Purpose
To quantify and compare normative catabolic and anabolic factor concentrations in
leukocyte-rich platelet-rich plasma (LR-PRP) at various time points, including baseline,
1 week after initiating naproxen use, and after a 1-week washout period.
Methods
Asymptomatic healthy donors aged between 18 and 70 years were recruited (average age,
36.6 years; range, 25-64 years). Subjects were excluded from the study if they were
actively taking any prescribed medications or nonsteroidal anti-inflammatory drugs
(NSAIDs) or if they had any of the following at present or previously: blood or immunosuppression
disorders, cancer, osteonecrosis, rheumatoid arthritis, avascular necrosis, NSAID
intolerance, gastrointestinal or peptic ulcer disease, or kidney dysfunction. The
anabolic factors vascular endothelial growth factor, fibroblast growth factor 2, platelet-derived
growth factor AB (PDGF-AB), and platelet-derived growth factor AA (PDGF-AA) and the
catabolic factors interleukin (IL) 1β, IL-6, IL-8, and tumor necrosis factor α in
LR-PRP were measured. Peripheral blood was drawn at 3 time points: baseline, after
1 week of naproxen use, and after a 1-week washout period.
Results
The angiogenic factors PDGF-AA (44% decrease in median) and PDGF-AB (47% decrease)
significantly declined from baseline (P < .05) after 1 week of naproxen use. There was a significant recovery (P < .05) of PDGF-AA (94% increase) and PDGF-AB (153% increase) levels after the 1-week
washout period, with a return to baseline levels. The catabolic factor IL-6 also had
a significant decline from baseline (77% decrease in median, P < .05) after 1 week of naproxen use. After a 1-week washout period, the IL-6 level
was similar to the baseline level (130% increase, P < .05).
Conclusions
Naproxen use diminished several biological factors in LR-PRP; however, a 1-week washout
period was sufficient for the recovery of PDGF-AA, PDGF-AB, and IL-6 to return to
baseline levels. Tumor necrosis factor α, IL-1β, IL-8, vascular endothelial growth
factor, and fibroblast growth factor 2 did not show differences between the 3 time
points of data collection. Discontinuing NSAIDs for a minimum of 1 week before LR-PRP
treatment may improve certain biological factor levels.
Level of Evidence
Level II, prospective comparative study.
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References
- Global burden of osteoarthritis and musculoskeletal diseases.BMC Musculoskeletal Disorders. 2015; 16: S3
- Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I.Arthritis Rheum. 2008; 58: 15-25
- The burden of musculoskeletal diseases in the United States.Semin Arthritis Rheum. 2016; 46: 259-260
- Cost of musculoskeletal diseases: Impact of work disability and functional decline.J Rheumatol Suppl. 2003; 68: 8-11
- The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells.Am J Sports Med. 2012; 40: 1742-1749
- Can platelet-rich plasma enhance tendon repair? A cell culture study.Am J Sports Med. 2008; 36: 1171-1178
- Muscle injuries and strategies for improving their repair.J Exp Orthop. 2016; 3: 15
- Muscle injuries and repair: Current trends in research.J Bone Joint Surg Am. 2002; 84: 822-832
- Gender and age differences in growth factor concentrations from platelet-rich plasma in adults.Mil Med. 2014; 179: 799-805
- Variance of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) concentrations in activated, concentrated platelets from healthy male donors.J Orthop Surg Res. 2014; 9: 29
- Physiology and homeostasis of musculoskeletal structures, injury response, healing process, and regenerative medicine approaches.2017
- Molecular mechanisms of platelet exocytosis: Insights into the "secrete" life of thrombocytes.Blood. 2000; 96: 3334-3342
- Pharmacologic pain treatment of musculoskeletal disorders: Current perspectives and future prospects.Clin J Pain. 2001; 17: 25-32
- Autologous platelet-rich plasma preparations: Influence of nonsteroidal anti-inflammatory drugs on platelet function.Orthop J Sports Med. 2015; 3 (2325967115588896)
- Effects of nonsteroidal antiinflammatory drugs on platelet function and systemic hemostasis.J Clin Pharmacol. 1995; 35: 209-219
- Platelet kinetics in patients with bone marrow hypoplasia: Evidence for a fixed platelet requirement.Blood. 1985; 66: 1105-1109
- Aspirin: Pharmacology and clinical applications.Thrombosis. 2012; 2012: 173124
- Chronic anti-platelet therapy: A contraindication for platelet-rich plasma intra-articular injections?.Eur Rev Med Pharmacol Sci. 2014; 18: 55-59
- Non-steroidal anti-inflammatory drugs selectively inhibit cytokine production by NK cells and gamma delta T cells.Exp Dermatol. 2006; 15: 981-990
- Inhibition of cyclooxygenase-2 decreases DNA synthesis induced by platelet-derived growth factor in Swiss 3T3 fibroblasts.J Pharmacol Exp Ther. 2000; 293: 509-513
- Direct and indirect actions of fibroblast growth factor 2 on osteoclastic bone resorption in cultures.J Bone Miner Res. 2000; 15: 466-473
- Inhibition of angiogenesis by NSAIDs: Molecular mechanisms and clinical implications.J Mol Med (Berl). 2003; 81: 627-636
- NSAID therapy effects on healing of bone, tendon, and the enthesis.J Appl Physiol (1985). 2013; 115: 892-899
- Effect of naproxen on serum concentrations of IL-I, IL-6, and TNF in patients with osteoarthritis.Rev Alerg Mex. 2001; 48 ([in Spanish]): 119-122
