Updated: Jan 6
Welcome to the Regenerative Research Roundup, where we look through recently published research and bring you the best of the best in a quick-to-read digest.
This month, we have some papers covering BMA for Hip OA; PRP for Knee OA; Age/dose efficacy with PRP; activated vs. non-activated-PRP; and PRP for hair restoration.
Let's dive in!
Bone marrow aspirate injection for osteoarthritis of the hip; A pilot study
Interventional Pain Medicine // LOI: lll
Hip OA is a pathology that has challenged orthobiologics such as PRP for many years. This is in part due to the smaller volumes of injectate that require much higher dosages to obtain positive outcomes.
This study evaluated the efficacy of the BMA from the novel Marrow Cellutions trocar (BMA without the need for centrifugation) in Hip OA under fluoscopy.
Thirty-one patients, aged 32 to 83, with Kellgren Lawrence (KL) Hip OA grading of 2–4 received intra-articular bone marrow aspirate injection into the hip and were followed for twelve months.
When stratifying by KL grade, 80% and 71% of KL2 and KL3 grades respectively were responders by 12 months. Patients experienced statistically significant improvement in HOOS-Jr scores at 6 and 12 months.
ACCESS HERE: https://doi.org/10.1016/j.inpm.2022.100163
Effects of Intra-articular Platelet Rich Plasma on Cartilage Thickness, Clinical and Functional Outcomes in Knee Osteoarthritis
Cureus // LOE: ll
The shortcoming of much research into PRP for knee OA comes from the lack of disease-modification confirmed by radiological imaging. This study assessed the efficacy of platelet-rich plasma (PRP) in osteoarthritis of knees as to changes in cartilage thickness and additional clinical and functional outcomes.
In this prospective, interventional study, a total of 30 patients with OA knee with a Kellgren-Lawrence score of 2/3 received 3 x 2ml IA PRP every 7 days. The PRP was classified as having a concentration of 2-5x above baseline, which is a low dose that may have been made up by using a 3-injection protocol. Equal or superior results may have been realized by using a higher dose PRP only once.
The mean cartilage thickness (femoral and trochlear cartilage) improved from baseline (day 0) to final follow-up on day 180, which was statistically significant and implied cartilage repair following PRP administration.
ACCESS HERE: https://doi.org/10.7759/cureus.32256
Aging Affects the Efficacy of Platelet-Rich Plasma Treatment for Osteoarthritis
American Journal of Physical Medicine & Rehabilitation // LOE: lV
As PRP research progresses, there has been a wealth of anecdotal and data sub-analysis that suggests an age-dose-response for orthobiologics treatment. However, it hasn't been understood whether younger patients produce a more effective PRP or whether their biological response to PRP treatment is greater. This study provides some insight into this important distinction.
In vitro, male osteoarthritic human chondrocytes were treated with PRP from young (18-35 years) or old (≥65 years) donors, and chondrogenic profile was evaluated using immunofluorescent staining for two markers of chondrogenicity, type II collagen and SOX-9. In vivo, authors used a within-subjects design to compare Osteoarthritis Research Society International (OARSI) scores in aged mouse knee joints injected with PRP from young or old individuals.
In vitro experiments revealed that PRP from young donors induced a more youthful chondrocyte phenotype, as evidenced by increased type II collagen (p = 0.033) and SOX-9 expression (p = 0.022). This benefit, however, was significantly blunted when cells were cultured with PRP from aged donors. Accordingly, in vivo studies revealed that animals treated with PRP from young donors displayed a significantly improved cartilage integrity when compared to knees injected with PRP from aged donors (p = 0.019).
ACCESS HERE: https://doi.org/10.1097/PHM.0000000000002161
Comparison of the clinical effectiveness of activated and non-activated platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis
Clinical Rheumatology // LOE: lV
I've covered the science and clinical relevancy of PRP activation in previous blog posts. And based on available evidence for intra-articular or soft tissue injections of PRP, there does not seem to be any evidence that suggests a benefit to exogenous activation.
That said, I'm covering this meta-analysis as it highlights the lack of granularity into this important clinical question. The authors found that overall, literature supports activation of PRP.
However, there are a few problems with their review.
They do not account for platelet concentration in their interpretation of results which we know is likely the most important consideration for PRP efficacy.
They include forms of platelet activation that use glass-etched beads in their review. This process also increases the release of anti-inflammatory cytokines in the solution which would completely alter the biological response of the injectate - it's not appropriate to compare this to other forms of PRP.
The question of activated vs. non-activated PRP in knee OA is easily addressed in a head-to-head RCT rather than a review paper. There are only a couple of pilot studies that existing to my knowledge and until a larger RCT is published, these review papers should be taken with a large grain of salt due to the aforementioned issues of study heterogeneity and lack of variable control.
ACCESS HERE: https://doi.org/10.1007/s10067-022-06463-x
Autologous Platelet-Rich Plasma Treatment for Androgenic Alopecia: A Systematic Review and Meta-analysis of Clinical Trials on Patient Safety, Efficacy and Outcomes.
Plastic and Reconstructive Surgery // LOE: lV
Another meta-analysis, but one that is co-authored by Dr. Pietro Gentile in the American Journal of Plastic and Reconstructive Surgery, so anybody interested in PRP for hair restoration should be paying attention. Dr. Pietro Gentile has been among the most prolific researchers in this field for well over a decade.
This review includes 11 RCTs that collectively demonstrated that PRP injections significantly increased the number of hair follicles, hair thickness and density compared to placebo interventions. Also, the patients reported high overall satisfaction with the PRP treatment. Only temporary minor side effects were noted, including localized pain, bleeding and itching.
ACCESS HERE: https://doi.org/10.1097/PRS.0000000000010076
If you have any questions or comments regarding the above research, or are wondering how you can apply it to your regenerative practice, please leave a comment below or shoot me an email at firstname.lastname@example.org
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