Key Points
-
Autologous blood products such as platelet-rich plasma (PRP) are sources of molecules that can actively participate in tissue repair
-
In the joint, PRP affects local and infiltrating cells, mainly synovial cells (synoviocytes and macrophages), endothelial cells, cells involved in innate immunity, and cellular components of cartilage and bone
-
PRP can alter many of the processes that are aberrant in patients with osteoarthritis (OA), including inflammation, angiogenesis, and the balance between anabolism and catabolism in cartilage
-
PRP can modify the biological microenvironment that exists at different points in the disease process, and could, therefore, provide an opportunity to interfere with the self-perpetuating mechanisms of OA
-
The microenvironment in joints with OA varies between patients and disease stages; the different therapeutic effects of PRP might result from the specific milieu present in the joint
-
Heterogeneity in PRP formulations and the way PRP is activated can generate uncertainty in the biological effects and clinical responses
Abstract
Osteoarthritis (OA) is a common disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture. Autologous blood-derived products, such as platelet-rich plasma (PRP), are key sources of molecules involved in tissue repair and regeneration. These products can deliver a collection of bioactive molecules that have important roles in fundamental processes, including inflammation, angiogenesis, cell migration and metabolism in pathological conditions, such as OA. PRP has anti-inflammatory properties through its effects on the canonical nuclear factor κB signalling pathway in multiple cell types including synoviocytes, macrophages and chondrocytes. PRP contains hundreds of different molecules; cells within the joint add to this milieu by secreting additional biologically active molecules in response to PRP. The net results of PRP therapy are varied and can include angiogenesis, the production of local conditions that favour anabolism in the articular cartilage, or the recruitment of repair cells. However, the molecules found in PRP that contribute to angiogenesis and the protection of joint integrity need further clarification. Understanding PRP in molecular terms could help us to exploit its therapeutic potential, and aid the development of novel treatments and tissue-engineering approaches, for the different stages of joint degeneration.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Bijlsma, J. W., Berenbaum, F. & Lafeber, F. P. Osteoarthritis: an update with relevance for clinical practice. Lancet 377, 2115–2126 (2011).
Sellam, J. & Berenbaum, F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat. Rev. Rheumatol. 6, 625–635 (2010).
Wruck, C. J. et al. Role of oxidative stress in rheumatoid arthritis: insights from the Nrf2-knockout mice. Ann. Rheum. Dis. 70, 844–850 (2011).
Lotz, M. K. & Caramés, B. Autophagy and cartilage homeostasis mechanisms in joint health, aging and OA. Nat. Rev. Rheumatol. 7, 579–587 (2011).
Andia, I., Sánchez, M. & Maffulli, N. Joint pathology and platelet-rich plasma therapies. Expert Opin. Biol. Ther. 12, 7–22 (2012).
Woodel-May, J. et al. Autologous protein solution inhibits MMP-13 production by IL-1β and TNF-stimulated human articular chondrocytes. J. Orthop. Res. 29, 1320–1326 (2011).
Baltzer, A. W., Moser, C., Jansen, S. A. & Krauspe, R. Autologous conditioned serum (Ortokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage 17, 152–160 (2009).
Dohan Ehrenfest, D. M., Rasmusson, L. & Albrektsson, T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 27, 158–167 (2009).
Sheth, U. et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J. Bone Joint Surg. Am. 94, 298–307 (2012).
Valentino, L. A. Blood-induced joint disease: the pathophysiology of hemophilic arthropathy. J. Thromb. Haemost. 8, 1895–1902 (2010).
Sánchez, M., Guadilla, J., Fiz, N. & Andia, I. Ultrasound-guided platelet rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford) 51, 144–150 (2012).
Sánchez, M. et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy 28, 1070–1078 (2012).
Cerza, F. et al. Comparison between hyaluronic acid and platelet rich plasma infiltration in the treatment of gonarthrosis. Am. J. Sports Med. 40, 2822–2827 (2012).
Patel, S., Dhillon, M. S., Aggarwal, S., Marwaha, N. & Jain, A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am. J. Sports Med. 41, 354–364 (2013).
