fibrin and Joint-Diseases

With the aging population, it is clear that the demand for future chronic pain treatment modalities is at an all-time high. One of the newest treatment modalities that is gaining popularity with both practitioners and patients alike is that of regenerative medicine and the use of stem cells to treat chronic painful conditions. This article aims to distill the most recent, available data from both laboratory research and clinical trials to better illuminate the potentials for these therapies in the treatment of chronic pain.. There are numerous investigations underway using mesenchymal stem cells (MSCs) to treat painful, largely degenerative conditions. A large majority of these investigations focus on osteoarthritis of the knee and have demonstrated significantly improved pain scores. Some of these investigations have demonstrated significantly increased articular cartilage and meniscus growth as well as improved function. These studies have been smaller (n, 18) and need to be corroborated on a macrolevel. Platelet-rich plasma (PRP)-based therapies have been most extensively studied in the treatment of knee osteoarthritis. Multiple prospective and randomized trials and meta-analyses have afforded level I evidence in support of PRP's safety and efficacy in chronic knee pain demonstrating both decreased pain (via VAS) and increased functional status (via WOMAC and IKDC). There have been randomized controlled trials examining PRP therapies in treatment degenerative disc disease (intradiscal treatment), facet arthropathy (intra-facet injections), and sacroiliitis (SIJ) which have all yielded similar positive results. Each RTC demonstrated decreased pain scores and increased function but lacks the scale to derive concrete guidelines. Newer investigations are underway examining modified PRP formulas with increased fibrin (PRF) or various growth factors (PRGF) and have shown positive outcomes with respect to osteoarthritic conditions in small trials. Animal trials are underway further investigating these therapies as well as specific gene modulation therapies. This review of the most recent investigations into the application and uses of biologic stem cell-derived treatments for chronic painful conditions should act to illustrate the growing, favorable data for these types of modalities both with respect to pain control and functional improvement.

Topics: Biological Therapy; Chronic Pain; Fibrin; Humans; Intercellular Signaling Peptides and Proteins; Intervertebral Disc Degeneration; Joint Diseases; Mesenchymal Stem Cell Transplantation; Osteoarthritis, Knee; Platelet-Rich Plasma; Sacroiliitis; Zygapophyseal Joint

The use of autologous chondrocyte implantation (ACI) and its further development combining autologous chondrocytes with bioresorbable matrices may represent a promising new technology for cartilage regeneration in orthopaedic research. Aim of our study was to evaluate the applicability of a resorbable three-dimensional polymer of pure polyglycolic acid (PGA) for the use in human cartilage tissue engineering under autologous conditions. Adult human chondrocytes were expanded in vitro using human serum and were rearranged three-dimensionally in human fibrin and PGA. The capacity of dedifferentiated chondrocytes to re-differentiate was evaluated after two weeks of tissue culture in vitro and after subcutaneous transplantation into nude mice by propidium iodide/fluorescein diacetate (PI/FDA) staining, scanning electron microscopy (SEM), gene expression analysis of typical chondrocyte marker genes and histological staining of proteoglycans and type II collagen. PI/FDA staining and SEM documented that vital human chondrocytes are evenly distributed within the polymer-based cartilage tissue engineering graft. The induction of the typical chondrocyte marker genes including cartilage oligomeric matrix protein (COMP) and cartilage link protein after two weeks of tissue culture indicates the initiation of chondrocyte re-differentiation by three-dimensional assembly in fibrin and PGA. Histological analysis of human cartilage tissue engineering grafts after 6 weeks of subcutaneous transplantation demonstrates the development of the graft towards hyaline cartilage with formation of a cartilaginous matrix comprising type II collagen and proteoglycan. These results suggest that human polymer-based cartilage tissue engineering grafts made of human chondrocytes, human fibrin and PGA are clinically suited for the regeneration of articular cartilage defects.

Topics: Absorbable Implants; Aged; Animals; Biomarkers; Cartilage; Cartilage, Articular; Cell Differentiation; Cells, Cultured; Chondrocytes; Fibrin; Graft Survival; Guided Tissue Regeneration; Humans; Joint Diseases; Mice; Mice, Nude; Microscopy, Electron, Scanning; Polyglycolic Acid; Polymers; Regeneration; Tissue Engineering; Tissue Transplantation; Transplantation, Heterologous

