Autologous peripheral blood-derived orthobiologics: Different types and their effectiveness in managing knee osteoarthritis

Undenatured type II collagen for knee osteoarthritis

INTRODUCTION

Knee Osteoarthritis (OA) leads to significant pain and reduced function and affects patients' overall quality of life (QoL). Conservative modalities are the first line of management, resorting to surgery only if they fail. However, these modalities have limitations, and do not address the underlying cause of knee OA. The use of nutraceuticals, including native/undenatured type II collagen (UC-2), has evolved and shown promise in the conservative management of knee OA. This article highlights the mechanism of action, and qualitatively presents the pre-clinical, clinical and on-going scientific literature exploring the safety and efficacy of UC-2 for the management of knee OA.

METHODS

A search was performed using multiple databases (PubMed, Web of Science, Embase and Scopus) employing terms for UC-2 and Knee OA for articles published in English language, while adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. All pre-clinical and clinical studies utilizing UC-2 for knee OA were included. Studies not using UC-2 alone or not focusing on the management of knee OA were excluded.

RESULTS

Twelve studies (3 pre-clinical studies, 8 clinical studies and 1 study with both pre-clinical and clinical component) met our pre-defined search and inclusion criteria, and were included in this review.

DISCUSSION

UC-2 acts via a specific immune mediated mechanism, known as oral tolerance, which can lead to reduced inflammation and enhanced cartilage repair in the knee joint. In addition, administration of UC-2 (40 mg daily) is safe and efficacious in the short- and mid-term, reducing inflammation and pain, and improving function, range of motion (ROM) and overall QoL. Nonetheless, more adequately powered, prospective, multi-center, non-randomized and randomized controlled trials with longer follow-up are warranted to establish the long-term efficacy of UC-2 in knee OA patients and justify its routine clinical use.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Elbow Disorders: A Review of Current Clinical Evidence

INTRODUCTION

Elbow ailments are common, but conventional treatment modalities have shortcomings, offering only interim pain relief rather than targeting the underlying pathophysiology. The last two decades have seen a marked increase in the use of autologous peripheral blood-derived orthobiologics (APBOs), such as platelet-rich plasma (PRP), to manage elbow disorders. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy remains debatable. Consequently, other APBOs, such as 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), have been considered. Only a few reviews summarize the results of clinical studies investigating the efficacy of these APBOs in elbow disorders. This review documents the results of clinical studies involving APBOs in managing elbow disorders and summarizes the ongoing clinical studies on different clinical trial protocol repositories comprising these APBOs to manage elbow disorders.

METHODS

This systematic review adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. In December 2024, PubMed, Embase, and Web of Science were accessed with no additional filters or time constraints. All available clinical studies published in English, French, Spanish, German, or Italian concerning the management of elbow disorders by means of APBOs were considered.

RESULTS

Only three clinical studies met our predefined search and inclusion criteria. In particular, two and one studies involving the use of PL and ACS, respectively, were included in this review. Data from 99 patients were obtained. Of them, 57.6% (57 of 99 patients) were women. The mean length of follow-up was 11.9 ± 0.6 months, and the mean age was 42.0 ± 3.5 years. No complications were reported in any of the studies included. The included studies have low to medium risk of bias, and a very low score on methodological quality. Finally, no clinical studies involving the use of GOLDIC, PRGF, APS or HS were identified, and only one ongoing clinical study involving the use of PL was registered.

CONCLUSIONS

The current peer-reviewed published studies demonstrated that administering APBOs, including PL and ACS, might be safe and effective in reducing pain and improving function in patients with elbow disorders. Further, high-quality studies are required.

Pathological Site Pain During Injections as a Predictive Sign for Clinical Response in Autologous Protein Solution and Hyaluronic Acid Injections for Knee Osteoarthritis

Objectives

Autologous peripheral blood-derived orthobiologics like platelet-rich plasma (PRP) have been gaining in popularity in symptomatic relief of knee osteoarthritis (OA). Autologous protein solution (APS) that is derived from PRP offers higher levels of growth factors and anti-inflammatory cytokines, reducing inflammation and improve cartilage quality. Additionally, hyaluronic acid (HA) has shown efficacy in relieving OA symptoms. This study aims to assess the clinical outcomes of combined APS and HA therapy, particularly a presence of pathological site pain (PSP) during injection as a predictive sign for clinical response.