Nurden, A. T. et al. Platelets and wound healing. Front. Biosci. 13, 3532–3548 (2008).
Maynard, D. M. et al. Proteomic analysis of platelet alpha-granules using mass spectrometry. J. Thromb. Haemost. 5, 1945–1955 (2007).
Thon, J. N. & Italiano, J. E. Platelets: production, morphology and ultrastructure. Handb. Exp. Pharmacol. 210, 3–22 (2012).
Anitua, E., Andia, I., Ardanza, B., Nurden, P. & Nurden, A. T. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb. Haemost. 91, 4–15 (2004).
Ren, Q., Ye, S. & Whiteheart, S. W. The platelet release reaction: just when you thought platelet secretion was simple. Curr. Opin. Hematol. 15, 537–541 (2008).
Andia, I., Sanchez, M. & Maffulli, N. Tendon healing and platelet-rich plasma therapies. Expert Opin. Biol. Ther. 10, 1415–1426 (2010).
Min-Ho, K., Fitz-Roy, E. C. & Scott, I. S. Dynamics of neutrophil extravasation and vascular permeability are uncoupled during aseptic cutaneous wounding. Am. J. Physiol. Cell Physiol. 296, 848–856 (2009).
Flad, H. D. & Brandt, E. Platelet-derived chemokines: pathophysiology and therapeutic aspects. Cell. Mol. Life Sci. 67, 2363–2386 (2010).
Vandercapellen, J., Van Damme, J. & Struyf, S. The role of CXC chemokines platelet factor-4 (CXCL4/PF4) and its variant (CXCLaL1/PF-avar) in inflammation, angiogenesis and cancer. Cytokine Growth Factor Rev. 22, 1–18 (2010).
El-Sharkawy, H. et al. Platelet-rich plasma: Growth factors and pro- and anti-inflammatory properties. J. Periodontol. 78, 661–669 (2007).
Scheuerer, B. et al. The CXC-chemokine platelet factor 4 promotes monocyte survival and induces monocyte differentiation into macrophages. Blood 95, 1158–1166 (2000).
O'Connor, R. et al. Proteomics strategy for identifying candidate bioactive proteins in complex mixtures: application to the platelet releasate. J. Biomed. Biotechnol. 2010, 107859 (2010).
Gleissner, C. A., Shaked, I., Little, K. M. & Ley, K. CXC chemokine ligand 4 induces a unique transcriptome in monocyte-derived macrophages. J. Immunol. 184, 4810–4818 (2010).
Vasina, E. M. et al. Microparticles from apoptotic platelets promote resident macrophage differentiation. Cell Death Dis. 2, e211 (2011).
Lindemann, S. et al. Activated platelets mediate inflammatory signalling by regulated interleukin 1β synthesis. J. Cell Biol. 154, 485–490 (2001).
Hassan, G. S., Merhi, Y. & Mourad, W. CD40 ligand: a neo-inflammatory molecule in vascular diseases. Immunobiology 217, 521–532 (2012).
Nurden, A. T. Platelets, inflammation and tissue regeneration. Thromb. Haemost. 105 (Suppl. 1), S13–S33 (2011).
Zaslavsky, A. et al. Platelet-derived thrombospondin-1 is a critical negative regulator and potential biomarker of angiogenesis. Blood 115, 4605–4613 (2010).
Tohidnezhad, M. et al. Platelets display potent antimicrobial activity and release human β-defensin 2. Platelets 23, 217–223 (2012).
Aidoudi, S. & Bikfalvi, A. Interaction of PF4 (CXCL4) with the vasculature: a role in atherosclerosis and angiogenesis. Thromb. Haemost. 104, 941–948 (2010).
Goumans, M. J., Lebrin, F. & Valdimarsdottir, G. Controlling the angiogenic switch: a balance between two distinct TGF-b receptor signaling pathways. Trends Cardiovasc. Med. 13, 301–307 (2003).
Neuss, S., Schneider, R. K., Tietze, L., Knüchel, R. & Jahnen-Dechent, W. Secretion of fibrinolytic enzymes facilitates human mesenchymal stem cell invasion into fibrin clots. Cells Tissues Organs 191, 36–46 (2010).
