Autologous Conditioned Plasma (ACP) and Osteoarthritis of the Knee: A Review of Current Clinical Evidence

The primary objective of this study is to record the clinical outcomes of autologous conditioned plasma (ACP) for the treatment of knee osteoarthritis (OA) based on published literature. Multiple databases (PubMed, Embase, Web of Science and Scopus) were searched using terms for "knee OA" and the intervention "ACP" for articles published in English to January 4, 2024. All clinical studies using ACP for knee OA were included. Studies not utilizing ACP alone, i.e. used as an adjunct with other modalities or not focusing on the management of knee OA, were excluded. Five studies, three randomized controlled trials (RCTs) and two real-world post-market studies conducted in a clinical practice met the inclusion/exclusion criteria and were included in this study. All studies demonstrated statistically significant improvements in various patient-reported outcome measures (PROMs), however the studies performed in the clinical practice reported non-accomplishment of minimally clinically important difference (MCID). The results demonstrated the potential of ACP for management of knee OA, however the MCID was not achieved in real-world clinical settings. Thus, more adequately powered RCTs with longer follow-up as well as real-world post-market studies are warranted to establish long-term efficacy and justify routine clinical use, respectively, of ACP in patients suffering with knee OA.

Can Platelet-Rich Plasma Reduce the Burden of Inflammatory Skin Diseases Such as Psoriasis and Atopic Dermatitis?

Objective In this study, our aim was to investigate the clinical effects of platelet-rich plasma (PRP) on the skin of patients suffering from plaque psoriasis or atopic dermatitis. Methods Over a period of 53 months, we treated a total of 40 patients for inflammatory skin diseases with PRP. All of these patients were included in this study; 5-6 ml of PRP were prepared with the autologous-conditioned plasma (ACP) double syringe and injected subdermally. Follow-ups were conducted at three, six, nine, and 12 weeks after treatment. Besides the lesion size, Psoriasis Area and Severity Index (PASI) and Eczema Area and Severity Index (EASI) were also calculated. Data were evaluated statistically at a significance level of p≤0.05. Results A total of 30 patients were treated for plaque psoriasis. The elbow area represented the most common area of treatment (17 cases). The average lesion size decreased from 8.2 cm² to 0.3 cm² (p<0.00001). Of note, 80% of all patients achieved complete remission (PASI100) at the last follow-up. The remaining 20% reached at least PASI70. Ten patients were treated for atopic dermatitis. In six cases, efflorescences on patients' arms were treated, and in four cases, patients' legs were treated. The average lesion size decreased from 8 cm² to 0.155 cm² (p<0.00001). Notably, 50% of all patients achieved complete remission (EASI100) at the last follow-up. The other half reached at least EASI70. In all cases, the lesion size decreased progressively. No adverse events were reported. Conclusion Our study revealed encouraging results for both psoriasis and atopic dermatitis. The autologous treatment was safe and effective in all patients. Further studies are required to validate these initial findings.

Successful Treatment of Alopecia Areata Barbae with Platelet-rich Plasma

Alopecia areata (AA) is a frequent autoimmune disorder in which inflammatory cells attack the hair follicles. AA affecting the beard area is well known and is referred to as alopecia areata barbae (AAB) when involvement is limited exclusively to the beard. Currently, no guidelines are established for specific therapeutic approaches for this condition. We present a case of a healthy 30-year-old male suffering from AAB. Three injections of platelet-rich plasma (PRP) with six-week intervals were applied. Stabilization of the condition was noted at the first follow-up (before the second injection), initial minimal hair regrowth was noted at the second follow-up (before the third injection) and robust regrowth at the one-year follow-up. To our knowledge, this case is the first report of a successful treatment of AAB using PRP. PRP represents a new, safe and potentially effective treatment option for AAB. More studies will be necessary to determine the efficacy of this treatment compared to conventional therapy.

Platelet-rich Plasma for Skin Rejuvenation and Treatment of Actinic Elastosis in the Lower Eyelid Area

Background

Treatment of the lower eyelid region to rejuvenate the skin or treat actinic elastosis often proves difficult. Established treatment options, such as hyaluronic acid injections, botulinum toxin injections, microneedling, skin resurfacing (microdermabrasion, chemical peel (exfoliation), laser treatment), as well as blepharoplasties and autologous fat transfers, can be associated with significant risks and increased patient burden. Furthermore, they may not be effective for treating the signs of skin aging or actinic elastosis, including dark rings under the eyes, a lack of volume and cutis laxa. A minimally invasive treatment approach which visibly improves the above-mentioned conditions and which involves minimal risk and patient burden would be a desirable alternative.

Materials & methods

Twenty patients were treated a total of three times at monthly intervals with PRP (platelet-rich plasma). The patients were examined on the days of treatment and one month after the third injection. The PRP was obtained directly prior to treatment using the Arthrex ACP double syringe at the point of care. The injections (2 ml PRP per side) were administered laterally using 27 G 38 mm cannulas. Accurate photographic documentation and skin elasticity measurements using a cutometer were performed to objectify the subjective assessments from the patient and practitioner questionnaires.

Results

A progressive improvement in the esthetic outcome and a high level of patient satisfaction were determined. The cutometer measurements showed a statistically significant higher level of skin firmness (due to increased collagen production) and a statistically significant increase in skin elasticity (thanks to increased elastin production). Other than the anticipated visible swelling directly after the PRP injection, no other undesirable side effects or complications occurred. The typical burning sensation during the injection had not been reported.

