Document Type: RESEARCH PAPER

Authors

1 Department of Biology, Ashrafi Esfahani University, Esfahan, Iran Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, Iran

2 Shahid Sadooghi Hospital, Isfahan, Iran

3 Department of Orthopedic Surgery, AJA University of Medical Sciences, Tehran, Iran

Abstract

Background: Intra-articular injection of Platelet-rich plasma (PRP) is an effective method for the treatment of patients
with knee osteoarthritis (OA). This study aimed to assess the effects of PRP injection on OA, based on gene expression
analysis.
Methods: A sample of 30 subjects with knee OA was asked to complete the Persian versions of the Intermittent and
Constant Osteoarthritis Pain (ICOAP) and Knee and Osteoarthritis Outcome Score (KOOS). Thereafter, the expression
of IGF-1, HIF-1, cartilage oligometric matrix protein (COMP), and bone morphogenetic proteins (BMP2) were compared
in the patient before and 1 month after PRP injection using real-time polymerase chain reaction (PCR).
Results: According to the results of the study, the expression of IGF-1, HIF-1, COMP and BMP2 were reported to be
higher in subjects with PRP injection; however, only the up-regulation of IGF-1 was statistically significant (P<007).
Moreover, the significant change in the KOOS and ICOAP scores was attributed to PRP injection (P<0.01).
Conclusion: Intra-articular injections of PRP were reported to ease the pain, decrease the stiffness, and improve
quality of life in patients with knee OA through the promotion of IGF-1 expression.
Level of evidence: V

Keywords

Main Subjects

1. Murray CJ, Lopez AD. Evidence-based health policylessons
from the Global Burden of Disease Study.
Science. 1996; 274(5288):740-3.
2. Sophia Fox AJ, Bedi A, Rodeo SA. The basic science
of articular cartilage: structure, composition, and
function. Sports Health. 2009; 1(6):461-8.
3. Blagojevic M, Jinks C, Jeffery A, Jordan KP. Risk factors
for onset of osteoarthritis of the knee in older adults:
a systematic review and meta-analysis. Osteoarthr
Cartilage. 2010; 18(1):24-33.
4. Loeser RF. Aging and osteoarthritis: the role of
chondrocyte senescence and aging changes in
the cartilage matrix. Osteoarthr Cartilage. 2009;
17(8):971-9.
5. Anandacoomarasamy A, March L. Current evidence for
osteoarthritis treatments. Ther Adv Musculoskelet
Dis. 2010; 2(1):17-28.
6. Heidari B. Knee osteoarthritis prevalence, risk
factors, pathogenesis and features: part I. Caspian J
Intern Med. 2011; 2(2):205-12.
7. Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi
M, Ghorbani E, Babaee M, et al. Knee osteoarthritis
injection choices: platelet- rich plasma (PRP) versus
hyaluronic acid (a one-year randomized clinical
trial). Clin Med Insights Arthritis Musculoskelet
Disord. 2015; 8(1):1-8.
8. Angoorani H, Mazaherinezhad A, Marjomaki O,
Younespour S. Treatment of knee osteoarthritis
with platelet-rich plasma in comparison with
transcutaneous electrical nerve stimulation plus
exercise: a randomized clinical trial. Med J Islam
Repub Iran. 2015; 29(1):223.
9. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich
plasma therapy-future or trend? Arthritis Res Ther.
2012; 14(4):21929.
10. Pochini A, Antonioli E, Bucci DZ, Sardinha LR,
Andreoli CV, Ferretti M, et al. Analysis of cytokine
profile and growth factors in platelet-rich plasma
obtained by open systems and commercial columns.
Einstein (Sao Paulo). 2016; 14(3):391-7.
11. Ghaffarpassand F, Shahrezaei M, Dehghankhalili M.
Effects of platelet rich plasma on healing rate of long 

bone non-union fractures: a randomized doubleblind
placebo controlled clinical trial. Bull Emerg
Trauma. 2016; 4(3):134-40.