Czekay, R. P., Kuemmel, T. A., Orlando, R. A. & Farquhar, M. G. Direct binding of occupied urokinase receptor (uPAR) to LDL receptor-related protein is required for endocytosis of uPAR and regulation of cell surface urokinase activity. Mol. Biol. Cell 12, 1467–1479 (2001).
Neuss, S., Becher, E., Wöltje, M., Tietze, L. & Jahnen-Dechent, W. Functional expression of HGF and HGF receptor/c-met in adult human mesenchymal stem cells suggests a role in cell mobilization, tissue repair, and wound healing. Stem Cells 22, 405–414 (2004).
Solokov, J. & Lepus, C. M. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Adv. Musculoskel. Dis. 7, 77–94 (2013).
Chen, G. Y. & Nuñez, G. Sterile inflammation: sensing and reacting to damage. Nat. Rev. Immunol. 10, 826–837 (2010).
Marcu, K. B., Otero, M., Olivotto, E., Borzi, R. M. & Goldring, M. B. NF-κB signaling: multiple angles to target OA. Curr. Drug Targets 11, 599–613 (2010).
Rasheed, Z., Akhtar, N. & Haqqi, T. M. Advanced glycation end products induce the expression of interleukin-6 and interleukin-8 by receptor for advanced glycation end product-mediated activation of mitogen-activated protein kinases and nuclear factor-κB in human osteoarthritis chondrocytes. Rheumatology (Oxford) 50, 838–851 (2011).
Niederberger, E. & Geisslinger, G. The IKK–NF-κB pathway: a source for novel molecular drug targets in pain therapy? FASEB J. 22, 3432–3442 (2008).
Chen, L. X. et al. Suppression of early experimental osteoarthritis by in vivo delivery of the adenoviral vector-mediated NF-κBp65-specific siRNA. Osteoarthritis Cartilage 16, 174–184 (2008).
Bendinelli, P. et al. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J. Cell Physiol. 225, 757–766 (2010).
van Buul, G. M. et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am. J. Sports Med. 39, 2362–2370 (2011).
Wu, C. C. et al. Regenerative potential of platelet-rich plasma enhanced by collagen in retrieving pro-inflammatory cytokine-inhibited chondrogenesis. Biomaterials 32, 5847–5854 (2011).
Anitua, E. et al. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology (Oxford) 46, 1769–1772 (2007).
Anitua, E. et al. Fibroblastic response to treatment with different preparations rich in growth factors. Cell Prolif. 42, 162–170 (2009).
Mazzocca, A. D. et al. An in vitro evaluation of the anti-inflammatory effects of platelet-rich plasma, ketorolac, and methylprednisolone. Arthroscopy 29, 675–683 (2013).
Montaseri, A. et al. IGF-1 and PDGF-bb suppress IL-1β-induced cartilage degradation through down-regulation of NF-κB signaling: involvement of Src/PI-3K/AKT pathway. PLoS ONE 6, e28663 (2011).
Coudriet, G. M. et al. Hepatocyte growth factor modulates interleukin-6 production in bone marrow derived macrophages: implications for inflammatory mediated diseases. PLoS ONE 5, e15384 (2010).
Lippross, S. et al. Intraarticular injection of platelet-rich plasma reduces inflammation in a pig model of rheumatoid arthritis of the knee joint. Arthritis Rheum. 63, 3344–3353 (2011).
Sohn, D. H. et al. Plasma proteins present in osteoarthritic synovial fluid can stimulate cytokine production via Toll-like receptor 4. Arthritis Res. Ther. 14, R7 (2012).
Kim, H. A. et al. The catabolic pathway mediated by Toll-like receptors in human osteoarthritic chondrocytes. Arthritis Rheum. 54, 2152–2163 (2006).
Liu-Bryan, R. & Terkeltaub, R. Chondrocyte innate immune myeloid differentiation factor 88-dependent signaling drives procatabolic effects of the endogenous Toll-like receptor 2/Toll-like receptor 4 ligands low molecular weight hyaluronan and high mobility group box chromosomal protein 1 in mice. Arthritis Rheum. 62, 2004–2012 (2010).