Methods

Patients with early-stage OA received APS and HA injections. Patients were evaluated pre-injection and at 1-year follow-up. Patient-reported outcomes were assessed with WOMAC, KOOS, VAS pain score, and SF-36 survey. The OMERACT-OARSI criteria determined treatment effects. Satisfaction and expectation fulfillment were also recorded.

Results

32 patients were included in the final analysis. Statistically significant improvements were observed in all outcome scores at 1 year. The responder rate per OMERACT-OARSI criteria was 65.6 %, with 96.9 % of patients reporting satisfaction and expectation fulfillment. When comparing responder-rates and improvement in patient-reported outcome measures with other studies, combined therapy does not appear to confer additional therapeutic benefit over APS monotherapy at the 1-year mark. No severe adverse events related to the injections were reported. Patients with PSP had significantly better outcomes in terms of pain, stiffness, symptoms, activities of daily living, quality of life, as well as statistically significantly higher satisfaction rates of expectation fulfilment.

Conclusions

At 1-year post-injection, the APS and HA combination significantly improved WOMAC, KOOS, SF-36 PCS, and VAS scores, with a high rate of patient satisfaction. PSP during injection could possibly be predictive of better outcomes and expectation fulfilment.

Level of evidence

Level III.

Autologous Peripheral Blood-Derived Orthobiologics for the Management of Shoulder Disorders: A Review of Current Clinical Evidence

INTRODUCTION

A multidisciplinary approach is recommended to manage shoulder pain, the third most common musculoskeletal disorder, but traditional modalities have limitations, providing only temporary symptomatic pain relief instead of targeting the underlying pathophysiology. Recently, autologous peripheral blood-derived orthobiologics (APBOs) have become popular for the management of shoulder disorders. Platelet-rich plasma (PRP) is the most frequently used APBO, but its efficacy remains disputable. Thus, the possibility of using other APBOs, such as platelet lysate (PL), autologous conditioned serum (ACS), gold-induced cytokine (GOLDIC), plasma rich in growth factors (PRGF), growth factor concentrate (GFC), autologous protein solution (APS), and hyperacute serum (HS), for the management of shoulder disorders have been considered. This review summarizes the outcomes of clinical studies involving APBOs to manage shoulder disorders.

METHODS

Multiple databases (PubMed, Web of Science, Embase, and Scopus) were searched employing terms for APBOs and various shoulder disorders for articles published in the English language to September 11, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Only six clinical studies fulfilled our pre-defined search and inclusion criteria. Specifically, one, two, two, and one studies involving the use of PL, ACS, PRGF, and APS, respectively, were included in this review. No clinical studies were identified involving the use of GOLDIC, GFC, and HS.

CONCLUSIONS

Administration of PL, ACS, PRGF, and APS is safe and can reduce pain and improve function in patients with shoulder disorders, including rotator cuff tendinopathy, subacromial impingement syndrome, glenohumeral osteoarthritis and delayed union fracture of the clavicle. Given the dearth of relevant literature and limitations of the available studies, more prospective clinical studies, and ideally, randomized controlled trials, with extended follow-up are necessary to establish the efficacy of APBOs and to select the ideal APBO for the management of shoulder disorders.

Platelet Lysate and Osteoarthritis of the Knee: A Review of Current Clinical Evidence

INTRODUCTION

Osteoarthritis (OA) of the knee affects millions of people with sizable socioeconomic burden. Conventional treatment modalities are prioritized, turning to surgical intervention only when they have failed. However, these traditional modalities have shortcomings, only aiming to reduce pain rather than targeting the underlying pathophysiology. Recently, the use of biologics, including autologous peripheral blood-derived orthobiologics (APBOs), has increased and demonstrated great promise for the management of knee OA. Platelet-rich plasma (PRP) is the most widely used APBO, but its efficacy is still uncertain, attributed to lack of standardized formulation protocols, characterization, and patient variables. To overcome the limitations posed by PRP, the use of other APBOs such as platelet lysate (PL) has been considered. This review summarizes the outcomes of clinical studies involving PL to manage OA of the knee.

METHODS

Multiple databases (Scopus, Embase, PubMed, and Web of Science) were searched employing terms "platelet lysate" and "knee osteoarthritis" for articles published in the English language to August 15, 2024, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Only three clinical studies fulfilled our search and inclusion criteria. Intra-articular injection of three doses of PL injected every 3-4 weeks is safe and efficacious, resulting in statistically significant improvements in different patient-reported outcome measures at 6-12 months follow-up.

