Autologous Cell-free Serum Preparations in the Management of Knee Osteoarthritis: What is the Current Clinical Evidence?

Overview

Journal Knee Surg Relat Res

Publisher Biomed Central

Date 2020 Jul 15

PMID 32660628

Citations 5

Authors

Darshan S Angadi

Hamish MacDonald

Navraj Atwal

Affiliations

Soon will be listed here.

Abstract

Background: There is paucity in the current literature regarding clinical outcomes of autologous cell-free serum preparations. The objective of this paper is to collate the clinical evidence and review the results of intraarticular injections of autologous cell-free serum preparations in the management of knee osteoarthritis (OA).

Methods: A comprehensive English literature search was undertaken using the healthcare database website (https://hdas.nice.org.uk/). The PubMed, Medline, CINAHL, Embase and the Cochrane library databases were searched to identify all studies of autologous protein solution/autologous conditioned serum (ACS/APS) in the management of knee OA. We evaluated the reported clinical outcomes with respect to pain, function, morbidity, adverse effects and complications.

Results: Fifteen relevant articles were identified in the current literature. Outcomes following injection of ACS/APS have been reported in patients with age range (34-87 years) and unilateral or bilateral knee OA. Seven studies reported improvement in visual analog scale (VAS) whereas the Western Ontario and McMaster Universities osteoarthritis instrument (WOMAC) score improved in nine studies. Considerable variation was noted in the injection technique and duration of post-procedure assessment with only one study reporting long-term follow-up beyond 24 months. Joint swelling and injection-site pain were reported to be the most common complications; only one study reported a case of septic arthritis. However, no evidence is available to clearly identify factors that may predict the outcomes following this procedure.

Conclusion: Current data from the clinical studies would suggest that the intraarticular administration of autologous cell-free serum preparations, such as ACS/APS, in patients with knee OA may improve pain and function, with limited morbidity. High-quality clinical trials with stratified patient cohorts, longer follow-up duration and robust reporting of outcome measures are essential to improve the understanding of the indications and clinical effectiveness of these novel products.

Citing Articles

Cartilage Regeneration Using Human Umbilical Cord Blood Derived Mesenchymal Stem Cells: A Systematic Review and Meta-Analysis.

Lee D, Kim S, Song J, Shetty A, Kim B, Kim S Medicina (Kaunas). 2022; 58(12).

PMID: 36557003 PMC: 9786930. DOI: 10.3390/medicina58121801.

State of the Art: The Immunomodulatory Role of MSCs for Osteoarthritis.

Kwon D, Kim M, Jeon Y, Nam Y, Park J, Ryu D Int J Mol Sci. 2022; 23(3).

PMID: 35163541 PMC: 8835711. DOI: 10.3390/ijms23031618.

Past, present, and future of cartilage restoration: from localized defect to arthritis.

Lee D, Kim S, Kim S, Ju G Knee Surg Relat Res. 2022; 34(1):1.

PMID: 35090574 PMC: 8800252. DOI: 10.1186/s43019-022-00132-8.

Potential Mechanism of Action of Current Point-of-Care Autologous Therapy Treatments for Osteoarthritis of the Knee-A Narrative Review.

Woodell-May J, Steckbeck K, King W Int J Mol Sci. 2021; 22(5).

PMID: 33800401 PMC: 7962845. DOI: 10.3390/ijms22052726.

Hemovac blood after total knee arthroplasty as a source of stem cells.

Kim S, Park H, Shin Y, Go E, Kim Y, Kim Y Ann Transl Med. 2020; 8(21):1406.

PMID: 33313151 PMC: 7723525. DOI: 10.21037/atm-20-2215.

References

Abbott J, Wilson R, Pinto D, Chapple C, Wright A . Incremental clinical effectiveness and cost effectiveness of providing supervised physiotherapy in addition to usual medical care in patients with osteoarthritis of the hip or knee: 2-year results of the MOA randomised controlled trial. Osteoarthritis Cartilage. 2018; 27(3):424-434. DOI: 10.1016/j.joca.2018.12.004. View

Messier S, Resnik A, Beavers D, Mihalko S, Miller G, Nicklas B . Intentional Weight Loss in Overweight and Obese Patients With Knee Osteoarthritis: Is More Better?. Arthritis Care Res (Hoboken). 2018; 70(11):1569-1575. PMC: 6203601. DOI: 10.1002/acr.23608. View

