The use of PRP vs cellular therapy for the Treatment of Tendinopathies

The aim was to compare the safety profiles of corticosteroids (CS), hyaluronic acid (HA), blood-derived products based on platelet concentrates (for simplicity indicated as PRP - platelet-rich plasma - being PRP the most common product), and cell-based therapies (namely products exploiting the therapeutic function of mesenchymal stromal cells and other cell populations, either expanded or prepared at the point of care) for knee osteoarthritis (OA) injective treatment. The literature search was conducted on PubMed, Cochrane, and Web of Science according to PRISMA guidelines on clinical studies reporting adverse events of CS, HA, PRP, or cell-based therapies. Number of patients with adverse events and number and type of adverse events were collected for each treatment. A meta-analysis was conducted for each product on the total, non-severe, severe adverse events, and on the infection rate. Out of 848 included studies, 559 reported data on the adverse events in 76,061 patients and were used for the meta-analysis. These studies included 7121 patients treated with CS, 51,146 patients with HA, 11,941 patients with PRP, and 5853 patients with cell-based therapies. The rates of patients reporting at least one adverse event were 11.0% for CS, 10.5% for HA, 8.7% for PRP, and 14.7% for cell-based therapies. The mean number of total adverse events per treated patient was 0.21 for CS, 0.13 for HA, 0.05 for PRP, and 0.19 for cell-based therapies, with a significant difference in each individual comparison (p < 0.001) except for CS versus cell-based therapies. The same trend was observed for non-severe adverse events. The rates of severe adverse events were 1.1% for CS, 0.7% for HA, 0.3% for PRP, and 0.5% for cell-based therapies, while infection rates were 0.4% for CS, 0.1% for HA, 0.3% for PRP, and 0.4% for cell-based therapies. CS, HA, PRP, and cell-based therapies for knee OA have different safety profiles. PRP presented the lowest total adverse event rate, followed by HA, cell-based therapies, and CS. The same trend was observed for non-severe adverse events. PRP demonstrated the lowest rate of severe adverse events, followed by cell-based therapies, HA, and CS, while HA showed the lowest infection rate followed by PRP, CS, and cell-based therapies. Level IV.

Hair is of high aesthetic value in human. Loss of hair is called alopecia. It is a common and complex concern causes frustration, negetive emotion and lack of confidence. Normal daily hair loss is about 100 to 150.Causes of Alopecia are Non Scarring alopecia, pattern alopecia /Androgenetic Alopecia, Unpattern alopecia - Alopecia areata, Telogen effluvium, anagen effluvium, Traction alopecia due to hair style, hair shaft damage by hot air dryers and by hair Straightening and Other causes:- Alopecia syphilitica, diabetesmellitus, hypothyroidism,anaemia, seborrheic dermatitis, psoriasis. Scarring alopecia are Lichen planopilaris, pseudopelade, DLE, Folliculitis decalvans, infections. Diagnostic approach to hair loss : step-1 - History of the hair problem , step-2 - obtain a through medical history, step-3 - Examination of scalp and hair and step - 4- Diagnostic tests are Hair pull test, Dermoscopy,scalp biopsy. Lab tests-CBC, Ferritin, TIBC,TSH,Testosteron and step-5: Treatment: - according to the cause of hair loss.Medical treatment. Topical and intralesional steroid, topical Minoxidil, tacrolimus, finasteride, spironolactone. Updated medical treatment: Tofacitinib. Updated procedural treatment( Procedure): - PRP therapy, Microneedling, Low level Laser therapy (LLLT), stem cell therapy, Hair transplant. Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation:137

Background/Objectives: This study investigates the benefits of incorporating stem cell therapy into arthroscopic rotator cuff repair by evaluating its impact on postoperative pain and functional recovery. Methods: A retrospective, comparative analysis was conducted with a small cohort of patients undergoing rotator cuff surgery, divided into two groups: one receiving adjunctive combined PRP and bursal stem cell therapy and the other undergoing standard arthroscopic repair alone. The outcomes were assessed using visual analog scale (VAS) scores for pain and the Constant-Murley score (CMS), which includes strength of abduction, VAS pain, limitation and range of motion, evaluated at baseline, 1, 2, 3 and 6 months postoperatively. Results: Patients in the stem cell group experienced significantly greater reductions in pain scores and more substantial improvements in functional scores at the follow-up points compared to the control group. A linear mixed-effects analysis showed that in the early postoperative period, the use of PRP and bursal stem cell therapy was associated with significantly reduced postoperative VAS pain scores (F 4.8, p = 0.045) and an increased CMS regarding postoperative pain (F 8.6, p = 0.01), alongside painless elevation level (F 6.5, p = 0.022), forward flexion (F 8.5, p = 0.01) and abduction scores (F 8.3, p = 0.011). The effect of PRP and bursal stem cell therapy remains constant during late follow-up, from the fourth to sixth postoperative month, with postoperative CMS regarding pain remaining statistically significantly higher in the stem cell therapy group (F 4.8, p = 0.008), alongside reduced night-time pain (F 7.4, p = 0.015), improved recreation ability (F 4.8, p = 0.044) and reduced activity restriction (F 5.8, p = 0.028). Conclusions: The findings suggest that the addition of stem cell therapy to arthroscopic rotator cuff repair may enhance postoperative recovery by alleviating pain and promoting functional gains.