Browning, S. R. et al. Platelet-rich plasma increases matrix metalloproteinases in cultures of human synovial fibroblasts. J. Bone Joint Surg. Am. 94, e1721–e1727 (2012).
Ashraf, S. & Walsh, D. A. Angiogenesis in osteoarthritis. Curr. Opin. Rheumatol. 20, 573–580 (2008).
Pufe, T., Petersen, W., Tillmann, B. & Mentlein, R. The splice variants VEGF121 and VEGF189 of the angiogenic peptide vascular endothelial growth factor are expressed in osteoarthritic cartilage. Arthritis Rheum. 44, 1082–1088 (2001).
Enomoto, H. et al. Vascular endothelial growth factor isoforms and their receptors are expressed in human osteoarthritic cartilage. Am. J. Pathol. 162, 171–181 (2003).
Street, J. et al. Vascular endothelial growth factor stimulates bone repair by promoting angiogenesis and bone turnover. Proc. Natl Acad. Sci. USA 99, 9656–9661 (2002).
Gudbjörnsson, B., Christofferson, R. & Larsson, A. Synovial concentrations of the angiogenic peptides bFGF and VEGF do not discriminate rheumatoid arthritis from other forms of inflammatory arthritis. Scand. J. Clin. Lab. Invest. 64, 9–15 (2004).
Italiano, J. E. et al. Angiogenesis is regulated by a novel mechanism: pro- and antiangiogenic proteins are organized into separate platelet alpha granules and differentially released. Blood 111, 1227–1233 (2008).
Ma, L. et al. Proteinase-activated receptors 1 and 4 counter-regulate endostatin and VEGF release from human platelets. Proc. Natl Acad. Sci. USA 102, 216–220 (2005).
Chatterjee, M. et al. Distinct platelet packaging, release and surface expression of proangiogenic and antiangiogenic factors upon different platelet stimuli. Blood 117, 3907–3911 (2011).
Peterson, J. E. et al. Normal ranges of angiogenesis regulatory proteins in human platelets. Am. J. Haematol. 85, 487–493 (2010).
Hsieh, J. L. et al. Intraarticular gene transfer of thrombospondin-1 suppresses the disease progression of experimental osteoarthritis. J. Orthop. Res. 28, 1300–1306 (2010).
Durzynska, J., Philippou, A., Brisson, B. K., Nguyen-McCarty, M. & Barton, E. R. The pro-forms of insulin-like growth factor I (IGF-I) are predominant in skeletal muscle and alter IGF-I receptor activation. Endocrinology 154, 1215–1224 (2013).
Annes, J. P., Munger, J. S. & Rifkin, D. B. Making sense of latent TGFβ activation. J. Cell Sci. 116, 217–224 (2003).
Tocchi, A. & Parks, W. C. Functional interactions between matrix metalloproteinases and glycosaminoglycans. FEBS J. http://dx.doi.org/10.1111/febs.12198.
Blaney Davidson, E. N. et al. Increase in ALK1/ALK5 ratio as a cause for elevated MMP-13 expression in osteoarthritis in humans and mice. J. Immunol. 182, 7937–7945 (2009).
Yin, W., Park, J. I. & Loeser, R. F. Oxidative stress inhibits insulin-like growth factor-I induction of chondrocyte proteoglycan synthesis through differential regulation of phosphatidylinositol 3-kinase–Akt and MEK–ERK MAPK signaling pathways. J. Biol. Chem. 284, 31972–31981 (2009).
van der Kraan, P. M., Goumans, M. J., Blaney Davidson, E. & Dijke, P. Age-dependent alteration of TGF-β signalling in osteoarthritis. Cell Tissue Res. 374, 257–265 (2012).
Kon, E. et al. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy 27, 1490–1501 (2011).
Kubota, S. et al. Abundant retention and release of connective tissue growth factor (CTGF/CCN2) by platelets. J. Biochem. 136, 279–282 (2004).