CONCLUSION

The existing published peer-reviewed literature suggests that intra-articular injection of PL is safe and can decrease pain and increase function in patients with knee OA. Nonetheless, given the dearth of pertinent literature, more adequately powered, multicenter, prospective, non-randomized and randomized controlled studies with extended follow-up are needed to confirm the effectiveness of PL in knee OA. Further comparative studies to help clinicians in choosing the best APBO for knee OA treatment are also warranted.

Gold-Induced Cytokine (GOLDIC) for the Management of Knee Osteoarthritis: A Systematic Review

Gold-induced cytokine (GOLDIC) is a novel orthobiologic approach utilizing gold particles to produce a serum rich in immunoregulating cytokines and growth factors, which is being explored for its potential in tissue regeneration and treating musculoskeletal issues like knee osteoarthritis (OA). This study aims to review its mechanism of action along with the outcomes of in vitro, preclinical, and clinical studies, with a secondary focus on documenting clinical trials related to its use in OA of the knee. A systematic search was conducted in four databases (Embase, Scopus, PubMed, Web of Science) for studies on GOLDIC therapy for knee OA, using specific keywords related to knee anatomy and OA. In vitro studies demonstrated that gold-containing compounds reduce nitric oxide production in chondrocytes, mitigating catabolic processes. Pre-clinical trials in horses with lameness showed significant symptom improvement. Clinical studies reported substantial improvements in pain, function, and joint homeostasis, with reduced synovial effusion and cytokine modulation following GOLDIC therapy. GOLDIC therapy, in addition to orthopedic indications such as for the management of OA of the knee, has also been investigated in non-orthopedic settings with early promising results. However, more research is needed to fully understand its mechanism of action and establish its clinical utility.

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.

Leukocyte-Poor Platelet-Rich Plasma for the Management of Knee Osteoarthritis: A Retrospective Study With 12 Months of Follow-Up

Introduction The knee, the most frequently affected joint in osteoarthritis (OA), impacts the life quality of millions of individuals globally, resulting in a considerable healthcare burden. Conservative treatments are preferred, turning to surgical intervention when necessary. Nonetheless, these conventional modalities have drawbacks. Recently, the use of regenerative medicine therapies, including autologous peripheral blood-derived orthobiologics (APBOs), such as leukocyte-poor platelet-rich plasma (LP-PRP), has evolved and demonstrated the ability to manage knee OA. The primary objective of this investigation was to evaluate the efficacy of LP-PRP via widely used patient-reported outcome measures (PROMs) in grade I or II (on the Kellgren-Lawrence scale) knee OA patients. The secondary objective was to characterize the formulated LP-PRP and determine the efficiency of the leukodepletion filter used for leukocyte removal and platelet recovery. Methods This investigation was a retrospective analysis of data collected from patients treated at a single center over a period of 15 months. Data from 40 patients included in this study were intra-articularly injected with 3mL of formulated LP-PRP under ultrasound guidance. PROMs questionnaires, including Kujala and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, were used and responses were documented at baseline and up to 12 months follow-up. The characterization of the formulated LP-PRP and the efficiency of the leukodepletion filter in removing leukocytes and recovering platelets were assessed via complete blood count (CBC) analysis. Results The intra-articular administration of LP-PRP resulted in statistically significant improvements in Kujala and WOMAC scores in patients with Grade I or II OA of the knee at all follow-up time points (four to 12 months) compared to the respective baseline scores. The subgroup analysis showed significant improvements in Kujala and WOMAC scores in both male and female grade I or II knee OA patients with or without comorbidities, including diabetes and/or hypertension. The characterization of formulated PRP showed platelet concentration to be at least 6x compared to the baseline whole blood levels, the absolute platelet count to be at least 5 billion, and total leukocytes, lymphocytes, neutrophils, and RBCs were depleted by over 88%, 82%, 98%, and 98%, respectively. In addition, the utilization of the PuriBlood leukocyte reduction filter (Puriblood Medical Co. Ltd., Baoshan Township, Taiwan) led to the depletion of approximately 93% of leukocytes and the recovery of about 83% of platelets. Conclusions Administration of LP-PRP resulted in significant improvements in pain and function of patients suffering from grade I or II OA of the knee. In addition, the leukodepletion filter used to formulate LP-PRP, successfully resulted in the depletion of leukocytes while recovering the platelets. More sufficiently powered, multi-center, prospective, non-randomized, and randomized controlled trials with long-term follow-up are needed to further establish the effectiveness of this formulation in knee OA patients.