Platelet-rich plasma (PRP) has shown to induce improvements in pain and mobility of osteoarthritic (OA) joints. However, PRP present high variability during manufacturing, making it not an optimal therapeutic. Hyperacute serum is a standarized and stable blood-derived product obtained from the serum fraction of platelet rich fibrin. Our aim is to test if intraarticular hyperacute serum injections result in an improved outcome for OA patients.
24 OA patients underwent 3 autologous intraarticular injections of hyperacute serum in OA knees. Clinical monitoring was followed up to 3 and 6 months and the outcome was validated by VAS, KOOS and Lysholm-Tegner scores. Synovial fluid (n=9) was collected prior hyperacute serum injection and cytokine profile was analyzed in order to understand the dynamic behaviour of the cytokines.
VAS, KOOS and Lysholm-Tegner scores showed an important improvement in pain and mobility of OA knees during the follow-up after hyperacute serum treatment. Patients with knee effusion showed more severe symptoms than patients without effusion; however, after 6 months, both groups equalized and improved notably. Multivariate factor analysis of cytokine levels revealed that instead of having an individual reaction to hyperacute serum, fluctuation was grouped. Two subgroups with a high correlation between the proteins included were identified. Group A consisted on: IL-8, MMP-9, fractalkine, IFNγ, IL-1β, IL-10, IL-1ra, IL-33, resistin and RANKL. Group B included MMP-3, IL-2, IL-5, VEGF-A, aggrecan, CCL-3, COL1a, IL-12p70, IL-2, IL-23, LIF, OSM and TNFα.
OA patiens who received hyperacute serum intraarticularly, reported pain decrease, together with improvement of knee mobility and stability after 6 months of treatment. Cytokine analysis from synovial fluids showed two patterns of cytokine expression. The high correlation within each subgroup suggests that by measuring a few cytokines, the expression of the whole subgroup may be predictable.