A New Approach to Treating Chronic Osteomyelitis

  For more than 100 years, the people of Jiaotong University have used their knowledge and wisdom to create fruitful achievements and write many “firsts” in modern history. This is the wisdom of cultivating talents, scientific research, serving the society and fighting for the glory of the country. News.com has launched the column of “Jiaotong University Wisdom” to focus on the light of wisdom of Jiaotong University people and show the significant contributions made by Jiaotong University people to national development and social progress. Recently, a study showed that plasma gel prepared from autologous whole blood, rich in leukocytes and platelets, can not only promote bone tissue and soft tissue regeneration, but also have significant antibacterial effects, and can be used in combination with antibiotics to effectively treat chronic osteomyelitis. This research has been published in the Journal of Orthopaedic Research, a leading orthopaedic journal, and is included in its recently published “China Album”.  Chronic osteomyelitis is an infection of bone tissue characterized by progressive osteonecrosis and dead bone formation. The gold standard of clinical treatment is strict surgical debridement, elimination of dead bone spaces, adequate soft tissue coverage, and four to six weeks of intravenous antibiotic therapy. However, chronic osteomyelitis tends to be more extensively resistant to traditional antibiotics during treatment, making it not only more difficult to cure but also more expensive to treat with a higher recurrence rate, and patients often suffer. To address the multi-drug resistance due to systemic antibiotic administration, antibiotic chain beads, including bone cement and biodegradable materials, are increasingly used in the local treatment of osteomyelitis. Indeed, topical administration of antibiotics increases antibiotic concentrations and reduces systemic toxicity. However, bone cement as a foreign body requires secondary surgical removal after antibiotic release. The anti-infective effect of biodegradable materials, on the other hand, is more controversial and more expensive. Leukocyte- and platelet-rich plasma gel (L-PRPgel) is a thrombin-stimulated concentrate derived from autologous blood by centrifugation and is rich in leukocytes and platelets. Since L-PRP can promote bone and soft tissue repair, and is derived from autologous, non-immune rejection, simple to produce, and has little damage to the organism, it has been applied to a variety of disciplines in the last decade or so, such as orthopedics, oral and maxillofacial surgery, cardiothoracic surgery, neurosurgery, obstetrics and gynecology, ophthalmology, otorhinolaryngology, general surgery, and plastic and cosmetic surgery. Especially in Europe and America, L-PRP has been widely used. A large number of clinical studies have reported that the application of L-PRP can accelerate fracture healing, promote wound repair, reduce intraoperative anesthetic dose, reduce intraoperative bleeding and postoperative wound exudation, reduce pain, reduce postoperative complications, shorten hospitalization days, and help promote postoperative functional recovery, etc.  In this study, we investigated the therapeutic effects of L-PRP gel on methicillin-resistant Staphylococcus aureus osteomyelitis in a rabbit model, focusing on the efficacy of L-PRP gel in antibacterial and antibacterial inhibition and promotion of bone regeneration by comparing with the control group (no therapeutic measures), vancomycin group (treated with vancomycin intravenously after debridement), L-PRP gel group (treated with leukocyte- and platelet-rich plasma gel locally after debridement), and the control group (treated with vancomycin intravenously after debridement). When comparing the L-PRP gel + vancomycin group (localized treatment with L-PRP gel injection + vancomycin intravenous injection after debridement), the L-PRP gel + vancomycin group (localized treatment with L-PRP gel injection + vancomycin intravenous injection after debridement) was significantly more effective than the other three groups in terms of infection clearance and bone defect repair, and had the best efficacy.  In this study, it was found that platelets and leukocytes in platelet-rich plasma were 7.2 times and 5.0 times higher, respectively, than in whole blood. And both platelets and leukocytes play an important role in host defense. In L-PRP gels, platelets can release a variety of growth factors upon activation by thrombin. All of these growth factors have a pro-angiogenic effect, and the new blood vessels promote the transport of antibiotics and the clearance of bacteria. These growth factors can likewise promote new bone formation to destroy the dead space formed after debridement (dead space can promote the persistence of infection). By promoting vascular regeneration and bone regeneration effects, L-PRP gel may indirectly achieve anti-infective efficacy.  The anti-infective and immunomodulatory effects of leukocytes in L-PRP gel have been confirmed by several experiments. leukocytes, especially neutrophils, can release a large number of antimicrobial peptides like platelets, and with the combined assistance of various proteins and peptides, leukocytes can play a significant bactericidal and antibacterial role. In addition to their antibacterial effects, activated leukocytes can also release large amounts of growth factors, which play an important role in promoting vascular regeneration and tissue regeneration.  The study showed that L-PRP gel combined with the use of antibiotics can play a significant antibacterial effect, and its role in promoting bone regeneration helps it to be effective in the treatment of bone defects caused by osteomyelitis debridement, which provides a new and effective solution for the treatment of chronic osteomyelitis. It is reported that the research group will do further exploration and actively promote the clinical application of L-PRP gel in the treatment of chronic osteomyelitis.