Angelo Boffa1, Manuela Salerno2, Giulia Merli3, Laura De Girolamo4, Lior Laver5,6,7, Jérémy Magalon8,9,10, Mikel Sánchez11,12, Thomas Tischer13, Giuseppe Filardo2,14,15. 1. Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. 2. Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. 3. Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy. giulia.merli@ior.it. 4. Orthopaedic Biotechnology Laboratory, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. 5. Department of Orthopaedics, Hillel Yaffe Medical Center (HYMC), Hadera, Israel. 6. Arthrosport Clinic, Tel-Aviv, Israel. 7. Rappaport Faculty of Medicine, Technion University Hospital (Israel Institute of Technology), Haifa, Israel. 8. Cell Therapy Laboratory, Hôpital de la Conception, AP-HM, Marseille, France. 9. INSERM, INRA, C2VN, Aix Marseille Univ, Marseille, France. 10. SAS Remedex, Marseille, France. 11. Arthroscopic Surgery Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain. 12. Advanced Biological Therapy Unit, Hospital Vithas Vitoria, Vitoria-Gasteiz, Spain. 13. Department of Orthopaedic Surgery, University of Rostock, Rostock, Germany. 14. Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland. 15. Facoltà di Scienze Biomediche, USI-Università della Svizzera Italiana, Lugano, Switzerland.
Abstract
PURPOSE: The mechanisms of action and disease-modifying potential of platelet-rich plasma (PRP) injection for osteoarthritis (OA) treatment are still not fully established. The aim of this systematic review of preclinical evidence was to determine if PRP injections can induce disease-modifying effects in OA joints. METHODS: A systematic review was performed on animal studies evaluating intra-articular PRP injections as treatment for OA joints. A synthesis of the results was performed investigating the disease-modifying effects of PRP by evaluating studies that compared PRP with OA controls or other injectable products, different PRP formulations or injection intervals, and the combination of PRP with other products. The risk of bias was assessed according to the SYRCLE's tool. RESULTS: Forty-four articles were included, for a total of 1251 animals. The publication trend remarkably increased over time. PRP injections showed clinical effects in 80% and disease-modifying effects in 68% of the studies, attenuating cartilage damage progression and reducing synovial inflammation, coupled with changes in biomarker levels. Evidence is limited on the best PRP formulation, injection intervals, and synergistic effect with other injectables. The risk of bias was low in 40%, unclear in 56%, and high in 4% of items. CONCLUSION: Intra-articular PRP injections showed disease-modifying effects in most studies, both at the cartilage and synovial level. These findings in animal OA models can play a crucial role in understanding mechanism of action and structural effects of this biological approach. Nevertheless, the overall low quality of the published studies warrants further preclinical studies to confirm the positive findings, as well as high-level human trials to demonstrate if these results translate into disease-modifying effects when PRP is used in the clinical practice to treat OA. LEVEL OF EVIDENCE: Level II.
PURPOSE: The mechanisms of action and disease-modifying potential of platelet-rich plasma (PRP) injection for osteoarthritis (OA) treatment are still not fully established. The aim of this systematic review of preclinical evidence was to determine if PRP injections can induce disease-modifying effects in OA joints. METHODS: A systematic review was performed on animal studies evaluating intra-articular PRP injections as treatment for OA joints. A synthesis of the results was performed investigating the disease-modifying effects of PRP by evaluating studies that compared PRP with OA controls or other injectable products, different PRP formulations or injection intervals, and the combination of PRP with other products. The risk of bias was assessed according to the SYRCLE's tool. RESULTS: Forty-four articles were included, for a total of 1251 animals. The publication trend remarkably increased over time. PRP injections showed clinical effects in 80% and disease-modifying effects in 68% of the studies, attenuating cartilage damage progression and reducing synovial inflammation, coupled with changes in biomarker levels. Evidence is limited on the best PRP formulation, injection intervals, and synergistic effect with other injectables. The risk of bias was low in 40%, unclear in 56%, and high in 4% of items. CONCLUSION: Intra-articular PRP injections showed disease-modifying effects in most studies, both at the cartilage and synovial level. These findings in animal OA models can play a crucial role in understanding mechanism of action and structural effects of this biological approach. Nevertheless, the overall low quality of the published studies warrants further preclinical studies to confirm the positive findings, as well as high-level human trials to demonstrate if these results translate into disease-modifying effects when PRP is used in the clinical practice to treat OA. LEVEL OF EVIDENCE: Level II.
Authors: Conny Mosley; Tara Edwards; Laura Romano; Geoffrey Truchetti; Laurie Dunbar; Teresa Schiller; Tom Gibson; Charles Bruce; Eric Troncy Journal: Front Vet Sci Date: 2022-04-26