Leukocytoclastic vasculitis is defined by histologic features and can be observed in a wide range of entities. Independent of the causative disease, extracutaneous complications are frequent, mainly in the kidneys and gastrointestinal tract. It has been suggested that the severity of histological changes could correlate with the clinical course of the disease. We have therefore compared the severity of histological changes of leukocytoclastic vasculitis to clinical and laboratory findings indicative of extracutaneous involvement in a large group of patients. Among 289 patients followed for cutaneous vasculitis, we included 184 patients with purpuric papules and proven leukocytoclastic vasculitis who all had standardized investigations. A cutaneous biopsy was performed early and standardized laboratory investigations were carried out. The slides were retrospectively randomized and the depth of vasculitis and severity of vascular necrosis were determined according to a semiquantitative scale. These data were compared to the renal, gastrointestinal and articular symptoms using Fischer's exact test, Chi-square test and variance analysis. The intensity of vascular necrosis and the depth of vasculitis were no more severe in patients having renal changes, gastrointestinal involvement or articular symptoms. Both variance analysis and Chi-square tests failed to show a significant increase in the severity score in patients having extracutaneous complications. In this study, the severity of histopathological changes was not predictive of extracutaneous involvement. Thus it appears that the degree of involvement of the cutaneous vessels probably does not correlate with that of vessels in visceral organs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Fibrin; Gastrointestinal Diseases; Humans; Joint Diseases; Kidney Diseases; Male; Middle Aged; Necrosis; Prognosis; Random Allocation; Severity of Illness Index; Skin Diseases, Vascular; Vasculitis, Leukocytoclastic, Cutaneous

The meniscal surfaces from patients with and without inflammatory joint diseases were investigated for the presence of superficially located polymorphonuclear granulocytes (PMNs). In histochemically stained tissue sections as well as in electron microscopic investigations on previously paraffin-embedded menisci, PMNs were observed in cases with inflammatory rheumatoid joint diseases. The inflammatory cells were located in fibrin adhering to the meniscal surface and in the fibrous meniscal tissue just beneath the fibrin. From these observations it is concluded that PMNs in the inflammatory synovial fluid may gain access to the fibrous structures of the joint, thus participating in tissue destruction, as has been assumed from in vitro investigations by other authors.

Topics: Arthritis, Rheumatoid; Fibrin; Humans; Joint Diseases; Menisci, Tibial; Microscopy, Electron; Neutrophils; Staining and Labeling; Synovial Membrane

A study of the use of immunofluorescence of synovial membranes in one hundred cases of various arthropathies reveals the value of the cytoplasmic localization of immune deposits and their type (Ig) in orienting the diagnosis, the influence of therapy, the lack of correlation with optical anatomopathology of synovial tissue (performed on another tissue fragment). Certain recurrent images such as fluorescence of blood vessel walls or the presence of fibrin are of little interest; other such as the cytoplasmic fluorescence of infiltrating cells and particularly, IgG-IgM mixed cellular fluorescence or coupled fluorescence-cellular with Ig and interstitial granular with Ig and C3 orientate the diagnosis to RA. Immunofluorescence appears to be of interest for inflammatory monoarthritis and probable RA. It is less interesting when the etiological context is limited. In addition, a negative immunofluorescent study does not rule out any diagnosis.

Topics: Arthritis, Rheumatoid; Complement C3; Fibrin; Fluorescent Antibody Technique; Humans; Immunoglobulin A; Immunoglobulin E; Immunoglobulin G; Immunoglobulin M; Joint Diseases; Synovial Membrane

In examination of 732 knee joints through the arthroscope since 1961, various types of debris were observed in 47. The debris was classified into four groups: precipitation of fibrin, degeneration and necrosis of villi, desquamation of articular cartilage, and metaplasia of villi. Diseases of the knee joint and their pathogenesis are discussed in the light of these findings.

Topics: Cartilage, Articular; Endoscopy; Fibrin; Humans; Joint Diseases; Knee Joint; Metaplasia; Necrosis

Topics: Adolescent; Adult; Anemia, Sickle Cell; Arthritis; Bone and Bones; Child; Child, Preschool; Erythrocytes, Abnormal; Female; Fibrin; Hemoglobin C Disease; Humans; Infarction; Joint Diseases; Male; Middle Aged; Mucins; Necrosis; Osteoporosis; Radiography; Sclerosis; Synovial Fluid; Synovial Membrane; Thalassemia; Uric Acid

Topics: Aged; Basement Membrane; Endothelium; Female; Fibrin; Fluorescent Antibody Technique; Humans; Joint Diseases; Male; Microscopy, Electron; Middle Aged; Necrosis; Rheumatoid Factor; Scleroderma, Systemic; Staining and Labeling; Synovial Fluid; Synovial Membrane; Viscosity

Topics: Albumins; Blood Coagulation; Blood Protein Electrophoresis; Fibrin; Fibrinolysis; Globulins; Humans; Immunoelectrophoresis; Joint Diseases; Leukocyte Count; Synovial Fluid

Topics: Arthritis, Rheumatoid; Chemistry Techniques, Analytical; Fibrin; Humans; Joint Diseases; Microscopy, Electron; Mucoproteins; Synovial Fluid

Topics: Arthritis; Blood Coagulation; Chronic Disease; Fibrin; Fibrinolysis; Humans; Joint Diseases