Osteoarthritis is the most common inflammation of the joints, with symptoms of joint pain when moving, stiffness, especially in the morning, weakening of the muscles around the problematic joint, sound when the joint is moved, and swelling in the joint area. The absence of treatment that can eliminate Osteoarthritis has led to an increasing demand for more effective treatment. In fact, common disease is age-related, and global statistics show that it is a significant health problem and financial burden on health and social welfare systems globally. This study aims to explain and analyze the effectiveness of combination therapy of stem cells and PRP in the treatment of Osteoarthritis. The research method used is a case study where combination therapy of stem cells and PRP offers the potential to modify the natural recovery of knee Osteoarthritis using stem cell-based technology. Stem cell therapy was given to 9 Osteoarthritis patients aged over 50 years, most of whom were female, who were proven to tend to improve their condition after undergoing stem cell therapy with PRP at the Vinski Regenerative Center and were able to carry out their daily activities again.

P37. MRI disc spectroscopy, a new diagnostic opportunity regarding biochemical evaluation of disc biology

Introduction Management of post-traumatic disorders of bone regeneration continues to be a substantial clinical challenge in orthopaedic trauma. These include refracture, nonunion, delayed consolidation. The purpose is to explore modern methods of treatment of delayed fracture consolidation. Methods The literature search was produced via open access electronic databases of scientific literature PubMed and eLIBRARY. Search depth was 10 years. Results The article presents methods of medication and local therapy for delayed fracture consolidation. The effectiveness of the use of the ossein-hydroxyapatite complex and vitamin D is reported in patients with normalized healing time of a long bone fracture. The findings showed that bisphophonates, denosumab and strontium ranelate can reduce the risk of fractures with no adverse effect on bone healing. There is controversy on the effect of Teriparatide improving fracture healing. This review will envisage the current clinical trials on bone healing augmentation based on bone grafts, bone substitutes, synthetic growth factors, cell therapy and PRP therapy. Local use of bisphosphonates administered either alone or in combination with other agents is of great interest. Bisphosphonates (etidronate) locally applied in combination with lanthanide ions and calcium for animal fractures demonstrated a positive effect on the reparative process. Conclusion The applicability of medication and local therapy is very high in the treatment of patients with delayed fracture consolidation. Despite numerous studies many questions remain unresolved, and there is a need for the investigations. The local use of bisphosphonates was shown to be promising in the management of delayed fracture consolidation.

To establish international expert consensus on the indications, terminology, clinical decision-making, outcome assessment and research priorities for biological augmentation techniques used in meniscus repair. A Delphi study was conducted in accordance with the latest Delphi guidance. A scoping review informed statement generation. An international multidisciplinary expert panel (n = 33) was objectively selected and participated in three rounds of anonymised surveys, with optional 'out-of-expertise' responses, and free-text comment boxes. Consensus thresholds were defined a priori: Rounds one and two required ≥70% agreement and <20% disagreement; whereas round three required ≥75% and <10%, respectively. All invited experts completed all three rounds (100% response rate). Ninety-eight initial statements were included in round one. Consensus was achieved for 66/67 (98.5%) in the final round. The panel agreed that biologic augmentation should be defined as the modification of the local healing environment rather than presumed regeneration. Consensus supported the selective use of simple, low-cost augmentation strategies (e.g., trephination/rasping, marrow venting procedures, fibrin clot) for meniscal repairs with increased failure risk, including radial, complex and horizontal cleavage tear morphologies. Evidence was considered inconclusive for routine use of autologous blood products (e.g., platelet-rich plasma [PRP]) and cell-based therapies (e.g., mesenchymal stromal cells, bone marrow aspirate concentrate). Routine postoperative magnetic resonance imaging to confirm healing in asymptomatic individuals was not recommended, but that imaging should be interpreted alongside clinical findings. For higher-cost, cell-based therapies, ethical concerns were highlighted, specifically regarding direct-to-consumer marketing, false claims and inconsistent reporting. This Delphi study provides pragmatic, tear-specific recommendations for the use of biological augmentation strategies in meniscal repair, prioritising low-cost strategies for higher-risk tear morphologies, while cautioning against the routine use of PRP and cell-based therapies without robust comparative evidence. Standardised terminology, outcome reporting and targeted comparative trials are priorities for future research to optimise repair outcomes. Level V.

