Quality comparison between two different types of platelet-rich plasma for knee osteoarthritis

Abstract

Introduction: Knee osteoarthritis (KOA), the most common form of osteoarthritis (OA) is a considerable health concern worldwide. Platelet-rich plasma (PRP) is a common therapeutic option for KOA. Different types of PRPs have varying efficacies. However, a comparative analysis of the qualities of these PRPs is lacking. Methods: Two types of PRPs, including autologous protein solution (APS), and leukocyte-poor PRP (LP-PRP) along with whole blood (WB) and platelet-poor plasma (PPP) were characterized for platelet content, leukocyte content, and composition in 10 healthy volunteers (HV) (the controlled laboratory study) and 16 KOA patients (a retrospective observational study). Additionally, the levels of the platelet-derived growth factor (PDGF)-BB, and different cytokines were estimated in HV. Results: In HV, the concentrations of platelets and leukocytes, levels of different cytokines, including interleukin 1 receptor antagonist (IL-1Ra), soluble TNF receptor type II (sTNF-RII), and IL-1β, and the ratio of IL-1Ra/IL-1β were significantly higher in APS, whereas the PDGF-BB was higher in LP-PRP than APS. In KOA patients, a higher concentration of platelets was observed in LP-PRP, and a higher concentration of leukocytes was observed in APS than LP-PRP. Following the PAW classification system, LP-PRP was classified as P2-B type in HV (51.3 × 104/μl) and KOA (53.4 × 104/μl), whereas APS was classified as P3-A type in HV (110.1 × 104/μl) and P2-A type in KOA (29.0 × 104/μl). In a retrospective observational study, the KOA patients who underwent APS injection had a higher incidence of arthralgia, and this arthralgia lasted for a longer time than LP-PRP injection in the same individual. Discussion: The quality of the two PRPs differed distinctively depending on their preparation methods, which might affect their clinical efficacies and adverse events. Therefore, the characterization of these parameters should be prioritized while choosing PRP.

Individual immune cell and cytokine profiles determine platelet-rich plasma composition

“…All PRP systems resulted in a significant proportional enhancement of leukocytes. This observation is consistent with previous findings [31][32][33][34][35][36][37][38]. Commercially available PRP systems result in products with varying leukocyte concentrations that can be categorized into two groups: leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP).…”

“…As PRP is mainly used for its anti-inflammatory properties, this finding appears counterintuitive. Previous studies have observed a concentration of pro-inflammatory cytokines, such as IL-1β, IL-6, and TNF-α, especially in LR-PRP products [ 33 , 34 , 38 – 40 ]. Increased levels of IL-1β and TNF-α directly contribute to cartilage degradation and enhanced IL-6 production, which then enhances inflammatory responses that cause bone resorption in OA [ 41 ].…”

“…Commercially available PRP systems result in products with varying leukocyte concentrations that can be categorized into two groups: leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP). While LR-PRP systems tend to aggregate leukocytes, LP-PRP systems reduce leukocyte concentrations compared to corresponding blood concentrations [31][32][33][34][35][36][37][38]. Slow spin speeds of around 1500 rpm are associated with an up to threefold concentration of platelets, an almost complete elimination of red blood cells (RBC), and a reduction of leukocyte concentrations (LP-PRP), whereas higher spin speeds of around 3200 rpm are associated with an up to ninefold concentration of platelets, some loss of RBCs, and an increase in leukocyte concentrations (LR-PRP) [31].…”

Therapeutic Effect of Autologous Activated Platelet-rich Plasma Therapy on Mid-dermal to Full-thickness Burns: A Case Series

“…3 aaPRP also exerts anti-inflammatory effects through the presence of cytokines, such as interleukin receptor antagonist and broad antibacterial effects through proteins such as connective tissue–activating peptide-III. 4 5 It has been used in several clinical studies involving soft and hard tissue injuries, as well as burn wounds. 2 6 7…”

Consecutive injections of leukocyte-rich platelet-rich plasma are effective in not only mild but also severe knee degeneration

“…The dose, properties of PRP, administration period, and methods of obtaining the optimum effects vary between PRP therapies. 10 , 11 , 12 , 13 , 14 Moreover, PRP therapy has not been shown to be effective for severely degenerated KOA. Furthermore, changes in cartilage damage, especially reductions in inflammation of the subchondral bone and continuous cartilage surface, observed upon magnetic resonance imaging (MRI) osteoarthritis knee score (MOAKS), suggest that PRP is effective for cartilaginous tissue.…”