2015 ISAKOS Biennial Congress ePoster #422
Chondrogenic Potential of Platelet-Rich-Plasma (PRP) in Comparison with Postoperative Hemarthrosis-Serum
Claudia Hartz, MD, Heidelberg GERMANY
Pascal Pluemacher, MD, Kiel GERMANY
Mersedeh Tohidnezhad, PhD, Aachen GERMANY
Esra Salin, MD, Aachen GERMANY
Frank Pries, Kiel-Kronshagen GERMANY
Thomas Pufe, Prof., Aachen GERMANY
Deike Varoga, Prof., Kiel GERMANY
Clinic for Orthopedics and Trauma Surgerty, Heidelberg University Hospital, Heidelberg, GERMANY
FDA Status Not Applicable
Summary: PRP has shown higher levels of chondrogenic growth factors in PRP compared to postoperative hemarthrosis-serum. This may result in higher chondrogenic potential for PRP. Interestingly PRP has higher levels of anabolic growth factors.
Despite extensive experimental research and therapeutic intervention either bone marrow stimulation technique nor autologous chondroyte implantation (ACI) are able to restore hyaline cartilage tissue in case of chondral lession. Neochondrogenetic process is influenced by mesenchymal stem cells (MSCs), chondrogenic growth factors (BMP-4, TGF-ß, PDG-BB) as well as angiogenetic growth factors such as IL-6 and VEGF. In previous studies we have shown the release of MSCs and growth factors into the hemarthrosis-serum through bone marrow-stimulation techniques such as microfracture and abrasion arthroplasty. An alternative source for growth factor is Platelet-rich plasma (PRP) wich is derived from whole blood to obtain a high platelet concentration. In some in vitro studies PRP proved to stimulate cartilage regeneration in osteochondral defects. And in case of intraarticular injections in the knee joint PRP reduces osteoarthritic symptoms (short term follow up) . Other experimental studies observe decreased cartilage restoration using PRP. The purpose of this study is to define the chondrogenic potential comparing to postoperative haemarthrosis-serum after bone marrow-stimulation techniques for cartilage regeneration.
In this study heamarthros-serum was collected from 10 patients (37-53 years) 22 hours after bone marrow stimulation technique in case of cartilage lesion grade III-IV in the knee. PRP was harvested and prepared from a healthy group (n=10, 26-40 years). Concentration of VEGF (vascular endothelial growth factor), BMP-4 (bone morphogenic protein-4), TGF-ß1 (transforming growth factor –ß1), platelet-derived growth factor (PDGF-BB) and cytokines IL-1, IL-6 (Interleukin-1,6) and TNF-a (tumor necrosis factor-a) were quantified by ELISA (enzyme-linked immunosorbent assay) and multiplex assay. These factors have also been measured in plasma and serum of healthy individuals. Statistical differences between the groups were evaluated using the Kruskal-Wallis-Test. Group differences were considered significant if p<0.05.
PRP shows significantly increased levels of BMP-4 and TGF-ß in comparison to hemarthros, especially PDGF-BB-levels were found to be highly elevated in PRP compared to haemarthrosis-serum. For VEGF and IL-6 there were no significance regarding PRP and haemarthrosis-serum. IL-1 and TNF-a were significantly increased in PRP as well. Compared to plasma, high levels of growth factors were found in both – PRP and haemarthrosis-serum.
PRP has shown higher levels of anabolic growth factors in PRP compared to postoperative hemarthrosis-serum. Perhaps this may result in higher chondrogenic potential for PRP. Interestingly PRP has higher levels of anabolic growth factors. In the literature no inflammatoric reaction is reported using PRP.
Further studies seems to be necessary before using PRP after arthroscopic procedure to stimulate neochondrogenetic process.