Differences in Synovial Cytokine Profile Associated with Long-Term Clinical Outcomes in Patients with Knee Osteoarthritis Undergoing Corrective Osteotomy with Platelet-Rich Plasma or Stromal Vascular Fraction Post-Treatments

Abstract

Functional outcomes and synovial fluid (SF) cytokine concentrations in response to platelet-rich plasma (PRP) or stromal vascular fraction (SVF) post-treatments following open wedge high tibial osteotomy (HTO) in 20 patients with knee osteoarthritis (OA) were examined. Six weeks after surgery, the knees of 10 patients were injected with autologous PRP (PRP subgroup), while another 10 patients were injected with autologous SVF (SVF subgroup) and monitored for 1.5 years. Pain assessment (VAS score) and functional activity (KOOS, KSS, Outerbridge, and Koshino scores) were applied. PRP subgroup performed better compared with the SVF subgroup according to KOOS, KSS, and VAS scores, while the SVF subgroup demonstrated better results according to Outerbridge and Koshino testing and produced more pronounced cartilage regeneration in the medial condyle and slowed down cartilage destruction in its lateral counterpart. SF was collected before and one week after PRP or SVF injections and tested for concentrations of 41 cytokines (Multiplex Assay). In the PRP subgroup, a significant decrease in IL-6 and CXCL10 synovial concentrations was accompanied by an increase in IL-15, sCD40L, and PDGF-AB/BB amounts. The SVF subgroup demonstrated a significant decrease in synovial TNFα, FLT-3L, MIP-1β, RANTES, and VEGF concentrations while SF concentrations of MCP-1 and FGF2 increased. Both post-treatments have a potential for increased tissue regeneration, presumably due to the downregulation of inflammation and augmentation of synovial growth factor concentrations.

Long-Term Structural Changes in the Osteochondral Unit in Patients with Osteoarthritis Undergoing Corrective Osteotomy with Platelet-Rich Plasma or Stromal Vascular Fraction Post-Treatment

“…Our previous investigation in the same cohort of patients revealed that the PRP subgroup performed better in terms of KOOS, KSS, and VAS scores compared to the SVF subgroup. However, the SVF subgroup showed superior results in Outerbridge and Koshino testings, leading to more pronounced cartilage regeneration in the medial condyle while slowing down cartilage destruction in its lateral counterpart [26].…”

“…The open wedge high tibial osteotomy procedure was carried out following established protocols and is described in detail in our previous study involving the same patient cohort [26]. Weight bearing on the operated joint was restricted for up to six weeks post-surgery.…”

“…Subsequently, 2 mL of PRP was obtained through double centrifugation at 130× g for 15 min at room temperature (RT) to separate erythrocytes, followed by centrifugation at 250× g for 15 min at RT to concentrate platelets, as previously described [26,33]. A total of 2 mL of autologous PRP preparation was then injected into the patient's knee joint.…”

“…The Celution 800/CRS device (Cytori Therapeutics Inc., San Diego, CA, USA) and enzymatic digestion with Cellase (Cytori Therapeutics Inc., San Diego, CA, USA) were employed to extract the SVF fraction from the autologous fat tissue, including cell counting and viability assessment, according to the manufacturer's guidelines. Subsequently, 3.5 mL of the SVF preparation was injected into the patient's knee joint [26].…”

“…Recently, we demonstrated significant clinical and radiological improvements after HTO by incorporating additional procedures for cartilage regeneration, which involved adipose mesenchymal stem cells as part of the stromal vascular fraction (SVF) and platelet-rich plasma (PRP) injections into the knee [26]. The autologous SVF fraction is a heterogeneous group of cells enclosed within adipose tissue that is usually isolated by means of enzymes, such as collagenase [27].…”