Precision Assessment of Platelet Rich Plasma for Joint Preservation

该项目解决了退伍军人管理局的关键临床需求。进行性膝部疼痛 关节退变和最终的骨关节炎(OA)是导致残疾的主要原因， 尤其是在退伍军人中，他们受到OA影响的频率更高，年龄更小 比一般人要多。膝骨性关节炎是一种进行性疾病， 目前的治疗是姑息性的，直到关节完全破坏和假肢膝关节 执行替换。可的松注射剂已经被广泛使用了60多年 多年治疗疼痛和肿胀，但也显示出对关节的不利影响 软骨。这带来了临床上对改善关节疼痛的注射疗法的高度需求。 和功能，同时保持软骨健康，特别是在那些早期疾病的人 有大量剩余关节软骨的地方。最近，关节内 自体富含血小板血浆(PRP)注射被认为是一种有前途的 治疗膝骨性关节炎的新疗法，不仅能缓解症状，而且还能 潜在地促进生长因子以刺激内源性关节修复过程。 然而，PRP的作用机制尚不清楚，临床结果也不清楚。 退伍军人。我们的初步数据还显示，在 自体PRP的生物学成分。在这个个性化和精确化的时代 医学方面，我们建议检查PRP治疗的结果，以及是否 PRP构成的个体差异与变化的客观指标相关 PRP注射治疗后患者的步行功能和软骨基质结构 退伍军人的早期膝骨性关节炎。实现这项提案的目标将决定是否 关节腔内注射自体富血小板血浆治疗早期膝关节骨性关节炎 退伍军人和其他女性，在实际临床环境中给予，结果为阳性 治疗效果。获得的信息还将通过以下方式填补关键的知识空白 PRP注射剂治疗慢性阻塞性肺疾病的可能作用机制 有症状的早期膝骨性关节炎并结合客观科学评估(步态分析 和MRI)，具有标准的患者报告结果(PRO)。最后，新的知识 Gain将通过告知对最佳患者至关重要的因素来改善临床护理 这种新疗法的选择。

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.