 12 months post therapy. Biochemical analysis was done with serum biomarker of cartilage degeneration, Collagen 2-1 (Coll2-1), estimated at baseline and at final follow up. Results Both the groups exhibited statistically significant improvements (P < 0.05) in VAS at 3,6 and 12 months. WOMAC improvement reached statistical significance for GFC group at every evaluation (P < 0.001) but only at 12 months in NS group (P = 0.029). The improvements were clinically meaningful only in GFC group throughout follow up (Minimal clinically important differences >12% of baseline in WOMAC and >2 cm difference in mean for VAS). Intergroup comparison revealed GFC to be much better for both scores at every evaluation (95% CI of 0.2-1.5,[P = 0.008], 1.4-2.9,[P < 0.0001], and 2.7-4.2,[P < 0.0001] for VAS, 7.3-16.0 [P < 0.001], 11.6-21.9 [P < 0.001] and 18.1-31.1[P < 0.001] for WOMAC). Statistically significant decrease in serum Coll2-1 levels were observed for GFC group only. No serious complications were seen. Conclusion Serial(three) monthly GFC injections result in clinically meaningful improvement of subjective pain and function outcome scores, sustaining up to 12 months in KOA grade II and III. GFC also lead to significant reduction in serum levels of cartilage degradation biomarker coll2-1.
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Affiliation(s)
- Amit Saraf
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Altaf Hussain
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Sandeep Bishnoi
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Hamza Habib
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
| | - Abhishek Garg
- Department of Orthopaedics, Teerthanker Mahaveer Medical College & Research Centre, Delhi Road. NH 24, Bagadpur, Moradabad, Uttar Pradesh, 244001, India
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Effect of Intra-Articular Injection of Platelet-Rich Plasma on the Serum Levels of Osteoarthritic Biomarkers in Patients with Unilateral Knee Osteoarthritis. J Clin Med 2021; 10:jcm10245801. [PMID: 34945097 PMCID: PMC8706559 DOI: 10.3390/jcm10245801] [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] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study is to determine the effect of three doses of intra-articular injection of platelet-rich plasma (PRP) into the osteoarthritic (OA) knee joint on the functional status and on the changes in the levels of specific OA biomarkers in blood serum. METHODS Forty patients with unilateral primary knee osteoarthritis were enrolled in this single center, prospective clinical trial. For each patient, three intra-articular PRP injections were administered one week apart. Clinical and laboratory assessment was performed before the first PRP injection (baseline), and 3 months after the third PRP application (3-month follow up). Pain in the affected knee joint was assessed with the Visual Analog Scale for Pain (VAS). Change in clinical status was evaluated with the Western Ontario and McMaster Universities Arthritis Index Questionnaire (WOMAC). Concentrations of 19 biomarkers (EGF, Eotaxin, FGF-2, GRO, IL-10, IL-1RA, IL-8, IP-10, MCP-1, PDGF-AB/BB, RANTES, MMP-3, MMP-13, Collagen type 2, BMP-2, TIMP-1, TIMP-2, TGF beta 1, and COMP) in the serum of studied patients were quantified. RESULTS At 3-month follow up, there was a significant decrease in the VAS score and significant improvement in the WOMAC score. There was a significant decrease in the levels of Eotaxin, MCP-1, MMP-1, IL-10, EGF, PDGF-AB/BB, TGF- β1 compared to baseline levels. A significant increase in markers BMP-2, COMP, Collagen type 2 and GRO was found at the same time point. There was no significant change in the concentrations of other biomarkers (FGF-2, IL-1RA, IL-8, IL-10, MMP-3, RANTES, TIMP-1, TIMP-3). CONCLUSIONS We found an increase in specific pro-anabolic and anti-inflammatory biomarkers with a concomitant decrease in pro-inflammatory biomarkers at 3 months after three intra-articular applications of PRP. Significant improvement in VAS and WOMAC scores was observed. Treatment with PRP may be an effective therapeutic option with anti-inflammatory and regenerative potential in patients with primary knee OA.
