Chahla et al 2019 (NSAIDS)
Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) consists of blood plasma with higher concentrations of platelets and leukocytes than typically available in a normal blood draw, and is commonly used to treat musculoskeletal injuries through regenerative processes in the body. Oftentimes, concentrations of platelets and leukocytes are highly variable in a given therapeutic sample, as well as the methods of preparing that biological product and the demographic characteristics from which the blood sample was drawn. All these factors, and more, contribute to the outcomes observed in clinical settings.
In this published study, Chahla and colleagues seek to investigate the effects of a nonsteroidal anti-inflammatory drug (NSAID), Naproxen, on the healing process elicited by LR-PRP and if the amount of time necessary to “wash out” NSAIDs from the system is sufficient to restore the healing processes affected by NSAID use. Researchers observed catabolic and anabolic biological factors in healthy subjects at three different timepoints: baseline, after 1 week of pharmacologic intervention, and after a 1 week washout period. These methods were used to evaluate and quantify the effects of NSAIDs on biological factors elicited in LR-PRP therapeutic models. Biological factors of key interests included anabolic factors, such as Platelet-derived Growth Factors (PDGF), Fibroblast Growth Factor 2 (FGF-2), Vascularized Endothelial Growth Factor (VEGF), and catabolic factors, such as interleukin 1-beta (IL-1beta), IL-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha).
From a total of 19 healthy volunteers, 15 subjects completed the study (7 women and 8 men). Biological variability in LR-PRP was present between subjects at the onset of the study. Researchers identified a negative association between age and levels of FGF-2, IL-1beta, and TNF-alpha at baseline, and a negative association between BMI and levels of VEGF at baseline. However, baseline variability between gender categories was unremarkable.
After 1 week of pharmacologic intervention with NSAIDs, Chahla and colleagues observed diminished levels of catabolic and anabolic factors in LR-PRP in healthy individuals. Subsequently, anabolic factors PDGF-AA and PDGF-AB isoforms returned to normal levels along with catabolic factor IL-6 following a 1 week washout period, as recommended prior to surgical interventions. However, researchers did not observe significant changes in anabolic factors (VEGF and FGF-2) nor catabolic factors (IL-8, IL-1beta, and TNF-alpha) throughout the three distinct time points. Therefore, Chahla and colleagues concluded that NSAID use may influence biological factors in LR-PRP, by which effects recover to near baseline after one week of discontinued use in a short-term intervention. Recommendations acknowledge the need for follow-up studies to evaluate the biological profiles in healthy subjects versus patients with a history of long-term NSAID use, by which “characterizing the biological profiles of PRP will allow a more targeted scientific approach to studying the mechanistic effects of PRP on various tissue types.” This study is figuratively the tip of the iceberg as a conceptual basis for understanding the effects of NSAIDs on these biological profiles.
Congratulations to TOBI Faculty, Dr. Jorge Chahla and his team of researchers for getting published in the Journal of Arthroscopic and Related Surgery, and breaking the ice on such an insightful topic on the influences of NSAIDs on biological factors in LR-PRP, and ushering in evidence-based practices. Check out the full article at https://www.ncbi.nlm.nih.gov/pubmed/30472018