Platelet-rich plasma combined with ozone prevents cartilage destruction and improves weight-bearing asymmetry in a surgery-induced osteoarthritis rabbit model

Abstract

Background: Osteoarthritis (OA) is the most common degenerative disease in older adults and its treatment remains unsatisfactory. This study aimed to evaluate the effectiveness and explore the therapeutic mechanisms of the combination of platelet-rich plasma (PRP) and ozone (O 3 ) for knee OA.Methods: Thirty male rabbits were randomly divided into five groups (Control group, OA group, PRP group, O 3 group, and PRP + O 3 group). Rabbit model of OA were induced by improved Hulth surgery.Gross articular observation, histopathological examination and cartilage scoring system were used to assess the articular cartilage destruction. The bone morphogenetic protein-2 (BMP-2) mRNA expression in joint fluid was determined by qRT-PCR. The expression of type II collagen, matrix metalloproteinase-1 (MMP-1) of cartilage was detected via Immunohistochemistry. Pain behavior was observed by percent ipsilateral weight-bearing (PIW) asymmetry. Results:The content of platelet in PRP was increased by 6.2-times that in whole blood. Among induced OA groups (the OA, PRP, O 3 and PRP + O 3 group), PRP + O 3 significantly inhibited the surgically induced increase in gross articular alterations, histopathological damage of cartilage and Mankin score when compared to the OA, PRP and O 3 groups (P<0.05). Observed pain behavior by weight-bearing asymmetry, in the PRP + O 3 group was reversed at 3 and 6 weeks after the administration of PRP + O 3 (PIW asymmetry: −10.66%±1.172%). In addition, surgery-induced BMP-2 mRNA expression was significantly downregulated after the treatment of PRP, O 3 and PRP + O 3 (P<0.01). PRP + O 3 group significantly increased the expression of type II collagen but decreased MMP-1 of cartilage in comparison to OA, PRP and O 3 groups (P<0.05) by immunohistochemical analysis.Conclusions: PRP combined with O 3 may prevent cartilage destruction and improve weight-bearing asymmetry by restoring homeostasis between anabolism and catabolism of extracellular matrix in progressive OA. Furthermore, a combination of PRP and O 3 might achieve even better results than the two agents alone.

Intra-articular Injections for Treating Knee Osteoarthritis: A Classification According to Their Mechanism of Action

“…Animal model studies have reported that IAI of ozone induced a decrease in TNF-α, IL-1β, and IL-6 levels, as well as a decrease in intra-articular oxidative stress regulation, without generating cartilage toxicity 35,36 ; in addition, it has been reported that IAI of ozone decreases the expression of matrix metalloproteinase 1 (MMP-1) and bone morphogenetic protein 2 compared with controls. 37 These results have been reproduced in humans. Hashemi et al 38 reported a decrease in serum levels of IL-1β and TNF-α in patients with KOA treated using IAI of ozone, without differences at 1 month of follow-up when compared with IAI of CSs.…”

“…Although the scientific bases to support its clinical use are not entirely clear, there is positive preclinical and clinical evidence on the mechanisms of action and the efficacy and safety of this intervention. Animal model studies have reported that IAI of ozone induced a decrease in TNF-α, IL-1β, and IL-6 levels, as well as a decrease in intra-articular oxidative stress regulation, without generating cartilage toxicity 35,36 ; in addition, it has been reported that IAI of ozone decreases the expression of matrix metalloproteinase 1 (MMP-1) and bone morphogenetic protein 2 compared with controls 37 . These results have been reproduced in humans.…”

The therapeutic effect of sufficient oxygen-rich PRP injection in facial rejuvenation by multiple objective evaluations in 26 cases

“…Recently, research on the combination of ozone and PRP is most prevalent in the fields of orthopedics and sports medicine, with promising outcomes [ [18] , [19] , [20] ]. Studies indicate that ozone can enhance the expression of some GFs in PRP which play a crucial role in skin tissue remodeling [ 21 ], but the role of ozone in enhancing the concentration of GFs in PRP in facial injections has not been studied yet.…”