nSTRIDE - Autologous Protein Solution

Resolution Physiotherapy is excited to team up with Orthopaedic Surgeon, Dr. Raaj Vora, who will be offering nSTRIDE intra-articular knee injections with the goal of reducing pain, improving function, and delaying the need for surgical interventions for our clients.

Book with Dr. Raaj Vora 705-252-5200

nSTRIDE is an exciting new treatment developed with the goal of reducing pain, increasing function, as well as slowing the progression of cartilage breakdown and delaying the need for surgery with Osteoarthritis.

The nSTRIDE APS System produces an autologous protein solution (APS), which is designed for the treatment of knee OA and uses the client’s own blood to concentrate anti-inflammatory cytokines and growth factors.

In healthy individuals, there is a steady-state equilibrium between proteins that produce inflammation (pro-inflammatory) and proteins that reduce inflammation (anti-inflammatory). This maintains the structural and functional integrity of the articular cartilage in the knee joint. With Osteoarthritis, an imbalance occurs and there is a higher proportion of pro-inflammatory cytokines which leads to cartilage breakdown and degeneration in the joint. This breakdown leads to the inflammation, pain and reduced function which occurs with Osteoarthritis.

The nSTRIDE APS Kit is a cell-concentration system designed to isolate and concentrate the good anti-inflammatory proteins and growth factors from whole blood so that they can be reintroduced to the knee joint with the goal of altering the biochemisty in the joint.

“Up until now, there have been no OA treatments which have changed the course of the disease.” (Kon 2018)

nSTRIDE is the first interventional treatment for OA that could potentially alter the course of the disease progression (van Drumpt 2016) in addition to significantly reducing pain and improving function for clients with Osteoarthritis.

nSTRIDE is a multi-step process which involves:

Blood is drawn from the client
Blood is placed into the ‘nSTRIDE Separater’ and then is spun using a centrifuge which separates the blood into 3 distinct layers which are red blood cells, white blood cells and platelets. White blood cells are important because they have the anti-imflammatory proteins and platelets are important because they have the growth factors. The anti-inflammatory proteins are theorized to counteract the high ratio of pro-inflammatory proteins which are found in joints that have OA and that lead to degenerative changes.
The white blood cell and platelet layer is then extracted and injected into the ‘nSTRIDE Concentrator’ which uses specialized polyacrimide beads that stimulate the client’s white blood cells to produce significantly more of the good anti-inflammatory proteins. Once this second process is complete, the serum will have a much higher amount of anti-inflammatory proteins (the serum can have up to 1000 times more anti-inflammatory proteins than pro-inflammatory proteins) while still maintaining all the important growth factors. It is this ratio that makes nSTRIDE different from PRP as PRP does not have this higher ratio of anti-inflammatory proteins.
The nSTRIDE processed serum is then reinjected into the joint where studies show is can lead to improved function and 2 or more years of reduced pain. Studies have also shown that bone marrow edema and bone spurring is reduced when compared to the control group at 1 year indicating that this serum may alter the course of the disease by improving the biomechanical balance in the joint.

nSTRIDE APS has been shown to:

Significantly reduce pain associated with Knee OA for up to 2 years with a single injection (70% of those injected experienced a 70% reduction in pain) (Kon 2018, Kon 2017, van Drumpt 2016, King 2016)
Significantly improve function in the knee joint associated with OA (Kon 2018, Kon 2017, van Drumpt 2016, King 2016)
To be safe and effective for patients with mild to moderate OA following a single injection (Kon 2018, Kon 2017, van Drumpt 2016, King 2016)
Protect cartilage in a meniscal-tear model (King 2017)
Stimulate cartilage cell proliferation (Matsuka 2013)
Inhibit pro-inflammatory proteins production and catabolic destruction of cartilage, thereby protecting cartilage tissue (King 2017, Matsuka 2013)
Produce a serus with a much higher ratio of anti-inflammatory to pro-inflammatory proteins (1000:1) so that there is a much higher amount of anti-inflammatory proteins - this balance is theorized to contribute to long-term pain relief due to the “potential disease-modifying properties of APS improving joint homeostasis and cartilage quality” (vanDrumpt 2016)

.

To read more about nSTRIDE, click on the image below to visit Zimmer Biomets information page.

References:

King, William, et al. "Human blood‐based anti‐inflammatory solution inhibits osteoarthritis progression in a meniscal‐tear rat study." Journal of Orthopaedic Research 35.10 (2017): 2260-2268.

King W, van der Weegen W, Van Drumpt R, Soons H, Toler K, Woodell-May J, “White bloodcell concentration correlates with increased concentration of IL-1ra and improvement in WOMAC pain scores in an open-label safety study of autologous protein solution.” Journal of Experimental Orthopaedics. 2016;3:9.

Kon E, Engebretsen L , Peter Verdonk P, Nehrer S and Filardo G. “Clinical Outcomes of Knee Osteoarthritis Treated with an Autologous Protein Solution. A1-year Pilot Double-Blinded Randomized Control Trial. American Journal of Sports Medicine, Oct. 2017.

Kon E, Engebretsen L , Peter Verdonk P, Nehrer S and Filardo G. “Two-year Clinical Outcomes of An Autologous Protein Solution Injection For Knee Osteoarthritis.” ICRS 14th World Congress, presented, 2018.

Matuska, Andrea, et al. "Autologous solution protects bovine cartilage explants from IL‐1α‐and TNFα‐induced cartilage degradation." Journal of Orthopaedic Research 31.12 (2013): 1929-1935.

van Drumpt, Rogier AM, et al. "Safety and treatment effectiveness of a single autologous protein solution injection in patients with knee osteoarthritis." BioResearch open access 5.1 (2016): 261-268.