Niemelä Tytti M, Tulamo Riitta-Mari, Aaltonen Kaisa, Sankari Satu M, Hielm-Björkman Anna K
Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.
BMC Vet Res. 2018 Jun 15;14(1):186. doi: 10.1186/s12917-018-1512-2.
Inflammatory and degenerative activity inside the joint can be studied in vivo via analysis of synovial fluid (SF) biomarkers, which are molecular markers of inflammatory processes and tissue turnover. The aim of this study was to investigate the response of selected biomarkers in the SF after an intra-articular (IA) high-molecular-weight non-animal stabilized hyaluronic acid (NASHA) treatment. Our hypothesis was that prostaglandin E (PGE), substance P, aggrecan chondroitin sulfate 846 epitope (CS846), and carboxypeptide of type II collagen (CPII) concentrations in SF would decrease more in the NASHA than in the placebo group. Twenty-eight clinically lame horses with positive responses to diagnostic IA anaesthesia of the metacarpophalangeal or metatarsophalangeal joints were randomized into treatment (n = 15) and control (n = 13) groups. After collection of baseline SF samples followed by IA diagnostic anaesthesia, horses in the treatment group received 3 ml of a NASHA product IA. Those in the placebo group received an equivalent volume of sterile 0.9% saline solution. The horses were re-evaluated and a second SF sample was obtained after a 2-week period.
CS846 concentration decreased in the NASHA group only (P = 0.010). Both PGE and CPII concentrations decreased within the groups (PGE, P = 0.010 for the NASHA group; P = 0.027 for the placebo group; CPII, P < 0.001 for NASHA group; P = 0.009 for placebo group). No significant treatment effect for any biomarker was found between groups. NASHA induced an increase in white blood cell count; this was significant compared with baseline (P = 0.021) and the placebo group (P = 0.045).
Although the SF concentration of the cartilage-derived biomarker CS846 decreased in the NASHA group, no statistically significant treatment effect of any of the biomarkers were observed between treatment groups. The significant increase in SF white blood cell count after IA NASHA may indicate a mild inflammatory response. However, as no clinical adverse effects were observed, we conclude that IA NASHA was well tolerated.
关节内的炎症和退变活动可通过分析滑液（SF）生物标志物进行体内研究，这些生物标志物是炎症过程和组织更新的分子标记物。本研究的目的是调查关节内（IA）注射高分子量非动物稳定化透明质酸（NASHA）治疗后SF中选定生物标志物的反应。我们的假设是，与安慰剂组相比，NASHA组中SF中前列腺素E（PGE）、P物质、聚集蛋白聚糖硫酸软骨素846表位（CS846）和II型胶原羧基肽（CPII）的浓度下降幅度更大。28匹对掌指关节或跖趾关节的IA诊断性麻醉有阳性反应的临床跛行马被随机分为治疗组（n = 15）和对照组（n = 13）。在采集基线SF样本并进行IA诊断性麻醉后，治疗组的马IA注射3 ml NASHA产品。安慰剂组的马接受等量的无菌0.9%盐水溶液。对马进行重新评估，并在2周后获取第二份SF样本。
仅NASHA组的CS846浓度下降（P = 0.010）。两组内PGE和CPII浓度均下降（PGE，NASHA组P = 0.010；安慰剂组P = 0.027；CPII，NASHA组P < 0.001；安慰剂组P = 0.009）。两组之间未发现任何生物标志物有显著的治疗效果。NASHA导致白细胞计数增加；与基线相比有显著性差异（P = 0.021），与安慰剂组相比也有显著性差异（P = 0.045）。
虽然NASHA组中软骨衍生生物标志物CS846的SF浓度下降，但各治疗组之间未观察到任何生物标志物有统计学上显著的治疗效果。IA注射NASHA后SF白细胞计数显著增加可能表明有轻度炎症反应。然而，由于未观察到临床不良反应，我们得出结论，IA注射NASHA耐受性良好。
