Precision Assessment of Platelet Rich Plasma for Joint Preservation

该项目解决了VA的关键临床需求。进行性膝关节疼痛 关节退化和最终的骨关节炎（OA）是残疾的主要原因， 特别是在更频繁和更年轻的受OA影响的退伍军人中 比一般人群。膝关节骨关节炎是一种进行性疾病， 目前的治疗是姑息性的，直到发生完全的关节破坏， 进行更换。可的松注射剂已被广泛使用超过60 多年来治疗疼痛和肿胀，但也显示出对关节炎的不利影响。 软骨这就引入了对注射治疗以改善关节疼痛的高度临床需求 并在保持软骨健康的同时发挥作用，特别是在那些患有早期疾病的人中， 那里有大量剩余的关节软骨。最近，关节内 自体富血小板血浆（PRP）注射作为一种有前途的 膝关节OA的新治疗方法，不仅可以缓解症状， 可能有助于生长因子刺激内源性关节修复过程。 然而，PRP的作用机制尚不清楚， 老兵我们的初步数据还显示， 自体PRP的生物组成。在这个个性化和精准化的时代 医学，我们建议检查PRP治疗的结果，以及是否 PRP组成的个体差异与变化的客观指标相关， PRP注射治疗后的行走功能和软骨基质结构 退伍军人中的早期膝关节OA。实现本提案的目标将决定是否 自体血小板血浆关节腔内注射治疗早期膝关节骨性关节炎 退伍军人和其他妇女，在实际的临床环境中， 治疗效果所获得的信息还将填补关键的知识空白， 阐明PRP注射治疗糖尿病的潜在作用机制 症状性早期膝关节OA和结合客观科学评估（步态分析 和MRI）与标准患者报告结局（PRO）。最后，新知识 获得的信息将通过告知对最佳患者重要的因素来改善临床护理 选择这种新的治疗方法。

This project addresses a critical clinical need for the VA. Knee pain due to progressive joint degeneration and eventual osteoarthritis (OA) are leading causes of disability, particularly in Veterans who are affected by OA at greater frequency and younger ages than the general population. Knee osteoarthritis is a progressive disease for which current treatment is palliative until complete joint destruction occurs and prosthetic knee replacement is performed. Cortisone injections have been widely used for more than 60 years to treat pain and swelling, but have also shown detrimental effects to articular cartilage. This introduces high clinical need for an injection therapy to improve joint pain and function while preserving cartilage health, especially in those with early disease where there is substantial remaining articular cartilage. Recently, intra-articular autologous platelet rich plasma (PRP) injections have gained traction as a promising new treatment for knee OA that can not only provide symptomatic relief but also potentially contribute growth factors to stimulate endogenous joint repair processes. However, the mechanisms of action of PRP are unknown as are the clinical outcomes in Veterans. Our preliminary data also shows substantial variability between individuals in the biological composition of autologous PRP. In this era of personalized and precision medicine, we propose to examine the outcomes of PRP treatment, and whether individual differences in PRP composition correlate with objective metrics of changes to ambulatory function and cartilage matrix structure following PRP injection treatment for early knee OA in Veterans. Achieving the Aims of this proposal will determine whether intra-articular injection of autologous platelet enriched plasma to treat early knee OA in Veterans and additional women, given within the actual clinical setting, results in positive treatment effects. The information gained will also fill critical knowledge gaps by elucidating potential mechanisms of action for PRP injections in the treatment of symptomatic early knee OA and combining objective scientific assessment (gait analysis and MRI) with standard patient-reported outcomes (PRO). Finally, the new knowledge gained will improve clinical care by informing on factors important to optimal patient selection for this new treatment.