Dr Steven Sampson publishes new Platelet Rich Plasma article

My PRP review article is now published in the Current Reviews in Musculoskeletal Medicine. http://www.springerlink.com/content/5708408818n30275/ The online version is available, and the printed version is coming soon. The article includes nearly 50 literature sources and provides a comprehensive overview regarding platelet rich plasma usage in orthopaedics and sports medicine. Also, the review discusses the promising realm of orthobiologics and describes experiences with using platelet rich plasma for cartilage disorders and osteoarthritis.

I have been conducting research on arthritis with encouraging results so far. I am planning on collaborating with other leading physicians and publishing many more articles to advance the field of orthobiologics.

Adult Stem Cells for Arthritis?

Perhaps the next frontier beyond PRP is Stem Cells. While the topic is the subject of much controversy politically, technology now allows us to utilize adult stem cells opposed to embryonic cells to treat disease.

Stem Cells are the birthplace of platelets rich in healing properties, which can potentially program cells to regenerate tissue & cartilage. Currently stem cells can be retrieved via embryo (controversial in US), umbilical cord, bone marrow, peripheral blood, & in the near future adipose (fat) cells via liposuction.

Peripheral blood, or simply drawing blood from a patient's arm is the least invasive & most promising method. Patients require a shot or medication to release stem cells from the marrow to the blood stream. It can then be processed & used for injection. In the future patients may have the option to store unused stem cells for future use as well.

Stem cells are being used in the US mostly for cancer patients to assist in recovery from the ill effects of chemotherapy. A few practitioners are using them orthopaedically with reportedly good results in arthritis. Internationally there are centers where patients seek alternative treatment to serious diseases like spinal cord injury, multiple sclerosis, and ALS.


There is an adult stem cell organization which lists numerous articles & personal stories.

www.adultstemcelleducation.com

New Platelet Rich Plasma (PRP) review article for tendon injuries and arthritis

In a Jan/Feb 08 issue of Practical Pain Management, the authors describe PRP use in tendon injuries, spine conditions, as well as hip & knee arthritis. The article emphasizes a need for agreed upon nomenclature.

An interesting concept addressed is whether a gel matrix is needed for the platelets to adhere to the target site. Because of their structure tendons & ligaments may not require the gel, however it is not known if adding calcium chloride with thrombin to the PRP is needed in joint spaces like knee & hip arthritis. Further data needs to compare the usage with gel versus without.

The article showed x-rays post prp injection with subtle smoothing of a previously arthritic femoral head (hip bone). It is not clearly known how PRP acts on arthritis, however a particular growth factor found in PRP, TGF-B has been linked to cartilage growth (chondrogenesis). Furthermore, another study showed that PRP influences hyauloronic acid production which balances cell proliferation (angiogenesis). Also, the authors suggested a possible role in serotonin decreasing pain. Lastly, utilizing "stem cells" (the birth place of platelets and their precursors)may offer the most ultimate potential.

http://www.ppmjournal.com/abstract.asp?articleid=P0801F01

http://prpinjection.blogspot.com/2007/11/new-article-on-osteoarthritis-and.html

Platelet Rich Plasma Cartilage/Arthritis Study in Rabbits

In a recent study from October 2007, a group from China was the first to document platelet rich plasma's ability to support chondrogenesis (cartilage cell growth). They took cartilage from the rabbit's ear, & mixed it with PRP and calcium chloride & thrombin (to form a matrix). Two months later, hard knobbles were found and seen on MRI, as well as histological analysis (cellular) and staining confirmed cartilage growth. Interestingly, there was no cartilage growth with the control group that received PRP alone. This study demonstrated successful formation of new cartilage with an injectable graft using PRP and cultured chondrocytes.

http://www.joms.org/article/PIIS0278239106021070/abstract

Autologous Blood Use in Horse Osteoarthritis

Another subset in "biologics" is the use a (ACS) Autologous Conditioned Serum. This treatment primarily used in Europe, invlolves production of a substance known as IL-1Ra that attacks the effects of arthritis. While this specific treatment is not approved in the U.S., similar treatments using PRP (Platelet rich Plasma) are being used here to address knee arthritis.

A recent study from Colorado State University published in The American Journal of Veterinary Research; demonstrated significant clinical improvements of Horse osteoarthritis affected joints with ACS compared to placebo.

http://avmajournals.avma.org/doi/abs/10.2460/ajvr.68.3.290?prevSearch=allfield%3A%28autologous+conditioned+serum%29

The process like PRP, involves drawing blood and spinning it down in a machine called a centrifuge. However, afterwards the blood is incubated at 37 degrees Celsius for 24 hours. The serum is then frozen until use.

This system, is used throughout Europe in professional race horses to treat arthritis. Also, it is used in Dusseldorf Germany on humans for osteoarthritis.

We are using a modified treatment performing a series of 3 PRP injections into the human knee joint under ultrasound guidance at 3 week intervals. We will be reporting on our findings.

Bone Marrow Aspirate, Using Adult Stem Cells To Treat Osteoarthritis

Platelet Rich Plasma provides a potent delivery of the body's healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult "mesenchymal stem cells" from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it's ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is: http://www.autologousadultstemcells.org/blogs.html

New Study on PRP use on Rabbit Cartilage

In the Journal of Oral & Maxillofascial Surgery, September 2007, A
Cartilage cells, (chondrocytes) were harvested from a rabbit ear and was added to PRP and injected into rabbits. After 2 months, histological slides and MRI suggested increased cartilage production.

PRP is seeing increased usage in cartilage defects, with many docs reporting promising results. However studies like this may lead to a more refined approach to PRP and knee osteoarthitis. In time, individual growth factors may be filtered out and applied for specific indications. For now, PRP contains a "cocktail" of potent healing properties. This exciting new field is termed, "Orthobiologics."

http://www.joms.org/article/PIIS0278239106021070/abstract

Knee Arthritis Helped with Platelet Rich Plasma, Warsaw, Poland Oct 07'

- Utilization of Platelet-derived growth factors for the treatment of cartilage degenerative pathology Clinical research / Knee (Chondral and Osteochondral defects)

E. Kon, G. Filardo, M. Lo Presti, M. Delcogliano, F. Iacono, C. Montaperto, M. Marcacci; Bologna/IT
Purpose
The influence of the growth factors on cartilage repair is not yet widely studied and its application in clinics is still experimental. PRP (Platelet Rich Plasma) is a natural concentrate of autologous growth factors and actually is widely experimented in different fields of medicine. The method is simple, low cost and minimally invasive. The aim of our study is to determine the short-term effect of PRP in cartilage degenerative pathology.
Methods and Materials
30 symptomatic patients (40 knees) were treated with autologous PRP intra-articular injections for degenerative cartilage pathology. Mean age of the patients was 51 years (range:35y to 80y). 3 injections were performed every 3 weeks. All patients were clinically evaluated at the end of the treatment and at 6 months follow up. IKDC, SF36, EQ-VAS, scores were used for clinical evaluation and patient stisfaction and functional status were also recorded.
Results
Statistically significant improvement of all scores was detected after treatment and was maintained at 6 months. Subjective IKDC evaluation showed a significant score enhancement from 37,9 before the treatment to 59,0 after the treatment. Significant correlation of clinical outcome with patients age was found. While the group of patients less then 60 years old have shown 85% of improvement, the group of patients over 60 showed only 30% of improvement of clinical outcome.

Conclusions
Our study have demonstrated a positive effect of treatment of degenerative cartilage pathology with Platelet-derived growth factors in middle-age patients (<60y) at short term. Medium-long term studies are needed to confirm the durability of this treatment.


ICRS - International Cartilage Repair Society.