- NSAIDS inhibit the IL-1 beta-induced IL-6 release from human post-mortem astrocytes: The involvement of prostaglandin E2.Brain Res. 1997; 777: 210-218
- Non-steroidal anti-inflammatory drugs inhibit the expression of cytokines and induce HSP70 in human monocytes.Cytokine. 1999; 11: 347-358
- Metabolism of human articular chondrocytes cultured in alginate beads. Longterm effects of interleukin 1beta and nonsteroidal antiinflammatory drugs.J Rheumatol. 2002; 29: 772-782
- Nonsteroidal anti-inflammatory drugs increase TNF production in rheumatoid synovial membrane cultures and whole blood.J Immunol. 2010; 185: 3694-3701
- Effect of COX-1/COX-2 inhibition versus selective COX-2 inhibition on coronary vasodilator responses to arachidonic acid and acetylcholine.Pharmacology. 2004; 71: 135-142
- Platelet function is inhibited by non-selective non-steroidal anti-inflammatory drugs but not by cyclo-oxygenase-2-selective inhibitors in patients with rheumatoid arthritis.Rheumatology (Oxford). 2002; 41: 458-461
- Molecular basis for cyclooxygenase inhibition by the non-steroidal anti-inflammatory drug naproxen.J Biol Chem. 2010; 285: 34950-34959
- Platelet-rich plasma: From basic science to clinical applications.Am J Sports Med. 2009; 37: 2259-2272
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- Platelet-rich plasma augmentation for hip arthroscopy.Arthrosc Tech. 2017; 6: e763-e768
- Early TBI-induced cytokine alterations are similarly detected by two distinct methods of multiplex assay.Front Mol Neurosci. 2011; 4: 21
- Effects of selective cyclooxygenase-2 and nonselective cyclooxygenase inhibition on ischemic myocardium.J Thorac Cardiovasc Surg. 2010; 140: 1143-1152
- A randomized, placebo-controlled study of the effects of naproxen, aspirin, celecoxib or clopidogrel on gastroduodenal mucosal healing.Aliment Pharmacol Ther. 2009; 29: 781-791
- Minimum information for studies evaluating biologics in orthopaedics (MIBO): Platelet-rich plasma and mesenchymal stem cells.J Bone Joint Surg Am. 2017; 99: 809-819
- Platelet-rich plasma: Renewed scientific understanding must guide appropriate use.Bone Joint Res. 2016; 5: 92-94
- Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems.Am J Sports Med. 2011; 39: 266-271
- Comparison of the cellular composition and cytokine-release kinetics of various platelet-rich plasma preparations.Am J Sports Med. 2015; 43: 3062-3070
- Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model.Arthroscopy. 2014; 30: 629-638
- Biologic treatments for sports injuries II think tank-current concepts, future research, and barriers to advancement, part 1: Biologics overview, ligament injury, tendinopathy.Am J Sports Med. 2016; 44: 3270-3283
- Biologic treatments for sports injuries II think tank-current concepts, future research, and barriers to advancement, part 2: Rotator cuff.Orthop J Sports Med. 2016; 4 (2325967116636586)
- Biologic treatments for sports injuries II think tank-current concepts, future research, and barriers to advancement, part 3: Articular cartilage.Orthop J Sports Med. 2016; 4 (2325967116642433)
- Cytokine, chemokine, and growth factor profile of platelet-rich plasma.Platelets. 2016; 27: 467-471
- Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma.Am J Sports Med. 2011; 39: 2135-2140
- The use of platelet-rich and platelet-poor plasma to enhance differentiation of skeletal myoblasts: Implications for the use of autologous blood products for muscle regeneration.Am J Sports Med. 2017; 45: 945-953
- The effect of platelet-rich plasma formulations and blood products on human synoviocytes: Implications for intra-articular injury and therapy.Am J Sports Med. 2014; 42: 1204-1210
- Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons.Am J Sports Med. 2012; 40: 1274-1281
- The effect of nonsteroidal anti-inflammatory drugs on tissue healing.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 540-549
- Platelet-rich plasma preparation for regenerative medicine: Optimization and quantification of cytokines and growth factors.Stem Cell Res Ther. 2013; 4: 67
Article info
Publication history
Published online: November 21, 2018
Accepted:
July 12,
2018
Received:
February 21,
2018
Footnotes
See commentary on page 211
The authors report the following potential conflict of interest or sources of funding: J.H. receives royalties from Cook Myosite. R.F.L. receives support from Arthrex, Ossur, and Smith & Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Platelet-Rich Plasma Details Are Critical to Outcome…Catching Is Always Better Than FishingArthroscopyVol. 35Issue 1
- PreviewThe use of platelet-rich plasma (PRP) and the spectrum of orthobiological interventions has been a major innovation in orthopedic surgery and medicine. Biological-based therapies for musculoskeletal disorders and injuries have gained popularity in the past decade and created significant expectation as the future of sports medicine, based on theoretical advantages including minimal invasiveness, greater healing potential, faster recovery, and a less expensive alternative to surgery. These therapies for musculoskeletal intervention include PRP, bone marrow aspirate concentrate, cellular-based therapies, and tissue engineering.
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