Conclusion

The results indicate that a series of PRP injections in the lower eyelid region is a safe, efficient, virtually pain-free, simple and rapid treatment option for an area with otherwise limited treatment alternatives.

A novel antimicrobial and remineralizing toothpaste containing CaCl₂/chitosan microspheres

PURPOSE

To investigate the feasibility of exploiting amorphous calcium phosphate (ACP) formed in situ from chitosan calcium microspheres and phosphate ions in water during brushing for caries control.

METHODS

A prototype toothpaste, namely Chi-ACP paste, was specially formulated containing CaCl₂/chitosan microspheres. The efficiency of Chi-ACP paste for remineralization on human tooth enamel was evaluated via an in vitro pH cycling approach. After 15 demineralization/remineralization cycles, the treated teeth were analyzed using scanning electron microscope (SEM) /energy dispersive X-ray spectroscopy (EDX), and polarized light microscope (PLM).

RESULTS

EDX analysis showed the treated enamel in the Chi-ACP paste group had statistically significantly higher calcium content and Ca/P weight ratios than those in the negative control group, while the MI plus group had a slightly higher Ca content and a slightly higher Ca/P weight ratio. PLM analysis revealed that the Chi-ACP paste group had a larger remineralization band in treated enamel than the negative control group, although there was no statistically significant difference on the demineralization depths in the enamel among the three groups.

CLINICAL SIGNIFICANCE

Antibacterial chitosan could be used to encapsulate CaCl₂ and then formulated into toothpaste for caries control through in-situ formed amorphous calcium phosphate (ACP) during brushing.

Crystal structure of FabZ-ACP complex reveals a dynamic seesaw-like catalytic mechanism of dehydratase in fatty acid biosynthesis

Fatty acid biosynthesis (FAS) is a vital process in cells. Fatty acids are essential for cell assembly and cellular metabolism. Abnormal FAS directly correlates with cell growth delay and human diseases, such as metabolic syndromes and various cancers. The FAS system utilizes an acyl carrier protein (ACP) as a transporter to stabilize and shuttle the growing fatty acid chain throughout enzymatic modules for stepwise catalysis. Studying the interactions between enzymatic modules and ACP is, therefore, critical for understanding the biological function of the FAS system. However, the information remains unclear due to the high flexibility of ACP and its weak interaction with enzymatic modules. We present here a 2.55 Å crystal structure of type II FAS dehydratase FabZ in complex with holo-ACP, which exhibits a highly symmetrical FabZ hexamer-ACP3 stoichiometry with each ACP binding to a FabZ dimer subunit. Further structural analysis, together with biophysical and computational results, reveals a novel dynamic seesaw-like ACP binding and catalysis mechanism for the dehydratase module in the FAS system, which is regulated by a critical gatekeeper residue (Tyr100 in FabZ) that manipulates the movements of the β-sheet layer. These findings improve the general understanding of the dehydration process in the FAS system and will potentially facilitate drug and therapeutic design for diseases associated with abnormalities in FAS.

Insect seminal fluid proteins: identification and function

Seminal fluid proteins (SFPs) produced in reproductive tract tissues of male insects and transferred to females during mating induce numerous physiological and behavioral postmating changes in females. These changes include decreasing receptivity to remating; affecting sperm storage parameters; increasing egg production; and modulating sperm competition, feeding behaviors, and mating plug formation. In addition, SFPs also have antimicrobial functions and induce expression of antimicrobial peptides in at least some insects. Here, we review recent identification of insect SFPs and discuss the multiple roles these proteins play in the postmating processes of female insects.

Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children

BACKGROUND

Clinicians observe that advanced cancer patients with dependent children agonize over the impact their death will have on their children. The objective of this study was to determine empirically whether advanced cancer patients with and without dependent children differ in treatment preferences, mental health, and end-of-life (EOL) outcomes.

METHODS

Coping with Cancer is a National Cancer Institute/National Institute of Mental Health-funded, multi-institutional, prospective cohort study of 668 patients with advanced cancer. Patients with and without dependent children were compared on rates of psychiatric disorders, advance care planning (ACP), EOL care, quality of their last week of life, and location of death.

RESULTS

In adjusted analyses, patients with advanced cancer who had dependent children were more likely to meet panic disorder criteria (adjusted odds ratio [AOR], 5.41; 95% confidence interval [95% CI], 2.13-13.69), more likely to be worried (mean difference in standard deviations [delta], 0.09; P=.006), and more likely to prefer aggressive treatment over palliative care (AOR, 1.77; 95% CI, 1.07-2.93). Patients with dependent children were less likely to engage in ACP (eg, do not resuscitate orders: AOR, 0.44; 95% CI, 0.26-0.75) and had a worse quality of life in the last week of life (delta, 0.15; P=.007). Among spousal caregivers, those with dependent children were more likely to meet criteria for major depressive disorder (AOR, 4.53; 95% CI, 1.47-14) and generalized anxiety disorder (AOR, 3.95; 95% CI, 1.29-12.16).

CONCLUSIONS

Patients with dependent children were more anxious, were less likely to engage in ACP, and were more likely to have a worse quality of life in their last week of life. Advanced cancer patients and spousal caregivers with dependent children represent a particularly distressed group that warrants further clinical attention, research, and support.