The immature platelet fraction affects the efficacy of platelet rich plasma therapy for knee osteoarthritis

Sayuri Uchino; Yoshitomo Saita; Atsushi Wada; Yohei Kobayashi; Takanori Wakayama; Hirofumi Nishio; Shin Fukusato; Yasumasa Momoi; Ryosuke Nakajima; Hiroshi Ikeda; Muneaki Ishijima

doi:10.1016/j.reth.2021.06.004

The immature platelet fraction affects the efficacy of platelet rich plasma therapy for knee osteoarthritis

Regen Ther. 2021 Jul 8:18:176-181. doi: 10.1016/j.reth.2021.06.004. eCollection 2021 Dec.

Authors

Sayuri Uchino^{1

2}, Yoshitomo Saita^{2

3}, Atsushi Wada⁴, Yohei Kobayashi², Takanori Wakayama², Hirofumi Nishio^{2

5}, Shin Fukusato², Yasumasa Momoi^{1

2}, Ryosuke Nakajima^{1

2}, Hiroshi Ikeda^{2

6}, Muneaki Ishijima^{1

2}

Affiliations

¹ Department of Medicine for Orthopaedics and Motor Organ, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
² Department of Orthopaedics, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
³ Department of Sports and Regenerative Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.
⁴ Scientific Research Division, Scientific Affairs, Sysmex Corporation, 1-3-2 Murotani, Nishi-ku, Kobe, Hyogo, Japan.
⁵ Department of Sports Science, Faculty of Health and Sports Science, Juntendo University, 1-1 Hiraka Gakuendai, Inzai, Chiba, Japan.
⁶ Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan.

Abstract

Introduction: Platelet-rich plasma (PRP) therapy is used to treat pathological conditions such as degenerative inflammatory diseases including osteoarthritis (OA) by enhancing tissue repair and promoting anti-inflammatory effects. Although PRP therapy for patients with knee OA improved pain and functional scores, the association of clinical outcomes and quality of PRP including cell composition and concentration is unclear.

Methods: Therefore, this study analyzed blood cell counts, including the immature platelet fraction (IPF), in peripheral blood and PRP of 144 patients with knee OA who underwent PRP therapy. The mean leukocyte and platelet concentrations in whole blood and PRP were analyzed using an XN-1000 automated hematology analyzer. Visual analogue scale (VAS) scores and knee injury and osteoarthritis outcome scores (KOOS) before and 1 month after a single PRP injection were also determined.

Results: Higher platelet and lower leukocyte concentration rates were observed in PRP compared with whole blood. The platelet concentration in whole blood was negatively correlated with VAS improvement. The percentage of IPF (IPF%) in whole blood was positively correlated with VAS improvement and KOOS (pain) improvement, whereas the IPF% in PRP tended to correlate with VAS improvement. Furthermore, multivariate logistic regression demonstrated the high IPF% in whole blood was significantly associated with VAS improvement. The low percentage of neutrophil (neutrophil%) in PRP was significantly associated with the VAS improvement and KOOS (ADL) improvement.

Conclusions: Therefore, PRP efficacy for OA might depend on the patient's biological status.

Keywords: ACD, acid citrate dextrose; EDTA, ethylenediaminetetraacetic acid; IPF, immature platelet fraction; Immature platelet fraction; KOOS, knee injury osteoarthritis outcome score; Knee osteoarthritis; OA, osteoarthritis; PRP, platelet rich plasma; Platelet-rich plasma; SFL, side fluorescence; VAS, visual analogue scale.