Objetivos: Describir los principales cambios histopatológicos presentes en las tendinopatías, su patogénesis y los avances terapéuticos encontrados en la literatura. Palabras Claves: Tendinopatías, histología, patogénesis, inflamación, tendinosis, regeneración. Materiales y métodos: Se realizó una búsqueda de literatura relacionada con las tendinopatías su patogénesis, cambios histológicos, avances terapéuticos en el uso de células madres, factores de crecimiento (plasma rico en plaquetas) y terapia farmacológica. Se utilizaron las bases de datos de pubmed, clinical key, science direct. Se incluyeron artículos de revisiones bibliográficas entre 2005 al 2018, escritos en inglés. Conclusiones: Las tendinopatías tienen un complejo origen multifactorial, donde los factores extrínsecos e intrínsecos juegan un papel importante para el desarrollo de dicha afectación. La inflamación tiene un rol determinante en el desarrollo de la patogenia de las tendinopatías. La terapia farmacológica antiinflamatoria tiene efectos a corto plazo en la disminución del dolor, sin embargo, resulta contraproducente a largo plazo. Existe controversia sobre el uso del Plasma rico en plaquetas (PRP) y de terapia celular (stem cells), se requiere de mayor investigación que pueda evidenciar la eficacia de dichos tratamientos.

Biothérapies pour les troubles de l’érection et la maladie de la Peyronie : ou en est-on ?

A 40-year-old male had recurrent episodes of optic neuritis. Best-corrected visual acuity was evaluated and Humphrey Visual Field analysis was done before and after treatment. Treatment consisted of three weekly cycles of intravenous platelet-rich plasma combined with exosomes, followed one week later by bilateral posterior sub-tenon, retrobulbar, and intravenous injections of blood-derived mononuclear cells.At 3 months of follow-up, Humphrey visual fields showed significant improvement. The patient reported subjective improvement in visual acuity. No further relapses occurred, and no steroid or other systemic therapy was required during the follow-up period.The combined approach of using autologous PRP, exosomes, and hematopoietic stem cell therapy may cause sustained visual field recovery in recurrent optic neuritis refractory to corticosteroids.

Safety and efficacy of regenerative medicine (PRP and PBD-VSEL stem cell therapy) for Parkinson’s disease

Regenerative Approaches to Tendon and Ligament Conditions

Endometrial thickness is an important and crucial factor that contributed to success rate in IVF. A thin endometrium &lt; 7 mm revealed inadequate endometrial blood flow which will affect the embryo implantation process. There are a number of intra uterine therapies currently being used to improve chances of implantation such as vaginal sildenafil, GCSF, PRP and stem cell therapy. However, despite these interventions many women with thin or damaged endometrial linings do not respond to these therapies. intrauterine autologous PRP in women with thin lining seems to show promise. Study in our group about regeneration of endometrial line using 3-D scaffold and self-endometrial cells was addressed particularly for unresponsive thin endometrium cases. Three-dimension acellular scaffolds, amnion bilayer womb patch enriched by autologous endometrial cell were attached into uterine cavity for 14 days. Endometrial sections indicated that initial biopsy before treatment had undefine histoarchitecture, while 14 days application of womb patch showed some areas had epithelial structure, although not obvious. After cell treatment, the epithelial had been formed, with high thoracal, rich with vacuoles, had cilia, and more complex with tubing system. The epithelial also expressed E-Cadherin, and the stroma cells had expressed ER, but not the PR. These had indicated patient phase secretion. This showed that 3d scaffold and self-endometrial cells look promising to improve regeneration of unresponsive thin endometrium.

1. Robert J. Reese, DO, FISHRS According to the medical textbook, Disorders of Hair Growth—Diagnosis and Treatment (2nd edition): ”Clinical features of permanent alopecias include inflammatory and noninflammatory changes. In the late stages of permanent alopecia common histologic features are

Back pain is one of the main global health problems with a high level of prevalence and patients’ disability. In most cases, it is associated with degenerative spine damage (degenerative disc disease), dorsopathy, discopathy (M51 and M53 according to the International Classification of Diseases, 10th revision), affecting all levels of the intervertebral disc (IVD) (cytological, chemical and biochemical) as a whole as well as biological molecules that regulate homeostasis of the disc intercellular substance (growth factors, pro-inflammatory cytokines, enzymes). A key point in IVD dehydration is that catabolic processes predominate over anabolic ones due to changed gene expression in the corresponding biologically active molecules, disc angiogenesis and neoinnervation of the structures of the fibrous ring and pulpous nucleus. The latter is responsible for chronic pain in patients.Cells supporting homeostasis in nucleus pulpous, chondrocytes, continuously synthesize and restore proteoglycans and hyaluronic acid in nucleus pulpous, restoring shock-absorbing functions of the vertebral-motor segment. Decreased activity and death of chondrocytes in the avascular disc structure is a serious problem for reparative medicine. In accordance with IVD molecular-cellular mechanisms, numerous approaches to treat degenerative disc disease are being developed, each of which, influencing one of the links in the pathogenesis, has a direct or indirect effect on IVD repair.The article describes morphology, pathogenesis and genetics of degenerative disc disease, as well as main modern strategies of biological therapy: tissue engineering, biologically active substances locally used in IVD matrix, including PRP therapy (Platelet Rich Plasma therapy), methods of gene (using the viral vector) and cell therapy, as well as experience in the local use of genetically engineered biological products. Most successful studies are a combination of cell and gene therapy with the use of synthesized matrices.