1,721,009 research outputs found
A contemporary view of platelet-rich plasma therapies: Moving toward refined clinical protocols and precise indications
No full textThe positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP+cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies
Platelet-rich Plasma for Muscle Injury and Tendinopathy.
No full textPlatelet-rich plasma (PRP) is increasingly used in Regenerative Medicine. The concept of PRP as a natural source of signaling molecules with paracrine effects in different cells is the basis for the increased PRP application as treatment for sports injuries. PRP recapitulates the principal functions of the natural healing response in orchestrating cell proliferation, differentiation, migration, and angiogenesis. After systematically searching the literature, we identified 21 trials for PRP injections in tendinopathy: 57% were uncontrolled trials and 1 cohort study in muscle. Leukocyte-PRP was used in 91.7% of tendons, of which 65.5% received 1 single injection. Given the lack of large controlled trials, it is clear that the effectiveness of conservative L-PRP treatments is not proven. The clinical evaluation of alternative formulations can be extremely informative. Other unexplored issues include activation, redosing, and concomitant longitudinal tenotomies. Limiting factors for the acceptance of PRP are the lack of evidence of obvious clinical improvement and reimbursement
Stromal vascular fraction technologies and clinical applications
No full textIntroduction: The heterogeneous pool of cells found in the stromal vascular fraction of adipose tissue (SVF) and the purified mesenchymal stromal/stem cells (ASCs) isolated from this pool have increasingly been used as therapeutic tools in regenerative medicine.Areas covered: As SVF and ASCs are different, and should be used in different manners according to various clinical and biological indications, we reviewed the current literature, and focused on the clinical use of SVF to appraise the main medical fields for development. Both enzymatic digestion and mechanical disruption have been used to obtain SVF for non-homologous use. The safety and/or benefits of SVF have been examined in 71 clinical studies in various contexts, mainly musculoskeletal conditions, wound healing, urogenital, and cardiovascular and respiratory diseases. The use of SVF as a therapy remains experimental, with few clinical trials.Expert opinion: SVF provides a cellular and molecular microenvironment for regulation of ASC' activities under different clinical conditions. SVF may enhance angiogenesis and neovascularization in wound healing, urogenital and cardiovascular diseases. In joint conditions, therapeutic benefits may rely on paracrine immune-modulatory and anti-inflammatory mechanisms. Novel point of care methods are emerging to refine SVF in ways that meet the regulatory requirements for minimal manipulation
Joint pathology and platelet-rich plasma therapies.
No full textINTRODUCTION:
At the beginning of the new millennium, there was a breakthrough in platelet-rich plasma (PRP) therapy for tissue repair. The mechanisms governing the effects of this therapy in joint pathology remain largely unexplored.
AREAS COVERED:
This review is primarily based on PubMed and Web of Knowledge searches with the terms osteoarthritis in combination with PRP, treatment, cartilage, synovium, platelets, inflammation and/or angiogenesis. This search was completed by a manual search for relevant studies. We mainly include papers from the last 5 years. The concept of dynamic reciprocity is used to shape understanding of the spatial relationship between cells and their microenvironments as well as between tissues within the joint. We describe the processes of joint injury and pathology relevant to the mechanism of action of PRP, and elaborate insights into how PRP components may influence inflammation, angiogenesis, cell death and cartilage chondroprotection.
