Safety and Efficacy of Autologous Intra-articular Platelet Lysates in Early and Intermediate Knee Osteoarthrosis in Humans: A Prospective Open-Label Study.

OBJECTIVE: To explore the safety and benefit from intra-articular autologous platelet lysate (PL) injection in early and intermediate knee osteoarthritis. DESIGN: Open-label prospective study. SETTING: Laboratory. PATIENTS: Adult patients, aged 35 to 70 years, with a history of chronic pain or swelling on one or both knees and imaging findings (radiograph or magnetic resonance imaging) of degenerative changes in the joint of grade I or II on the Kellgren scale were included. INTERVENTIONS: Autologous PL was given in the knee joint by percutaneous intra-articular route every 3 weeks for a total of 3 injections. MAIN OUTCOME MEASURES: Response was evaluated by nonnormalized Knee Osteoarthritis and Disability Outcome Score (KOOS). RESULTS: There was a significant improvement in the 5 aspects evaluated at weeks 32 and 52 compared with baseline. Symptoms score significantly improved at weeks 32 and 52 from a mean of 11.1 at baseline to 9.0 (P < 0.0001) and 8.7 (P < 0.0001). Stiffness score significantly improved at weeks 32 and 52 from 2.2 at baseline to 1.7 (P < 0.022) and 1.6 (P < 0.016). Pain score improved at 32 weeks and at 52 weeks from a baseline of 14.2 to 9.8 (P < 0.0001) and 9.2 (P < 0.0001). Daily Living score improved from 25.0 to 18.7 at 32 weeks (P < 0.0001) and to 15.6 at 52 weeks (P < 0.0001). Sport score improved from 10.7 to 8.4 at 32 weeks (P < 0.0001) and to 8.1 at 52 weeks (P < 0.0001). CONCLUSIONS: Intra-articular PL significantly improved score of all aspects evaluated by KOOS. Platelet lysate seems to be a safe product. CLINICAL RELEVANCE: To the best of our knowledge, this is the first clinical study addressing the use of autologous PL as a treatment measure for knee osteoarthrosis (KOA). There are no studies published regarding the treatment of KOA by intra-articular injections of PL. The previous studies were on the use of platelet-rich plasma (PRP) treatment for KOA. Platelet-rich plasma use has been in place for several years, however, a standardized protocol has not yet been established. Platelet lysate represents a safe, economical, easy to prepare, and easy to apply source of growth factors in the treatment of KOA. A head-to-head study is needed to compare PRP with PL in KOA.

Prevalence of thrombophilic genetic factors among patients with retinitis pigmentosa.

PURPOSE: To determine the prevalence of thrombophilic factors in patients with retinitis pigmentosa (RP). METHODS: Fifty consecutive patients with RP and 50 controls matched by age and gender were tested for the presence of the following mutations: factor II (GA20210), factor V Leiden (GA1691), methylenetetrahydrofolate reductase (CT677), factor XIIIa (Val→Leu), ß-fibrinogen (GA455), tumor necrosis factor receptor (TNFRII) (M196R), plasminogen activator inhibitor-1 (PAI-1) (4 G/5 G), and plasminogen activator inhibitor-1 (PAI-1) (GA844). RESULTS: The following heterozygous mutations were found in patients/controls: factor V Leiden (12/14), factor XIIIa (20/30), methylenetetrahydrofolate reductase 677 TT (48/52), ß-fibrinogen GA455 (36/36), TNFRII (M196R) (40/42), PAI-1 4 G/5 G (40/48), and PAI-1 GA844 (50/52). The difference between patients with RP and the control group was not statistically significant for the prevalence of any of the studied factors (P > 0.05). CONCLUSION: In this study, thrombophilic mutations were not increased in patients with RP. Thrombophilic mutations do not seem to be risk factors for RP. Routine investigation of hereditary thrombophilia in these patients is not justified.

Measurement of platelet reactivity of patients with cardiovascular disease on-treatment with acetyl salicylic acid: a prospective study.

Acetyl salicylic acid (ASA) and clopidogrel are extensively used in the prevention of cardiovascular disease. However, the responsiveness to ASA treatment may vary among individuals. This study was conducted to investigate the profile and prevalence of ASA resistance in cardiac patients. From August 2007 to August 2008, a total of 282 cardiac patients were enrolled. Two study groups were identified: patients taking 100 mg ASA daily but without clopidogrel, and patients taking both 100 mg ASA and 75 mg clopidogrel daily. Platelet function was determined with the Multiplate analyzer to determine platelet responsiveness. Salicylate blood level was measured for all patients on ASA. Seventy-three patients (26%) were determined to be nonresponsive to ASA, and 45 patients (16%) were partially responsive, whereas 164 patients (58.2%) were responsive to ASA. Myocardial infarction and coronary obstruction were both strongly associated with ASA nonresponsiveness (p < 0.001). ASA resistance occurred more in female patients (p = 0.002). The salicylate blood level was found to be low in ASA-resistant patients (35.33 ± 50.22 mg/l) and higher in sensitive patients (54.26 ± 18.7 mg/l; p < 0.001). Quantitative assessment of platelet functions is predictive of ASA treatment failure in individual patients. Dual antiplatelet treatment with clopidogrel and ASA was found to have greater inhibitory effects on platelet aggregation than either agent alone. Non-adherence may be a significant mediator of poor outcome.

Comparison of platelet aggregation using light transmission and multiple electrode aggregometry in Glanzmann thrombasthenia.

We examined platelet aggregation in platelet-rich plasma (PRP) and in whole blood in nine patients with Thrombasthenia Glanzmann (TG). In PRP, aggregation was measured by monitoring the changes in light absorbance that occurred in response to adenosine 5-diphosphate (ADP), collagen and ristocetin. To measure platelet aggregation in whole blood, we used multiple electrode Impedance aggregometry using the same aggregating agents. In PRP, the patient's platelets showed defective aggregation in response to ADP, collagen, epinephrine and partially to ristocetin in all patients. In whole blood, platelet aggregation in response to the same aggregating agents showed similar response and appeared to be very similar to that which occurred in PRP. Whole blood impedance aggregometry seems to give similar results to PRP light transmission aggregometry in patients with TG. Multiple electrode aggregometry (MEA) is faster and more convenient to use in these patients.

Common antimicrobial resistance phenotypes and genotypes of fecal Escherichia coli isolates from a single family over a 6-month period.

This study investigated the antimicrobial resistance phenotypes and genotypes among fecal Escherichia coli isolates from the members of a single Jordanian family over a 6-month period. A total of 55 (51%) E. coli isolates were resistant to >2, and 21 (19%) to >3 of the 14 tested antimicrobial agents, respectively. The highest resistance rates were observed to tetracycline (42%), followed by coamoxyclav and cotrimoxazole (32%), gentamicin (31%), and nalidixic acid (27%). Sixteen out of 21 (76%) multiresistant E. coli isolates (resistant to >3 drugs) transferred most of their resistance markers in vitro to E. coli K12. Five out of the six family members were colonized with E. coli carrying one or two of the two common plasmid sizes (54.3 and 13.2 kb). Ten of these isolates (48%) were positive for class 1 integron genes and harbored four tet (A) and five tet (B) genes, respectively, but all were negative for tet (39). The genetic diversity of E. coli isolates using randomly amplified polymorphic DNA-PCR demonstrated 13 major clusters of genotype groups, and most of the isolates (63%) belonged to one genotype group. This study indicates that all six family members are colonized with fecal E. coli isolates exhibiting a common number of antimicrobial resistance phenotypes and at least one prevalent genotype.