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 studies on PRP consensus statements; PRP for KOA; PRP for Melasma; and AD-MSCs for Glenohumeral OA.
Let's dive in!
Experts Achieve Consensus on a Majority of Statements Regarding Platelet Rich Plasma Treatments for Treatment of Musculoskeletal Pathology
Arthroscopy // LOE: NA
The purpose of this paper was to gather thought-leaders and practitioners of regenerative medicine to establish consensus statements on platelet-rich plasma (PRP) for the treatment of musculoskeletal pathologies. In total, 35 orthopedic surgeons and sports medicine physicians participated.
Consensus was defined as achieving 80-89% agreement, strong consensus was defined as 90-99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement.
The following statements reached consensus:
PRP should be classified based on platelet count, leukocyte count, red blood count, activation method, and pure-plasma vs. fibrin matrix
PRP characteristics for reporting in research studies are platelet count, leukocyte count, neutrophil count, red blood cell count, total volume, the volume of injection, delivery method, and the number of injections
The prognostic factors for those undergoing PRP injections are age, BMI, severity/grade of pathology, chronicity of pathology, prior injections and response, primary diagnosis (primary vs. post-surgery vs. post-trauma vs. psoriatic), comorbidities, and smoking
Regarding age and BMI, there is no minimum or maximum, but clinical judgment should be used at extremes of either
The ideal dose of PRP is undetermined
The minimal volume required is unclear and may depend on the pathology
Consensus statements 1 and 2 provide a strong basis for research best practices. In my opinion, 5 and 6 as a consensus may mislead readers into believing that these items are unimportant. It is important to note that there have been numerous reviews and publications to date that illustrate the importance of platelet dose and it is broadly understood that a minimum dose of 5x baseline is required for adequate tissue healing.
ACCESS HERE: https://doi.org/10.1016/j.arthro.2023.08.020
Retrospective Analysis of Responders and Impaired Patients with Knee Osteoarthritis Treated with Two Consecutive Injections of Very Pure Platelet-Rich Plasma (PRP)
Bioengineering // LOE: lll
This retrospective study assessed the effectiveness of two consecutive intraarticular injections of PRP to treat knee osteoarthritis (KOA), discriminating between responders and impaired patients - with the latter seeing significant worsening of symptoms over the follow up period.
The quality of the PRP product was characterized, however, the reported figures appear inconsistent. Authors suggested that 10ml of PRP was administered one week apart at a concentration of ~10x baseline. Although, it appears that 45ml of whole blood was spun once to yield 10ml of PRP. At most, we would expect only a 4.5x baseline at a 100% PLT capture rate.
None the less, at a 1-year follow up, authors found 36 (49.3%) patients who fulfilled the criteria of responders, and 21 (28.8%) patients were impaired. The rest of the patients saw no change. Authors noted that there was an inverse correlation between responders and KL-Grade severity.
With the confusing PRP numbers, it is difficult to properly evaluate this study. Especially given that prior studies (i.e. Bennell 2022) have suggested that PRP products of at least 10 billion platelets per dose yield improvements in KOA with only a single injection.
ACCESS HERE: https://doi.org/10.3390/bioengineering10080922
Intradermal platelet-rich plasma for the treatment of melasma: A clinical and dermoscopic evaluation in dark skin
Journal of Cutaneous and Aesthetic Surgery // LOE: l
A prospective study of 20 female patients of Fitzpatrick skin type IV–V with mixed type of melasma and bilateral involvement of the face were enrolled for the study. PRP was injected intradermally at 4 weeks interval for three sittings, and the results were assessed clinically (by modified melasma area and severity score) and dermoscopically.
Only 0.3ml of PRP was produced from 5ml, with an expected PLT concentration of ~4x above baseline. However, CBC data was not provided.
Modified melasma area and severity score and dermoscopic changes showed statistically significant improvement compared at the end of study in mild to severe cases. Authors concluded that PRP shows a significant improvement in melasma after 12 weeks of treatment with no relapse even after 3 months.
ACCESS HERE: https://doi.org/10.4103/JCAS.JCAS_176_22
Efficacy and Long-Term Outcomes of Intra-Articular Autologous Micro-Fragmented Adipose Tissue in Individuals with Glenohumeral Osteoarthritis: A 36-Month Follow-Up Study
J. Pers. Med // LOE: l
Intra-articular injection of adipose-derived mesenchymal stem cells (ADMSCs) is a widely used regenerative medicine approach for treating osteoarthritis. The aim of this retrospective study was to report the safety and clinical outcomes of intra-articular injection of ADMSCs in patients with GOA over 36-months - a very long follow up period.
Adipose tissue was harvested via a syringe lipo-aspiration and subsequently processed using the Lipogems product, which separates the lipid oils from the fat graft.
The postoperative clinical scores showed significant improvement. At 36 months, the CMS was 84.60, the VAS score was 3.34, and the SST score was 10.15 (all p < 0.0001). The SANE score at 36 months indicated that 54 patients (83.08%) were completely satisfied with the treatment.
ACCESS HERE: https://doi.org/10.3390/jpm13091309
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 cdowns@mdbiologix.com
Cheers!
Connor
This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and any related subjects. The views and opinions expressed in this post are those of the author and may not reflect the views and opinions of MDBiologix. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if any treatment is right for you.
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