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Hick AC, Fonck M, Costes B, Cobraiville E, Pirson S, Garcia L, Labasse A, Vander Poelen S, Henrotin Y. Serum Levels of Coll2-1, a Specific Biomarker of Cartilage Degradation, Are Not Affected by Sampling Conditions, Circadian Rhythm, and Seasonality. Cartilage 2021; 13:540S-549S. [PMID: 31631693 PMCID: PMC8808846 DOI: 10.1177/1947603519878489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess intraindividual biological variability of serum cartilage specific biomarker Coll2-1 and define the best standardized conditions for blood sampling. DESIGN Blood samples were taken from 116 subjects with knee osteoarthritis (OA) at a single time point (PRODIGE study) and from 15 healthy subjects under various conditions, including fasting condition, sampling time and season, blood treatment, and type of blood collection tube (COVAR study). Type II collagen-specific biomarker Coll2-1 was directly measured in serum using an immunoassay. RESULTS There was no significant difference on Coll2-1 values between samples collected at any of the 5 sampling times or at any of the sampling days measured. None of the sampling parameters tested had a significant impact on Coll2-1 value (clotting time, clotting temperature and temperature of blood centrifugation, type of tube). On the contrary, differences were found in between subjects and between subjects with knee OA and healthy subjects. CONCLUSION Coll2-1 measurement is not affected by sampling specific conditions, circadian rhythm or seasons but was found elevated in subject with knee OA indicating that Coll2-1 serum variation is not linked to the study environment, but to cartilage degradation in OA. Coll2-1 assay is sufficiently robust for use in OA clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yves Henrotin
- ARTIALIS SA, Liège, Belgium,Bone and Cartilage Research Unit,
Arthropole Liège, University of Liège, Liège, Belgium,Yves Henrotin, ARTIALIS SA, 11 avenue de
l’hôpital, GIGA Tower, level 3, CHU Sart-Tilman, Liège, 4000, Belgium.
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Chou SH, Shih CL. Efficacy of different platelet-rich plasma injections in the treatment of mild-moderate knee osteoarthritis: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14068. [PMID: 33544424 DOI: 10.1111/ijcp.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/01/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS This study aimed to compare the efficacy of different numbered sets of injections of platelet-rich plasma (PRP) in the treatment of mild-moderate knee osteoarthritis (OA). METHODS A comprehensive search in three databases of Cochrane Library, Embase, and PubMed was conducted to find relevant articles that investigated the efficacy of PRP injection therapies in the treatment of mild-moderate knee OA through August 2020. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores were the primary outcomes and visual analogue scale (VAS) was the secondary outcome. The pooled improvements amongst different injection therapies were compared. RESULTS No significant differences in the improvement of WOMAC pain were observed amongst 1-, 2-, and 3-injection therapies at 3- (P = .26) and 6-month (P = .13) follow-ups. For a 12-month follow-up, the difference amongst different therapies reached borderline significance (P = .05) in which 3-injection therapy had a significantly better improvement than 2-injection therapy (P = .02) and reached borderline significance compared with 1-injection (P = .07). However, no significant differences in the improvement of VAS scores were observed amongst three injection therapies for all the follow-up visits (P > .05). For WOMAC function score, 3-injection therapy performed significantly better than 1-injection (P < .00001) or 2-injection therapy (P < .0001) only at 12-month follow-up visit. CONCLUSIONS Our results demonstrated that 3-injection therapy of PRP in the treatment of mild-moderate knee OA had the best efficacy in pain relief and function improvement compared with 1- and 2-injection therapies.
