Autologous Platelet Therapy
Osteoarthritis is an inflammatory condition–it is just not a neutrophilic inflammation. We know that OA involves increased activity of certain immune cells, increased production of IL-1 and TNF-alpha, and release of many other cytokines and inflammatory proteins from the synovium and cartilage. Platelets contain a large number of growth factors and proteins that modulate inflammation, healing, and the immune system.
There has been a lot of interest in recent years in harnessing the properties of platelets and other blood proteins in order to modulate the inflammatory process and decrease pain associated with osteoarthritis.
The technique of using the animal’s own platelets to treat an injury or arthritic joint is typically called “platelet rich plasma.” However, this terminology may not be quite accurate, because there are some products in which the platelets are not truly “concentrated” compared to peripheral blood. There are other autologous (from the same animal) blood products that isolate certain anti-inflammatory proteins in addition to platelets. So, as a profession we are currently left without the perfect descriptive word to encompass all available blood product therapies. However, I typically still lump all of these products together as “PRP,” even though I recognize that scientifically this is inaccurate. For the sake of this article, please understand that PRP includes products that are not truly concentrated and those that have additional steps in processing.
PRP therapy involves collecting the dog’s own blood and isolating the platelets using a commercially available syringe and centrifuge. Each commercial product has a different collection and processing method, but they can all be done in the hospital (do not need to send out to a lab). The processing generally takes about 20 minutes.
- There are currently 3 products available in the US that have research from clinical trials that show positive results in dogs with OA:
- Autologous Conditioned Plasma (ACP, Arthrex) (Franklin S 2013)
- Autologous Protein Solution (APS) (Pro-Stride, Zoetis) (Wanstrath AW 2016, Franklin S, 2019)
- PALL V-Pet (Vet Stem) (Fahie MA, 2013)
- There are several other PRP products on the market that do not yet have clinical evidence to support their use in dogs with OA. There are no studies comparing the different products, and each product contains a different concentration of platelets, white blood cells, and red blood cells. Pro-Stride contains IL-Receptor antagonist protein (anti-inflammatory protein) in addition to platelets.
There is currently a debate within human and veterinary sports medicine as to the optimal concentration of platelets and WBC (leukocyte-poor vs. leukocyte-rich).
Until clear evidence supports one product over others, we recommend choosing one of the 3 products listed above that have undergone clinical research in dogs.
Studies suggest that clinical effects are seen between 1-3 months after injection. Studies with the APS and V-Pet systems showed significant improvement in weight bearing as measured by force plate (in fact, the degree of improvement was more than is expected with NSAIDs!).
Client-assessed outcomes, using the CBPI, also showed significant improvement. It is currently unknown how long the positive effects last, but repeat injections are likely needed every 6-12 months.
References
Franklin SP, Cook JL. Prospective trial of autologous conditioned plasm versus hyaluronan plus corticosteroid for elbow osteoarthritis in dogs. Can Vet J 2013;54:881-884.
Fahie MA, Ortolano GA, Guercio V, et al. A randomized controlled trial of the efficacy of autologous platelet therapy for the treatment of osteoarthritis in dogs. J Am Vet Med Assoc 2013;243:1291-1297.
Wanstrath AW, Hettlich BF, Su L, et al. Evaluation of a single intra-articular injection of autologous protein solution for treatment of osteoarthritis in a canine population. Vet Surg 2016;45:764-774.
Franklin S. A pilot clinical study assessing treatment of canine hip dysplasia using autologous protein solution. Frontiers Vet Sci 2019.
Arnhold S, Wenisch S. Adipose tissue-derived mesenchymal stem cells for musculoskeletal repair in veterinary medicine. Am J Stem Cells 2015;4:1-12.
Frisbie DD, Kisiday JD, Kawcak CE, et al. Evaluation of adipose-derived stromal vascular fraction or bone marrow-derived mesenchymal stem cells for treatment of osteoarthritis. J Orthop Res 2009.
Black LL, Gaynor J, Gahring D, et al. Effect of adipose-derived mesynchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: A randomized, double-blinded, multicenter, controlled trial. Vet Therapeutics 2007.
Black LL, Gaynor J, Adams C, et al. Effects of intraarticular injection of autologous adipose-derived mesenchymal stem and regenerative cells on clinical signs of chronic osteoarthritis of the elbow joint in dogs. Vet Therapeutics 2008.
Harman R, Carlson K, Gaynor J, et al. A prospective, randomized masked, and placebo-controlled efficacy study of intraarticular allogeneic adipose stem cells for the treatment of osteoarthritis in dogs. Frontiers Vet Sci 2016.
Upchurch DA, Renberg WC, Roush JK, et al. Effects of administration of adipose-derived stromal vascular fraction and platelet-rich plasma to dogs with osteoarthritis of the hip joints. Am J Vet Res 2016;77:940-951.
Kuroki K, Cook JL, Kreeger JM. Mechanisms of action and potential uses of hyaluronan in dogs with osteoarthritis. J Am Vet Med Assoc 2002;221:944-950.
Canapp SO, Cross AR, Brown MP, et al. Examination of synovial fluid and serum following intravenous injections of hyaluronan for the treatment of osteoarthritis in dogs. Vet Comp Orthop Traumatol 2005;18:19-174.
Smith GN, Mickler EA, Myers SL, Brandt KD. Effect of intraarticular hyaluronan injections on synovial fluid hyaluronan in the early stage of canine post-traumatic osteoarthritis. J Rheumatol 2001;28:1341-1346.
Pashuck TD, Kuroki K, Cook CR, et al. Hyaluronic acid versus saline intra-articular injections for amelioration of chronic knee osteoarthritis: A canine model. J Orthop Res 2016; 34:1772-1779.
Carapebe GOL, Cavaleti P, Nicacio GM, et al. Intra-articular hyaluronic acid compared to traditional conservative treatment in dogs with osteoarthritis associated with hip dysplasia. Evidence-Based Comp Alt Med 2016.