Osteoarthritis (OA) is the most common form of arthritis. It is a degenerative and chronic disorder associated with damage to the cartilage and surrounding tissues. Characterized by damage and loss of cartilage, OA causes friction between bones, which causes huge pain and disability.

Joints of the knees, hips, back (spine), fingers, thumbs and neck are commonly affected.

The conventional therapies used in the initial phases are analgesics, anti-inflammatories, and chondroprotectives. When pain and dysfunction increase, injections of corticosteroids, hyaluronic acid, and/or PRP (platelet-rich plasma) are prescribed. These treatments may have limitations in the doses that can be delivered, and ultimately, a prosthesis is implanted.

Worldwide, 9,6% of men and 18% of women aged>60 suffer from OA.

Regenerative medicine is the name for the therapies applied to tissue regeneration and organism structure improvement.

The goal of regenerative medicine is to repair damaged tissues using cells, proteins, and/or biomaterials, addressing the disease’s root cause directly, not only symptoms.

Regenerative therapies based on stem cells have proven very promising in the treatment of degenerative diseases related to age. However, more studies are required to widen the field of clinical effectiveness.

Recently, a step forward has been taken in using immune system modulating elements, like cytokines or exosomes. These elements support existing regenerative strategies, such as mesenchyme cells of bone marrow or adipose tissue, and in some cases, they can substitute for them.

Regenerative therapies will be the next medicine revolution.

Cytokines are proteins released by blood cells and platelets. These proteins are messages used by cells to manage different processes.

Several families of cytokines exist, including proinflammatory cytokines, which promote inflammation; anti-inflammatory cytokines, which have the opposite effect; and growth factors*, which stimulate cell proliferation.

Our body works properly when pro-inflammatory, anti-inflammatory and growth factors are balanced, in other words, when homeostasis exists. Even though inflammation is a necessary process of regeneration, this state cannot be prolonged for an extended period since tissues can be damaged permanently, and this would cause cartilage degradation.

Regenerative medicine treatments can be divided into two different groups:

• Mesenchymal stem cells* treatments obtained from bone marrow or adipose tissue. This kind of treatment requires surgery and anaesthesia.

• Treatments with non-substitute products obtained from the patient’s venous blood. These kinds of treatments are outpatient. To get the product, the medical centre must have closed devices; if they are opened, the appropriate equipment must be used to avoid contamination. In this category, the following treatments can be found.
• • Platelet-Rich Plasma and/or growth factors*(PRP)
  • Platelet-Rich Fibrin (PRF)
  • Autologous* Conditioned Serum (ACS).
  • Autologous Protein Solution (APS).
  • Autologous Cytokine Rich Serum (ACRS) obtained by KIT QREM CYTOKINE and QREM DEVICE.

PRP, PRF, ACS, APS, and ACRS are not cell therapies or treatments or advanced medicine therapies. However, they must always be administered under medical prescription and guarantee some quality requirements of production.

PRP is the acronym for Platelet-Rich Plasma. It is a blood-derived product obtained through blood centrifugation, and it contains a high concentration of platelets (between 4 and 6 times normal values). When platelets are activated, they release growth factors that stimulate tissue regeneration.

Platelets can be activated naturally if they come into contact with the body’s activation triggers, or artificially by adding calcium chloride before infiltration. The latter is the most common activation method.

ACS is the acronym for Autologous Conditioned Serum. It is a blood-derived product obtained by incubating blood for 6 hours or more at 37ºC. During this incubation, anti-inflammatory cytokines from leukocytes are released.

APS is the acronym for Autologous Protein Solution. APS contains a high concentration of leukocytes and platelets. The process does not include incubation but requires blood processing with an open system. Part of the leukocytes and platelets are activated during this process, releasing anti-inflammatory cytokines and growth factors. The rest can be activated after injection when contacting coagulation factors produced by the body.

ACRS  is the acronym for Autologous Cytokine Rich Serum. It is a cell-free serum with a balanced concentration of cytokines from plasma, leukocytes and platelets. The ACRS directly contains the active ingredient, cytokines and growth factors. The ACRS is obtained using the KIT QREM CYTOKINE and the QREM DEVICE (with Lab-in-a-box* technology). It is indicated for all treatments in musculoskeletal or dermatological clinical specialities that require platelet byproducts, such as growth factors, cytokines and biological mediators to achieve the stimulation and acceleration of the repair of both soft and hard tissues (including bone). Autologous platelet byproducts can be used for the treatment of:

• Osteoarthritis
• Tendinopathy (lateral epicondylitis, carpal tunnel syndrome, rotator cuff tears, plantar fasciitis, Achilles tendinopathy, and patellar tendinopathy)
• Musculoskeletal soft tissue injuries
• Healing of bone fractures
• Chronic low back pain
• Correction of hypertrophic and atrophic scars
• Chronic wounds that do not heal.