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Affiliation(s)
- Shih-Hsiang Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Chia-Lung Shih
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan
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Andia I, Atilano L, Maffulli N. Moving toward targeting the right phenotype with the right platelet-rich plasma (PRP) formulation for knee osteoarthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211004336. [PMID: 33854574 PMCID: PMC8010808 DOI: 10.1177/1759720x211004336] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022] Open
Abstract
Intra-articular injections of platelet-rich plasma (PRP) and other novel blood-derived products developed specifically for osteoarthritis (OA) can provide pain relief and potential benefits in disease progression. Meta-analyses show the clinical superiority of PRP compared with other intra-articular injections, but results are modest and the effect sizes are small. PRP injections in knee OA are performed indiscriminately, but the clinical response varies enormously between patients because of an array of mixed OA phenotypes. Subgroup analyses are scarce; some studies stratify patients according to radiographic severity and found better results in early OA, without consensus for more advanced stages of the condition. Parallel identification of soluble and imaging biomarkers is essential to personalise and leverage PRP therapies. The inflammatory phenotype is most interesting from the PRP perspective because PRPs modulate inflammation by releasing a large pool of chemokines and cytokines, which interact with synovial fibroblasts and macrophages; in addition, they can modulate the innate immune response. No soluble biomarkers have been discovered that have implications for OA research and PRP interventions. Clinical examination of patients based on their inflammatory phenotype and imaging identification of pain sources and structural alterations could help discern who will respond to PRP. Synovial inflammation and bone marrow lesions are sources of pain, and intra-articular injections of PRP combined with subchondral bone injection can enhance clinical outcomes. Further refining ultrasound phenotypes may aid in personalising PRP therapies. Intra-articular delivery combined with injections in altered ligamentous structures, medial and coronal ligaments or premeniscal pes anserinus showed positive clinical outcomes. Although the evidence supporting these approaches are weak, they merit further consideration to refine PRP protocols and target the right OA phenotypes.
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Affiliation(s)
- Isabel Andia
- Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, Barakaldo, Bizkaia, 48903, Spain
| | - Leire Atilano
- Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Interventionist Radiology Unit, Department of Radiology, Cruces University Hospital, Barakaldo, Bizkaia, 48903, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentristry, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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Intra-articular injections of platelet-rich plasma in symptomatic knee osteoarthritis: a consensus statement from French-speaking experts. Knee Surg Sports Traumatol Arthrosc 2021; 29:3195-3210. [PMID: 32583023 PMCID: PMC8458198 DOI: 10.1007/s00167-020-06102-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 11/02/2022]
Abstract
PURPOSE There has been much debate regarding the use of intra-articular injections of platelet-rich plasma (PRP) as symptomatic treatment for knee osteoarthritis. The objective of this consensus was to develop guidelines for PRP injections in knee osteoarthritis according to the French National Authority for Health recommendations. METHODS Fifteen physicians from different French-speaking countries (10 rheumatologists, 4 specialists in rehabilitation and sports medicine and 1 radiologist) were selected for their expertise in the areas of PRP and osteoarthritis. A comprehensive literature review was conducted on Medline including all published therapeutic trials, open studies, meta-analysis and systematic reviews focusing on the effects of PRP in knee OA, as well as fundamental studies concerning the characteristics of the various types of PRP and their mechanisms, indexed before April 2019. Using the method recommended by the French National Authority for Health inspired by the Delphi consensus process, 25 recommendations were finally retained and evaluated. The recommendations were classified as appropriate or not appropriate, with strong or relative agreement, or uncertain if a consensus was not achieved. RESULTS Among the 25 recommendations selected, the main ones are the following: (1) Intra-articular injections of PRP are an effective symptomatic treatment for early to moderate knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 6-9). Level of evidence 1A. (2) A PRP treatment sequence in knee osteoarthritis may include 1-3 injections. This recommendation was considered appropriate with a strong agreement (Median = 9; rank = 7-9). Level of evidence 1A. (3) Leucocytes-poor PRP should be preferred in knee osteoarthritis. This recommendation was considered appropriate with a relative agreement (Median = 8; rank = 5-9). Level of evidence 5. (4) Intra-articular PRP knee injections should be performed under ultrasound or fluoroscopic guidance. This recommendation was considered uncertain with no consensus (Median = 8; rank = 3-9). Level of evidence 5. (5) PRP should not be mixed with an anesthetic or intra-articular corticosteroid. This recommendation was considered appropriate with a relative agreement (Median = 9; rank = 6-9). Level of evidence 5 CONCLUSION: Those 25 recommendations should standardize and facilitate the use of IA PRP injections, which are considered by experts as an effective treatment especially in early or moderate knee OA. Although a strong or relative agreement from the experts was obtained for most of the recommendations, many of them had a very low level of evidence (Level 5) and were principally based on the clinical experience of the experts.