12. van den Dolder J, Mooren R, Vloon AP, Stoelinga PJ,
Jansen JA. Platelet-rich plasma: quantification of
growth factor levels and the effect on growth and
differentiation of rat bone marrow cells. Tissue Eng.
2006; 12(11):3067-73.
13. Mardani M, Kabiri A, Esfandiari E, Esmaeili A,
Pourazar A, Ansar M, et al. The effect of platelet rich
plasma on chondrogenic differentiation of human
adipose derived stem cells in trans well culture. Iran
J Basic Med Sci. 2013; 16(11):1163-9.
14. Middleton KK, Barro V, Muller B, Terada S, Fu FH.
Evaluation of the effects of platelet-rich plasma (PRP)
therapy involved in the healing of sports-related soft
tissue injuries. Iowa Ortho J. 2012; 32(1):150-63.
15. Nirmal RS, Nair PD. Significance of soluble growth
factors in the chondrogenic response of human
umbilical cord matrix stem cells in a porous
three dimensional scaffold. Eur Cell Mater. 2013;
26(11):234-51.
16. Indrawattana N, Chen G, Tadokoro M, Shann
LH, Ohgushi H, Tateishi T, et al. Growth factor
combination for chondrogenic induction from
human mesenchymal stem cell. Biochem Biophys
Res Commun. 2004; 320(3):914-9.
17. Maleki-Fischbach M, Jordan JM. Sex differences in
magnetic resonance imaging-based biomarkers
and in those of joint metabolism. Arthritis Res Ther.
2010; 12(4):212.
18. Kavadar G, Demircioglu DT, Celik MY, Emre
TY. Effectiveness of platelet-rich plasma in the
treatment of moderate knee osteoarthritis: a
randomized prospective study. J Phys Ther Sci. 2015;
27(12):3863-7.
19. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A.
Treatment with platelet-rich plasma is more effective
than placebo for knee osteoarthritis: a prospective,
double-blind, randomized trial. Am J Sports Med.
2013; 41(2):356-64.
20. Hart R, Safi A, Komzak M, Jajtner P, Puskeiler M,

Hartová P. Platelet-rich plasma in patients with
tibiofemoral cartilage degeneration. Arch Orthop
Trauma Surg. 2013; 133(9):1295-301.

21. Dhollander AA, De Neve F, Almqvist KF, Verdonk R,
Lambrecht S, Elewaut D, et al. Autologous matrixinduced
chondrogenesis combined with plateletrich
plasma gel: technical description and a five
pilot patients report. Knee Surg Sports Traumatol
Arthrosc. 2011; 19(4):536-42.
22. Gobbi A, Karnatzikos G, Mahajan V, Malchira S.
Platelet-rich plasma treatment in symptomatic
patients with knee osteoarthritis: preliminary
results in group of active patients. Sports Health.
2012; 4(2):162-72.
23. De Ceuninck F, Caliez A, Dassencourt L, Anract P,
Renard P. Pharmacological disruption of insulinlike
growth factor 1 binding to IGF-binding proteins
restores anabolic responses in human osteoarthritic
chondrocytes. Arthritis Res Ther. 2004; 6(5):R393-403.
24. Dieppe PA, Lohmander LS. Pathogenesis and
management of pain in osteoarthritis. Lancet. 2005;
365(9463):965-73.
25. Hochberg MC, Lethbridge-Cejku M, Scott WM Jr,
Reichle R, Plato CC, Tobin JD. Serum levels of insulinlike
growth factor 1 in subjects with osteoarthritis
of the knee. Arthritis Rheum. 1994; 37(8):1177-80.
26. van der Kraan PM, Blaney Davidson EN, van den
Berg WB. Bone morphogenetic proteins and
articular cartilage: to serve and protect or a wolf
in sheep clothing’s? Osteoarthritis Cartilage. 2010;
18(6):735-41.
27. Verma P, Dalal K. Serum cartilage oligomeric matrix
protein (COMP) in knee osteoarthritis: a novel
diagnostic and prognostic biomarker. J Orthop Res.
2013; 31(7):999-1006.
28. Hoch JM, Mattacola CG, Medina McKeon JM, Howard
JS, Lattermann C. Serum cartilage oligomeric matrix
protein (sCOMP) is elevated in patients with knee
osteoarthritis: a systematic review and meta- analysis.
Osteoarthr Cartilage. 2011; 19(12):1396-404.
29. Clark AG, Jordan JM, Vilim V, Renner JB, Dragomir
AD, Luta G, et al. Serum cartilage oligomeric matrix
protein reflects osteoarthritis presence and severity:
the Johnston County Osteoarthritis Project. Arthritis
Rheum. 1999; 42(11):2356-64.
30. Pfander D, Cramer T, Swoboda B. HIF-1 alpha in
osteoarthritis. Int Orthop. 2005; 29(1):6-9.
31. Yudoh K, Nakamura H, Masuko-Hongo K, Kato T,
Nishioka K. Catabolic stress induces expression
of hypoxia-inducible factor (HIF)-1α in articular
chondrocytes: involvement of HIF-1α in the
pathogenesis of osteoarthritis. Arthritis Res Ther.
2005; 7(4):R904.