Z. Lacza (Krems an der Donau, AT)
OrthoSeraPresenter Of 2 Presentations
10.1.10 - Cytokine Analysis and Clinical Outcome After Intraarticular Hyperacute Serum Injections in Osteoarthritic Knee Joints
- I. Olmos Calvo (Krems an der Donau, AT)
- Z. Lacza (Krems an der Donau, AT)
- E. Fodor (Budapest, HU)
- D. Kardos (Budapest, HU)
- I. Hornyák (Budapest, HU)
- A. Hinsenkamp (Budapest, HU)
- O. Kuten-Pella (Krems an der Donau, AT)
- Z. Gyevnar (Budapest, HU)
- G. Erdelyi (Tata, HU)
- T. Bardos (Tata, HU)
- T. Paukovits (Tata, HU)
- K. Magos (Tata, HU)
- G. Beres (Tata, HU)
- S. Nehrer (Krems, AT)
Abstract
Purpose
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.
Methods and Materials
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.
Results
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.
Conclusion
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.
10.2.1 - Characterization of the Regenerative Effect of Lyophilized Hyperacute Serum in the Context of Osteoarthritis
Abstract
Purpose
Hyperacute serum is a blood-derived product that has demonstrated equivalent outcomes in osteoarthritis (OA) as the well-known platelet-rich plasma (PRP) in previous research. Moreover, hyperacute serum is a stable and standardized product, which overcomes the production disadvantages of PRP. In this study we focused on characterizing and defining a final lyophilized product and to test its regenerative capacities in tissue engineering in OA, alone and in combination with hyaluronic acid (HA).
Methods and Materials
Two-dimensional (2D) cultures of primary chondrocytes were kept in culture under different supplementation conditions, including three versions of hyperacute serum (one liquid and two lyophilized). XTT analysis and gene expression quantification were performed. Hyperacute serum was tested on a human co-culture of synovium, bone, and cartilage explants, previously inflamed. Cytokine profiles from supernatants were quantified and analyzed.
Results
Filtered lyophilized hyperactute serum did not present the same strong effect than the liquid format in promoting cell viability (P=0.0047). We hypothesize that due to the further filtration process, nutrients including growth factors were removed. Therefore, a new non-filtered lyophilized hyperacute serum was produced, which showed no significant difference in promoting cell viability when compared to the liquid format and PRP; furthermore, surpassing the supplementation gold standard FCS (P=0.03). Gene expression of OA-related genes including Col1a1, Col2a1, Acan, Sox9, Mmp3, Mmp13 and Prg4 presented high variability between patients, leading to not significant differences between the groups. However, a tendency suggesting that hyperacute serum supports more extracellular matrix protein secretion than PRP was noticed. Clusters of correlated cytokine and growth factor profiles were identified, showing that hyperacute serum controls inflammation significantly.
Conclusion
Non-filtered lyophilized hyperacute serum is a stable and standardized blood product with regenerative potential in the context of OA, maintaining the supplementation capacity of the liquid format and PRP.