Tardif, G., Reboul, P., Pelletier, J. P. & Martel-Pelletier, J. Ten years in the life of an enzyme: the story of the human MMP-13 (collagenase-3). Mod. Rheumatol. 14, 197–204 (2004).
Tortorella, M. D. et al. α2-macroglobulin is a novel substrate for ADAMTS-4 and ADAMTS-5 and represents an endogenous inhibitor of these enzymes. J. Biol. Chem. 279, 17554–17561 (2004).
Anitua, E. et al. Relationship between investigative biomarkers and radiographic grading in patients with knee osteoarthritis. Int. J. Rheumatol. 2009, 747432 (2009).
Milano, G. et al. The effect of platelet rich plasma combined with microfractures on the treatment of chondral defects: an experimental study in a sheep model. Osteoarthritis Cartilage 18, 971–980 (2010).
Milano, G. et al. Repeated platelet concentrate injections enhance reparative response of microfractures in the treatment of chondral defects of the knee: an experimental study in an animal model. Arthroscopy 28, 688–701 (2012).
Chim, H., Miller, E., Gliniak, C. & Alsberg, E. Stromal-cell-derived factor (SDF) 1-α in combination with BMP-2 and TGF-β1 induces site-directed cell homing and osteogenic and chondrogenic differentiation for tissue engineering without the requirement for cell seeding. Cell Tissue Res. 350, 89–94 (2012).
Krüger, J. P. et al. Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells. J. Orthop. Res. 30, 845–852 (2012).
Xie, X. et al. Comparative evaluation of MSCs from bone marrow and adipose tissue seeded in PRP-derived scaffold for cartilage regeneration. Biomaterials 33, 7008–7018 (2012).
Spreafico, A. et al. Biochemical investigation of the effects of human platelet releasates on human articular chondrocytes. J. Cell Biochem. 108, 1153–1165 (2009).
Park, S. I., Lee, H. R., Kim, S., Ahn, M. W. & Do, S. H. Time-sequential modulation in expression of growth factors from platelet-rich plasma (PRP) on the chondrocyte cultures. Mol. Cell. Biochem. 361, 9–17 (2012).
Gaissmaier, C. et al. Effect of human platelet supernatant on proliferation and matrix synthesis of human articular chondrocytes in monolayer and three-dimensional alginate cultures. Biomaterials 26, 1953–1960 (2005).
Drengk, A., Zapf, A., Stürmer, E. K., Stürmer, K. M. & Frosch, K. H. Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells. Cells Tissues Organs 189, 317–326 (2009).
Zaky, S. H., Ottonello, A., Strada, P., Cancedda, R. & Mastrogiacomo, M. Platelet lysate favours in vitro expansion of human bone marrow stromal cells for bone and cartilage engineering. J. Tissue Eng. Regen. Med. 2, 472–481 (2008).
Moreira Teixeira, L. S. et al. High throughput generated micro-aggregates of chondrocytes stimulate cartilage formation in vitro and in vivo. Eur. Cell. Mater. 23, 387–399 (2012).
Shih, D. T. et al. Expansion of adipose tissue mesenchymal stromal progenitors in serum-free medium supplemented with virally inactivated allogeneic human platelet lysate. Transfusion 51, 770–778 (2011).
Sun, Y., Feng, Y., Zhang, C. Q., Chen, S. B. & Cheng, X. G. The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int. Orthop. 34, 589–597 (2010).
Saito, M. et al. Intraarticular administration of platelet-rich plasma with biodegradable gelatin hydrogel microspheres prevents osteoarthritis progression in the rabbit knee. Clin. Exp. Rheumatol. 27, 201–207 (2009).
Serra, C. I. et al. Effect of autologous platelet-rich plasma on the repair of full-thickness articular defects in rabbits. Knee Surg. Sports Traumatol. Arthrosc. http://dx.doi.org/10.1007/s00167-012-2141-2140.
Kon, E. et al. Platelet autologous growth factors decrease the osteochondral regeneration capability of a collagen-hydroxyapatite scaffold in a sheep model. BMC Musculoskelet. Disord. 11, 220 (2010).
