The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis

Abstract

Knee osteoarthritis (KOA) represents a clinical challenge due to poor potential for spontaneous healing of cartilage lesions. Several treatment options are available for KOA, including oral nonsteroidal anti-inflammatory drugs, physical therapy, braces, activity modification, and finally operative treatment. Intra-articular (IA) injections are usually used when the non-operative treatment is not effective, and when the surgery is not yet indicated. More and more studies suggesting that IA injections are as or even more efficient and safe than NSAIDs. Recently, research to improve intra-articular homeostasis has focused on biologic adjuncts, such as platelet-rich plasma (PRP). The catabolic and inflammatory intra-articular processes that exists in knee osteoarthritis (KOA) may be influenced by the administration of PRP and its derivatives. PRP can induce a regenerative response and lead to the improvement of metabolic functions of damaged structures. However, the positive effect on chondrogenesis and proliferation of mesenchymal stem cells (MSC) is still highly controversial. Recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, significant progress has been made in understanding the mechanism of PRP action. In this review, we will discuss mechanisms related to inflammation and chondrogenesis in cartilage repair and regenerative processes after PRP administration in in vitro and animal studies. Furthermore, we review clinical trials of PRP efficiency in changing the OA biomarkers in knee joint.

Anti-inflammatory and immunomodulatory effects of the extracellular vesicles derived from human umbilical cord mesenchymal stem cells on osteoarthritis via M2 macrophages

“…Next, we established a model of OA-like chondrocytes by co-incubation of chondrocytes with 10 ng of IL-1β. After 48 h of IL-1β induction, OA chondrocytes were co-cultured with the supernatant of M2 macrophages (M2S) caused by hUCMSCs-EVs, and platelet-rich plasma (PRP) was employed as a positive control [ 25 , 26 ]. As exhibited in Fig.…”

CD226 Is Required to Maintain Megakaryocytes/Platelets Homeostasis in the Treatment of Knee Osteoarthritis With Platelet-Rich Plasma in Mice

“…Although clinical outcomes and efficiency of PRP-administrated OA were variable, PRP is still widely used in the knee OA treatment ( Zahir et al, 2021 ). It is known that the underlying mechanism of PRP to treat knee OA is mainly to stimulate immune cell activation and trigger cell proliferation and inflammation through release or secretion of various growth factors ( Szwedowski et al, 2021 ). Sundman et al have demonstrated that when synovium and cartilage harvested from OA patients were co-cultured with PRP or HA, the media concentration of TNF-α was reduced compared with the controls ( Sundman et al, 2014 ).…”

Hyaluronic Acid as a Carrier Supports the Effects of Glucocorticoids and Diminishes the Cytotoxic Effects of Local Anesthetics in Human Articular Chondrocytes In Vitro

“…This is where the present study fills the gap. Recently the use of autologous blood products such as platelet-rich plasma (PRP) has become very popular in the orthopedic field [ 36 ]. Platelets comprise anabolic growth factors and anti-inflammatory cytokines that positively effects the osteoarthritic state by inducing cellular proliferation, migration, differentiation and synthesis of the ECM [ 37 ].…”