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Nagy EE, Nagy-Finna C, Popoviciu H, Kovács B. Soluble Biomarkers of Osteoporosis and Osteoarthritis, from Pathway Mapping to Clinical Trials: An Update. Clin Interv Aging 2020; 15:501-518. [PMID: 32308378 PMCID: PMC7152733 DOI: 10.2147/cia.s242288] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/02/2020] [Indexed: 12/20/2022] Open
Abstract
Serum biomarkers of osteoarticular diseases have been in the limelight of current clinical research trends. Laboratory validation of defined and candidate biomarkers for both osteoarthritis and osteoporosis is of key importance for future decisional algorithms in the diagnosis, monitoring, and prognosis of these diseases. The current guidelines recommend the use of collagen degradation remnants, eg, CTX-I and CTX-II, in the complementary diagnosis of both osteoporosis and osteoarthritis. Besides the collagen degradation markers, enzymes that regulate bone and articular metabolism are useful in the clinical evaluation of osteoarticular pathologies. Along these, several other recommended and new nominee molecules have been recently studied. Wnts and Wnt-related molecules have a cardinal role in the bone-joint homeostasis, making them a promising target not only for pharmaceutical modulation, but also to be considered as soluble biomarkers. Sclerostin and dickkopf, two inhibitor molecules of the Wnt/β-catenin signaling, might have a dual role in the assessment of the clinical manifestations of the osteoarticular unit. In osteoarthritis, besides fragments of collagen type II many pathway-related molecules have been studied and proposed for biomarker validation. The most serious limitation is that a significant proportion of studies lack statistical power due to the reduced number of cases enrolled. Serum biomarkers of bone and joint turnover markers represent an encouraging possibility for the diagnosis and prognosis of osteoarticular diseases, although further studies and laboratory validations should be carried out as to solely rely on them.
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Affiliation(s)
- Előd Ernő Nagy
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Csilla Nagy-Finna
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
- Department M4, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania; Rheumatology Clinic, Clinical Emergency Hospital, Târgu Mureș, Romania
| | - Horațiu Popoviciu
- Department M4, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania; Rheumatology Clinic, Clinical Emergency Hospital, Târgu Mureș, Romania
| | - Béla Kovács
- Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Târgu Mureș, Romania
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Mariani E, Pulsatelli L. Platelet Concentrates in Musculoskeletal Medicine. Int J Mol Sci 2020; 21:ijms21041328. [PMID: 32079117 PMCID: PMC7072911 DOI: 10.3390/ijms21041328] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 12/02/2022] Open
Abstract
Platelet concentrates (PCs), mostly represented by platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous biological blood-derived products that may combine plasma/platelet-derived bioactive components, together with fibrin-forming protein able to create a natural three-dimensional scaffold. These types of products are safely used in clinical applications due to the autologous-derived source and the minimally invasive application procedure. In this narrative review, we focus on three main topics concerning the use of platelet concentrate for treating musculoskeletal conditions: (a) the different procedures to prepare PCs, (b) the composition of PCs that is related to the type of methodological procedure adopted and (c) the clinical application in musculoskeletal medicine, efficacy and main limits of the different studies.
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Affiliation(s)
- Erminia Mariani
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-6366803
| | - Lia Pulsatelli
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
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Mehrabani D, Seghatchian J, Acker JP. Platelet rich plasma in treatment of musculoskeletal pathologies. Transfus Apher Sci 2019; 58:102675. [DOI: 10.1016/j.transci.2019.102675] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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12
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Mobasheri A, Lambert C, Henrotin Y. Coll2-1 and Coll2-1NO2 as exemplars of collagen extracellular matrix turnover - biomarkers to facilitate the treatment of osteoarthritis? Expert Rev Mol Diagn 2019; 19:803-812. [PMID: 31327279 DOI: 10.1080/14737159.2019.1646641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Osteoarthritis (OA) is the most common form of arthritis. However, there are no structure or disease-modifying OA drugs (DMOADs). Introducing personalized healthcare to patients and health-care practitioners is a high priority for the management of arthritic and musculoskeletal diseases. However, there are no biomarker tools that can be used for patient stratification, disease management, and drug development. Biomarkers are capable of diagnosing and prognosing some arthritic and musculoskeletal diseases. Cartilage-based biomarkers have the potential to be used in this context to guide the precision treatment of OA. Areas covered: The aim of this review is to focus on the pre-clinical and clinical utility of the Coll2-1 and Coll2-1NO2 biomarkers as unique cartilage-based biomarkers that can guide the development of new treatments for OA. This expert report will begin with a background to collagens and their important biomechanical roles in the musculoskeletal system, but particularly cartilage, before exploring the data and scientific evidence to support the utility of Coll2-1 and Coll2-1NO2 as unique biomarkers. Expert opinion: This review summarises the authors' expert view on the pre-clinical and clinical utility of the Coll2-1 and Coll2-1NO2 biomarkers and their potential for use as drug development tools.
