Platelet-rich plasma for managing pain and inflammation in osteoarthritis

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.

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Figure 1: PRP components and main target cells.
Figure 2: Anti-inflammatory activities of PRP in chondrocytes.
Figure 3: Synthetic and degradative processes can be modified with autologous blood products.

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Acknowledgements

I. Andia is supported in part by Basque Government grant Saio12-PE12BF007.

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Both authors researched data for the article, discussed content, and wrote, reviewed and edited the article.

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Correspondence to Nicola Maffulli.

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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

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