Platelet‐rich plasma protects rotator cuff‐derived cells from the deleterious effects of triamcinolone acetonide

Abstract

Triamcinolone acetonide (TA) injections are widely used to treat enthesopathy, but they may induce adverse effects such as tendon impairment and rupture. Platelet-rich plasma (PRP) is a blood fraction containing high platelet concentrations and various growth factors that play a role in tissue repair processes. The purpose of this study is to investigate whether TA has deleterious effects on human rotator cuff-derived cells, and if PRP can protect these cells from the effects of TA. Human rotator cuff-derived cells were cultured with and without TA and PRP, and the culture without any additive served as the control. Cell morphology was assessed at days 7 and 21. Cell viability was evaluated at days 1, 7, 14, and 21 by a water-soluble tetrazolium salt assay. Induction of apoptosis was measured by immunofluorescence staining and flow cytometry at day 7. Induction of cleaved caspase-3 was measured by immunofluorescence staining at day 7. The cells cultured with TA had a flattened and polygonal shape at day 7. The cells cultured with both TA and PRP were similar in appearance to control cells. Exposure to TA also significantly decreased cell viability, but cell viability did not decrease when PRP was added along with TA. The number of apoptotic cells increased with TA exposure, while addition of PRP prevented cell apoptosis. In conclusion, the deleterious effect of TA was prevented by PRP, which can be used as a protective agent for patients receiving local TA injections. Keywords: triamcinolone acetonide (TA); platelet-rich plasma (PRP); rotator cuff-derived cells; apoptosis; cell viability Enthesopathy caused by rotator cuff injury clinically impairs joint function. Rotator cuff disease represents a spectrum of pathological conditions ranging from tendinosis to full-thickness tears. Conservative therapy, including rest, physical therapy, non-steroidal anti-inflammatory medications, and steroid injections are the primary treatments for these conditions. 1,2The effectiveness of subacromial steroid injections for treatment of rotator cuff tendinosis has been equivocal. 3,4 Some clinical studies have demonstrated improvement in shoulder function and decrease in shoulder pain following steroid injection.3,5 However, other studies have shown that steroids afford no clinical benefits over those provided by injections of lidocaine alone 4 or physical therapy alone. 6 Triamcinolone acetonide (TA) injections are widely used for treatment of rotator cuff tendinosis, but they may cause tendon impairment and rupture; many cases of tendon rupture after TA injections have been reported. 7-11Despite previous studies on the deleterious histological and biomechanical changes in tendons after TA injections, 8,12 TA administration is still considered to be a conservative treatment option.Platelet-rich plasma (PRP) is an autologs concentration of platelets that contains many growth factors, including platelet-derived growth factor (PDGF), transforming growth factor b (TGF-b), fibroblastic growth factor (FGF), vascular endoth...

Effects of platelet-rich plasma and triamcinolone acetonide on interleukin-1ß-stimulated human rotator cuff-derived cells

“…8 Approximately 5000 cells were seeded in each well of a 96-well plate in inflammatory medium for three hours. In order to detect the effects of serum-free medium or IL-1β, the cells were exposed to serum-free medium for zero, one and three days, and exposed to IL-1β for zero and three hours (zero days and hours is the control, i.e.…”

“…The administration of corticosteroid has been shown to suppress the cell viability of rotator cuff-derived cells, whereas PRP was shown to stimulate cell viability. 8 However, the molecular pathology of rotator cuff-derived cells after PRP or TA treatment has not been made clear. In our previous study, 8 rotator cuff-derived cells were not cultivated under an inflammatory condition.…”

“…8 However, the molecular pathology of rotator cuff-derived cells after PRP or TA treatment has not been made clear. In our previous study, 8 rotator cuff-derived cells were not cultivated under an inflammatory condition. In order to investigate the mechanisms of corticosteroids and PRP and their interaction on alleviating the symptoms of rotator cuff disease further, we focused on their effects on rotator cuff-derived cells that were cultured under an inflammatory condition to mimic a clinical situation.…”

Tendon and Ligament Tissue Engineering, Healing and Regenerative Medicine

“…Perhaps, preparation method of PRP, its concentration, source (e.g. auto-alloand xenogenic base) and its constitutions (platelet or platelet with buffy coat) are suggested to be different between several studies [30,[101][102][103]. As a general rule, effective PRP is prepared via two steps centrifugation with the combination of platelets and buffy coats (inflammatory cells) and has a 6 to 7 times more platelets than the circulating blood [30].…”

Growth factor delivery vehicles for tendon injuries: Mesenchymal stem cells and Platelet Rich Plasma

“…This early angiogenic effect is vital for tendon and ligament healing 13 . Furthermore, some studies even indicate, that PRP may protect tenocytes from impaired function caused by certain drugs [19][20][21] . Besides the reported positive effect of PRP on tenocytes, an additional antiinflammatory activity has been reported in several studies © C I C E d i z i o n i I n t e r n a z i o n a l i attributed to the HGF [22][23][24] .…”