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Affiliation(s)
- Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine , Vilnius , Lithuania.,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre , Nottingham , UK.,European Commission, The D-BOARD FP7 Consortium.,The APPROACH IMI Consortium.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu , Oulu , Finland
| | - Cecile Lambert
- Bone and Cartilage Research Unit, Arthropole Liège, Institute of Pathology, University of Liège , Liège , Belgium
| | - Yves Henrotin
- European Commission, The D-BOARD FP7 Consortium.,The APPROACH IMI Consortium.,Bone and Cartilage Research Unit, Arthropole Liège, Institute of Pathology, University of Liège , Liège , Belgium
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Muir SM, Reisbig N, Baria M, Kaeding C, Bertone AL. The Concentration of Plasma Provides Additional Bioactive Proteins in Platelet and Autologous Protein Solutions. Am J Sports Med 2019; 47:1955-1963. [PMID: 31125271 DOI: 10.1177/0363546519849671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, platelet-poor plasma (PPP) is a discarded waste product of platelet-rich plasma (PRP) and may contain valuable proteins. PURPOSE/HYPOTHESIS The study's goal was to evaluate the concentration of plasma as a potential additive biotherapy for the treatment of osteoarthritis. We hypothesized that a novel polyacrylamide concentration device would efficiently concentrate insulin-like growth factor-1 (IGF-1) from PPP and be additive to PRP or autologous protein solution (APS). STUDY DESIGN Descriptive laboratory study. METHODS A laboratory study was conducted with human and equine whole blood from healthy volunteers/donors. Fresh samples of blood and plasma were processed and characterized for platelet, white blood cell, and growth factor/cytokine content and then quantified by enzyme-linked immunosorbent assays specific for IGF-1, transforming growth factor-β, interleukin-1β, and interleukin-1 receptor antagonist as representatives of cartilage anabolic and inflammatory mediators. RESULTS A potent cartilage anabolic protein, IGF-1, was significantly concentrated by the polyacrylamide concentration device in both human and equine PPP. The polyacrylamide device also substantially increased plasma proteins over whole blood, most dramatically key proteins relevant to the treatment of osteoarthritis, including transforming growth factor-β (29-fold over blood) and interleukin-1 receptor antagonist (70-fold over plasma). CONCLUSION Concentrated PPP is a unique source for biologically relevant concentrations of IGF-1. PRP and APS can produce greater concentrations of other anabolic and anti-inflammatory proteins not found in plasma. CLINICAL RELEVANCE The polyacrylamide device efficiently concentrated PPP to create a unique source of IGF-1 that may supplement orthopaedic biologic therapies.
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Affiliation(s)
- Sean M Muir
- The Ohio State University, Columbus, Ohio, USA
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Saberi Hosnijeh F, Bierma-Zeinstra SM, Bay-Jensen AC. Osteoarthritis year in review 2018: biomarkers (biochemical markers). Osteoarthritis Cartilage 2019; 27:412-423. [PMID: 30552966 DOI: 10.1016/j.joca.2018.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/23/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this narrative review is to summarize important findings from biochemical marker studies relevant to osteoarthritis (OA) in the context of new discoveries and clinical and scientific need. DESIGN We conducted a systematic search of electronic medical databases (Embase, Medline, Web of Science, Cochrane central) between 01-03-2017 and 31-03-2018. The search was restricted to human studies, English language and full text available publications while reviews were excluded. Only papers describing protein based biomarkers measured in human body fluids (blood, urine and synovial fluid (SF)) were included. Of the 992 papers, 86 were reviewed here, with inclusion primarily based on relevance to OA biochemical markers. RESULTS This review highlights a selection of studies based on their quality and perceived importance to the field mainly including those that1 evaluate prognostic value of biomarkers for OA progression (i.e., biomarkers reflecting change in composition of joint tissues and biomarkers of inflammation)2, help in assessment of intervention efficacy, and3 are innovative and uncover new candidate biomarkers, or use new approaches in biomarker discovery. CONCLUSIONS Key findings and implications for possible clinical utility of biochemical markers are summarized and discussed. Given the paucity of robust biomarkers within the field, and the heterogeneity of the condition, enormous works are needed for development and validation of novel and clinically applicable biomarkers to reduce the impact of this highly prevalent and debilitating condition.