EXPERT OPINION:
PRP therapies are more complicated than previously acknowledged, and an understanding of the fundamental processes and pivotal molecules involved will hopefully be elucidated soon. This challenge is to provide a comprehensive description of the relationship between PRP components, healing mechanisms and clinical outcomes. Although PRP therapies in clinical trials await assessment, they have shed light on new avenues of management because of their effects on repair functions
Advances with platelet rich plasma therapies for tendon regeneration
No full textIntroduction: PRPs can be used in the management of tendinopathy if we improve our understanding of pathophysiology and to integrate molecular knowledge about PRP participation in healing mechanisms.Areas covered: We provide new insights into the pathophysiology of tendinopathy, PRP therapies, and the potential links between both. We discuss the place of PRP in promoting tendon repair within what is currently understood regarding the role of PRP molecules in promoting tendon regeneration.Expert opinion: Development of PRP treatments is challenging because a typical group of patients with tendinopathy does not exist, as it affects multiple segments of the population. Moreover, the pathophysiology and origin of pain are not elucidated yet. Although some degree of success has been achieved, PRP is not considered standard medical treatment, and it is largely not paid nor reimbursed by insurance companies. However, the arguments for using PRP in tendinopathy are increasing, and its potential to rebalance inflammation merits further research. Moreover, PRP contains tendoinductive factors that can drive the fate of stem cells. Tailoring PRPs to the specific needs of the host tendon has not been possible to date, because unanswered questions remain about the characteristics of tendinopathy within the different stages of progression
New biotechnologies for musculoskeletal injuries
No full textThe practice of any sport is inherently associated with the risk of musculoskeletal lesions. We describe regenerative medicine technologies, including cellular therapies, gene therapies and multimolecular preparations of growth factors and cytokines, which are expected to advance the field of orthopaedics and sports medicine. Gene therapy involves the introduction of genetic information in the injured tissue to help that tissue to heal and, possibly, regenerate. Cell therapies used in clinical practice are based on the transplantation of adult human cells, which can be at different stages of differentiation. Currently, the stromal vascular fraction, containing stem cells and other niche components, has been injected in the articular cartilage of the knee or delivered via arthroscopy. Bone marrow concentrate (BMC) has been used to manage focal chondral defects via arthroscopy with promising clinical results. In addition, purified mesenchymal stem cells (MSCs) have been injected or delivered as an adjuvant to arthroscopic microfractures, and patients have shown improved clinical outcomes. Laboratory-expanded MSCs injected in osteoarthritis moderately improved pain and functional outcomes. MSC treatment in the form of stromal vascular fraction (SVF) or BMC or laboratory expanded adhesive cells (bone marrow and adipose derived stem cells, BM-MSCs and ADSCs) has been proven to be safe. Despite their safety, expensive regulatory complexities required to implement cell-based therapies make these treatments unavailable for most patients. At present, although some results are promising, all biological interventions are experimental, and cost/efficacy has not been demonstrated yet. Moreover, short follow-up in most studies questions the durability of treatments
Platelet-rich plasma for managing pain and inflammation in osteoarthritis.
No full textOsteoarthritis (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
Blood-derived products for tissue repair/regeneration
No full textMedical interest in "blood-derived products for tissue repair/regeneration" has old roots, starting with chronic wounds in the 1980s, and boosted by sports medicine at the beginning of the millennium, when elite athletes treated with platelet rich plasma (PRP) resumed competition earlier than expected [...]
Freeze‐drying of platelet‐rich plasma: The quest for standardization
Full text linkThe complex biology of platelets and their involvement in tissue repair and inflammation have inspired the development of platelet‐rich plasma (PRP) therapies for a broad array of medical needs. However, clinical advances are hampered by the fact that PRP products, doses and treatment protocols are far from being standardized. Freeze‐drying PRP (FD‐PRP) preserves platelet function, cytokine concentration and functionality, and has been proposed as a consistent method for product standardization and fabrication of an off‐the‐shelf product with improved stability and readiness for future uses. Here, we present the current state of experimental and clinical FD‐PRP research in the different medical areas in which PRP has potential to meet prevailing medical needs. A systematic search, according to PRISMA (Preferred Reported Items for Systematic Reviews and Meta‐Analyses) guidelines, showed that research is mostly focused on wound healing, i.e., developing combination products for ulcer management. Injectable hydrogels are investigated for lumbar fusion and knee conditions. In dentistry, combination products permit slow kinetics of growth factor release and functionalized membranes for guided bone regeneration
Management of limited joint mobility in diabetic patients.
Full text linkSeveral rheumatologic manifestations are more pronounced in subjects with diabetes, ie, frozen shoulder, rotator cuff tears, Dupuytren's contracture, trigger finger, cheiroarthropathy in the upper limb, and Achilles tendinopathy and plantar fasciitis in the lower limb. These conditions can limit the range of motion of the affected joint, thereby impairing function and ability to perform activities of daily living. This review provides a short description of diabetes-related joint diseases, the specific pathogenetic mechanisms involved, and the role of inflammation, overuse, and genetics, each of which activates a complex sequence of biochemical alterations. Diabetes is a causative factor in tendon diseases and amplifies the damage induced by other agents as well. According to an accepted hypothesis, damaged joint tissue in diabetes is caused by an excess of advanced glycation end products, which forms covalent cross-links within collagen fibers and alters their structure and function. Moreover, they interact with a variety of cell surface receptors, activating a number of effects, including pro-oxidant and proinflammatory events. Adiposity and advanced age, commonly associated with type 2 diabetes mellitus, are further pathogenetic factors. Prevention and strict control of this metabolic disorder is essential, because it has been demonstrated that limited joint motion is related to duration of the disease and hyperglycemia. Several treatments are used in clinical practice, but their mechanisms of action are not completely understood, and their efficacy is also debated
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