Felson D, Niu J, Gross K, Englund M, Sharma L, Cooke T . Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheum. 2012; 65(2):355-62. PMC: 3558618. DOI: 10.1002/art.37726. View

Fox B, Stephens M . Treatment of knee osteoarthritis with Orthokine-derived autologous conditioned serum. Expert Rev Clin Immunol. 2010; 6(3):335-45. DOI: 10.1586/eci.10.17. View

Linardi R, Dodson M, Moss K, King W, Ortved K . The Effect of Autologous Protein Solution on the Inflammatory Cascade in Stimulated Equine Chondrocytes. Front Vet Sci. 2019; 6:64. PMC: 6414419. DOI: 10.3389/fvets.2019.00064. View

Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G . Clinical Outcomes of Knee Osteoarthritis Treated With an Autologous Protein Solution Injection: A 1-Year Pilot Double-Blinded Randomized Controlled Trial. Am J Sports Med. 2017; 46(1):171-180. DOI: 10.1177/0363546517732734. View

Jevsevar D . Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013; 21(9):571-6. DOI: 10.5435/JAAOS-21-09-571. View

Liu Q, Niu J, Li H, Ke Y, Li R, Zhang Y . Knee Symptomatic Osteoarthritis, Walking Disability, NSAIDs Use and All-cause Mortality: Population-based Wuchuan Osteoarthritis Study. Sci Rep. 2017; 7(1):3309. PMC: 5468322. DOI: 10.1038/s41598-017-03110-3. View

Barreto A, Braun T . A method to induce Interleukin-1 Receptor Antagonist Protein from autologous whole blood. Cytokine. 2016; 81:137-41. DOI: 10.1016/j.cyto.2016.03.008. View

10.

Yang K, Raijmakers N, van Arkel E, Caron J, Rijk P, Willems W . Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial. Osteoarthritis Cartilage. 2007; 16(4):498-505. DOI: 10.1016/j.joca.2007.07.008. View

11.

Bertone A, Ishihara A, Zekas L, Wellman M, Lewis K, Schwarze R . Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in horses. Am J Vet Res. 2014; 75(2):141-51. DOI: 10.2460/ajvr.75.2.141. View

12.

Frisbie D, Kawcak C, Werpy N, Park R, McIlwraith C . Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res. 2007; 68(3):290-6. DOI: 10.2460/ajvr.68.3.290. View

13.

Baltzer A, Moser C, Jansen S, Krauspe R . Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage. 2008; 17(2):152-60. DOI: 10.1016/j.joca.2008.06.014. View

14.

Rutgers M, Creemers L, Auw Yang K, Raijmakers N, Dhert W, Saris D . Osteoarthritis treatment using autologous conditioned serum after placebo. Acta Orthop. 2014; 86(1):114-8. PMC: 4366668. DOI: 10.3109/17453674.2014.950467. View

15.

Baselga Garcia-Escudero J, Miguel Hernandez Trillos P . Treatment of Osteoarthritis of the Knee with a Combination of Autologous Conditioned Serum and Physiotherapy: A Two-Year Observational Study. PLoS One. 2015; 10(12):e0145551. PMC: 4692499. DOI: 10.1371/journal.pone.0145551. View

16.

Altman R, Hackel J, Niazi F, Shaw P, Nicholls M . Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018; 48(2):168-175. DOI: 10.1016/j.semarthrit.2018.01.009. View

17.

Collins J, Beutel B, Strauss E, Youm T, Jazrawi L . Bone Marrow Edema: Chronic Bone Marrow Lesions of the Knee and the Association with Osteoarthritis. Bull Hosp Jt Dis (2013). 2016; 74(1):24-36. View

18.

Wehling P, Moser C, Maixner W . How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts. Ther Adv Musculoskelet Dis. 2016; 8(3):72-85. PMC: 4872173. DOI: 10.1177/1759720X16642405. View

19.

Crnogaca K, Bicanic G, Delimar D . Elevated CRP level could herald less efficient autologous conditioned serum (ACS) treatment. Med Hypotheses. 2015; 86:135-7. DOI: 10.1016/j.mehy.2015.11.001. View

20.

Richards M, Maxwell J, Weng L, Angelos M, Golzarian J . Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. Phys Sportsmed. 2016; 44(2):101-8. PMC: 4932822. DOI: 10.1080/00913847.2016.1168272. View