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Affiliation(s)
- F Saberi Hosnijeh
- Immunology Department, Erasmus University Medical Center, Rotterdam, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.
| | - S M Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - A C Bay-Jensen
- Biomarker and Research, Nordic Bioscience, Herlev, Denmark.
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15
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Andia I, Maffulli N. A contemporary view of platelet-rich plasma therapies: moving toward refined clinical protocols and precise indications. Regen Med 2018; 13:717-728. [PMID: 30246605 DOI: 10.2217/rme-2018-0042] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP + cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies.
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Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine & Dentristry, Salerno, Italy.,Queen Mary University of London, Barts & the London School of Medicine & Dentistry, London, UK
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Şahin Ş, Tuncel SA, Salimi K, Bilgiç E, Korkusuz P, Korkusuz F. Advanced Injectable Alternatives for Osteoarthritis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1077:183-196. [DOI: 10.1007/978-981-13-0947-2_11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Eo SH, Kim SJ. Rosmarinic acid induces rabbit articular chondrocyte differentiation by decreases matrix metalloproteinase-13 and inflammation by upregulating cyclooxygenase-2 expression. J Biomed Sci 2017; 24:75. [PMID: 28923043 PMCID: PMC5603189 DOI: 10.1186/s12929-017-0381-5] [Citation(s) in RCA: 7] [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: 07/11/2017] [Accepted: 09/06/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) are known to play an important role in the degradation of the extracellular matrix and the pathological progression of osteoarthritis (OA). The natural polyphenolic compound rosmarinic acid (Ros. A) has been shown to suppress the inhibitory activity of matrix metalloproteinases (MMPs). However, the effects of Ros. A on OA have not been investigated. METHODS In the current study, primary articular chondrocytes were cultured from rabbit articular cartilage and treated with Ros. A. Phenotypic characterization was performed by western blotting to assess specific markers, prostaglandin E2 (PGE2) assays, and alcian blue staining to measure sulfated-proteoglycan production. RESULTS We report that in rabbit articular chondrocytes, Ros. A increased type II collagen, sulfated-proteoglycan, cyclooxygenase-2 (COX-2), and PGE2 production in a dose- and time-dependent manner. Furthermore, Ros. A suppressed the expression of MMP-13. In addition, treatment with Ros A activated extracellular signal-regulated kinase (ERK)-1/2 and p38 kinase signaling pathways. Inhibition of MMP-13 enhanced Ros. A-induced type II collagen expression and sulfated-proteoglycan synthesis but COX-2 and PGE2 production were unchanged. Ros. A-mediated up-regulation of ERK phosphorylation was abolished by the MEK inhibitor, PD98059, which prevented induction of the associated inflammatory response. Inhibition of p38 kinase with SB203580 enhanced the increase in type II collagen expression via Ros. A-mediated down-regulation of MMP-13. CONCLUSIONS Results suggest that ERK-1/2 regulates Ros. A-induced inflammation and that p38 regulates differentiation by inhibiting MMP-13 in rabbit articular chondrocytes.
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Affiliation(s)
- Seong-Hui Eo
- Department of Biological Sciences, College of Natural Sciences, Kongju National University, Gongju, 32588 Republic of Korea
| | - Song Ja Kim
- Department of Biological Sciences, College of Natural Sciences, Kongju National University, Gongju, 32588 Republic of Korea
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