Abstract
Many alternative treatments aimed at modulating osteoarthritis (OA) progression have been developed in the past decades, including the use of cytokine inhibitors. IL-1β is considered one of the most impactful cytokines in OA disease and therefore, its blockage offers a promising approach for the modulation of OA. Interleukin-1 receptor antagonist (IL-1Ra) is a naturally occurring anti-inflammatory protein belonging to the IL-1 family that competes with IL-1β for occupancy of its receptors, without triggering the same downstream inflammatory response. Because of its natural anti-inflammatory properties, different methods have been proposed to use IL-1Ra therapeutically in OA. Autologous conditioned serum (ACS) and autologous protein solution (APS) are blood-derived products produced with the use of specialized commercial kits. These processes result in hemoderivatives with high concentrations of IL-1Ra and other cytokines and growth factors with potential modulatory effects on OA progression. Several studies have demonstrated potential anti-inflammatory effect of these therapies with promising clinical results. However, as with any hemoderivatives, clinical outcomes may vary. For optimal therapeutic use, further research is warranted for a more comprehensive understanding of the product's composition and interaction of its components in joint inflammation. Additionally, differences between ACS and APS treatments may not be clear for many clients and clinicians. Thus, the objective of this narrative review is to guide the reader in important aspects of ACS and APS therapies, in vitro and in vivo applications and to compare the use of both treatments in OA.
Highlights
Osteoarthritis is a common cause of lameness observed in horses (1), and has been described as a disease with a common end stage of progressive degeneration of the articular cartilage (2)
Positive results were observed with clinical use of autologous conditioned serum (ACS) and autologous protein solution (APS), others demonstrated that ACS did not have a direct effect on cartilage metabolism compared with unstimulated serum
The conflicting results observed in vivo may be attributed to the reduction of therapeutic cytokine concentrations in the synovial fluid after injection, suggesting that new intra-articular therapies should focus on the prolonged presence of the cytokines in the joint space
Summary
Osteoarthritis is a common cause of lameness observed in horses (1), and has been described as a disease with a common end stage of progressive degeneration of the articular cartilage (2). Biological therapies such as platelet-rich plasma (PRP), autologous protein solution (APS), and autologous conditioned serum (ACS) provide a more physiological alternative to conventional treatments capable of modulating inflammation in OA (6–8) These products are derived from the patient’s own blood and are rich in anti-inflammatory cytokines and growth factors that reduce inflammation and promote anabolism in tissues (7). These therapies have demonstrated significant clinical and histological improvement in horses with OA (8, 9). Over a decade after the initial investigation of ACS (32), a newer hemoderivative called autologous protein solution (APS) was developed This method proposes to increase the antiinflammatory and anabolic concentrations of hemoderivatives of Camargo Garbin and Morris clinical use. Whilst such correlations are still in their infancy, further studies, focusing on the integration of APS cytokines on the multiple inflammatory pathways in the different stages of OA, are warranted
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