Mifune, Y. et al. The effect of platelet-rich plasma on the regenerative therapy of muscle derived stem cells for articular cartilage repair. Osteoarthritis Cartilage 21, 175–185 (2013).
Lee, J. C. et al. Synovial membrane-derived mesenchymal stem cells supported by platelet-rich plasma can repair osteochondral defects in a rabbit model. Arthroscopy 29, 1034–1046 (2013).
Lee, G. W., Son, J. H., Kim, J. D. & Jung, G. H. Is platelet-rich plasma able to enhance the results of arthroscopic microfracture in early osteoarthritis and cartilage lesion over 40 years of age? Eur. J. Orthop. Surg. Traumatol. 23, 581–587 (2013).
Dhollander, A. A. et al. Autologous matrix-induced chondrogenesis combined with platelet-rich plasma gel: technical description and a five pilot patients report. Knee Surg. Sports Traumatol. Arthrosc. 19, 536–542 (2011).
Siclari, A., Mascaro, G., Gentili, C., Cancedda, R. & Boux, E. A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year. Clin. Orthop. Relat. Res. 470, 910–919 (2012).
Koh, Y. G. et al. Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy 29, 748–755 (2013).
Pak, J., Lee, J. H. & Lee, S. H. A novel biological approach to treat chondromalacia patellae. PLoS ONE 8, e64569 (2013).
Mei-Dan, O. et al. Platelet rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am. J. Sports Med. 40, 534–541 (2012).
Kon, E. et al. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy 27, 1490–1501 (2011).
Spakòva, T., Rosocha, J., Lacko, M., Harvanová, D. & Gharaibeh, A. Treatment of knee joint osteoarthritis with autologous platelet-rich plasma in comparison with hyaluronic acid. Am. J. Phys. Med. Rehabil. 91, 1–7 (2012).
Filardo, G. et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg. Sports Traumatol. Arthrosc. 19, 528–535 (2011).
Gobbi, A., Karantzikos, G., Mahajan, V. & Malchira, S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health 4, 162–172 (2012).
Hart, R. et al. Platlet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch. Orthop. Trauma Surg. http://dx.doi.org/10.1007/s00402-013-1782-x.
Wang-Saegusa, A. et al. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch. Orthop. Trauma Surg. 131, 311–317 (2011).
Qureshi, A. H. et al. Proteomic and phospho-proteomic profile of human platelets in basal, resting state: insights into integrin signaling. PLoS ONE 4, e7627 (2009).
Castillo, T. N., Pouliot, M. A., Kim, H. J. & Dragoo, J. L. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am. J. Sports Med. 39, 266–271 (2011).
Mazzocca, A. D. et al. The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells. Am. J. Sports Med. 40, 1742–1749 (2012).
Sundman, E. A., Cole, B. J. & Fortier, L. A. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am. J. Sports Med. 39, 2135–2140 (2011).
Dougados, M. Synovial fluid cell analysis. Baillieres Clin. Rheumatol. 10, 519–534 (1996).
Filardo, G. et al. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg. Sports Traumatol. Arthrosc. 20, 2082–2091 (2012).
Acknowledgements
I. Andia is supported in part by Basque Government grant Saio12-PE12BF007.
Author information
Authors and Affiliations
Contributions
Both authors researched data for the article, discussed content, and wrote, reviewed and edited the article.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Andia, I., Maffulli, N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 9, 721–730 (2013). https://doi.org/10.1038/nrrheum.2013.141
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrrheum.2013.141
This article is cited by
-
Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study
International Journal of Impotence Research (2024)
-
Is there a role for platelet rich plasma injection in vulvar lichen sclerosus? A self-controlled pilot study
Archives of Gynecology and Obstetrics (2024)
-
Decoding the Decade: Exploring the Efficacy of Platelet-Rich Plasma (PRP) in Complex Wound Management — A Comprehensive Study
Indian Journal of Orthopaedics (2024)
-
Comparative evaluation of silver nanoparticles and human platelet rich-plasma versus traditional therapy in the treatment of murine chronic toxoplasmosis
Journal of Parasitic Diseases (2024)
-
Adhesive hydrogels in osteoarthritis: from design to application
Military Medical Research (2023)