Autologous Protein Solution (nSTRIDE) as a Novel Therapeutic Option in Osteoarthritis: Implications for Clinical Practice

Authors

  • Jihad Abouali, MD, FRCSC Orthopedic Surgeon, Toronto East Health Network, Toronto, ON, Assistant Professor, University of Toronto, Toronto, ON, Medical Director, Push Pounds Sports Medicine, Toronto, ON

DOI:

https://doi.org/10.58931/cpct.2025.3s0253

Abstract

Osteoarthritis (OA) is a disabling disease affecting hundreds of millions of people globally. It develops through a combination of mechanical stress and aging, leading to chondrocyte dysfunction and an imbalance between matrix degradation and synthesis. This imbalance is driven by upregulation of matrix metalloproteinases and pro-inflammatory cytokines. The joint degeneration causes inflammation, pain, limited mobility, and a negative impact on one’s quality of life. There are a variety of treatments for OA, including lifestyle changes, physiotherapy, intra-articular injections, and more invasively, arthroplasty. Common intra-articular injections include corticosteroids, hyaluronic acid (HA), and platelet-rich plasma (PRP).

Author Biography

Jihad Abouali, MD, FRCSC, Orthopedic Surgeon, Toronto East Health Network, Toronto, ON, Assistant Professor, University of Toronto, Toronto, ON, Medical Director, Push Pounds Sports Medicine, Toronto, ON

Dr. Jihad Abouali is an Orthopaedic Surgeon specializing in Sports Medicine, Knee and Shoulder Arthroscopy, and Regenerative Medicine. He earned his Doctor of Medicine and completed his residency in Orthopaedic Surgery at McMaster University. He then went on to complete a fellowship in Sports Medicine at the University of Toronto. He has been invited to present his cutting-edge sports medicine research at numerous national and international conferences. As an Assistant Professor at the University of Toronto and Assistant Clinical Professor at McMaster University, he trains resident physicians and orthopedic surgeons of the future. He is the current team physician for the Scarborough Shooting Stars basketball team, has acted as the team Orthopaedic Surgeon for the Toronto Argonauts and Toronto FC, and has consulted with several other organizations including Canada Basketball senior men’s national team and Canada Soccer women’s senior national team.

References

Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508–e522. doi:10.1016/s2665-9913(23)00163-7 DOI: https://doi.org/10.1016/S2665-9913(23)00163-7

Aboulenain S, Saber AY. Primary osteoarthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Updated 18 Aug 2022. Bookshelf ID: NBK557808.

Ayhan E, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop. 2014;5(3):351–361. doi:10.5312/wjo.v5.i3.351 DOI: https://doi.org/10.5312/wjo.v5.i3.351

McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of Intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. Jama. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283 DOI: https://doi.org/10.1001/jama.2017.5283

American Academy of Orthopaedic Surgeons. Cortisone Shot (Steroid Injection). OrthoInfo [Internet]. 2025: (Accessed 17 August 2025). Available from: https://orthoinfo.aaos.org/en/treatment/cortisone-shot-steroid-injection

European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). ESSKA Orthobiologic Initiative (ORBIT): Consensus Process on Blood-Derived Products [Internet]. 2022: [Updated 25 January 2022, Accessed 17 August 2025]. Available from: https://www.esska.org/news/593282/ESSKA-Orthobiologic-Initiative-ORBIT-Consensus-Process-on-Blood-Derived-Products-.htm.

Ferkel E, Manjoo A, Martins D, Bhandari M, Sethi P, Nicholls M. Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties. CARTILAGE. 2023;14(4):424–432. doi:10.1177/19476035231154530 DOI: https://doi.org/10.1177/19476035231154530

American Academy of Orthopaedic Surgeons (AAOS). Management of Osteoarthritis of the Knee (Non-Arthroplasty): Evidence-Based Clinical Practice Guideline 2021 [Available from: https://www.aaos.org/oak3cpg.

Russo F, D’Este M, Vadalà G, Cattani C, Papalia R, Alini M, et al. Platelet rich plasma and hyaluronic acid blend for the treatment of osteoarthritis: rheological and biological evaluation. PLoS One. 2016;11(6):e0157048. doi:10.1371/journal.pone.0157048 DOI: https://doi.org/10.1371/journal.pone.0157048

Hollister SJ, Murphy WL. Scaffold translation: barriers between concept and clinic. Tissue Eng Part B Rev. 2011;17(6):459–474. doi:10.1089/ten.TEB.2011.0251 DOI: https://doi.org/10.1089/ten.teb.2011.0251

King W, Toler K, Woodell-May J. Role of white blood cells in blood- and bone marrow-based autologous therapies. Biomed Res Int. 2018;2018:6510842. doi:10.1155/2018/6510842 DOI: https://doi.org/10.1155/2018/6510842

Di Martino A, Boffa A, Andriolo L, Romandini I, Altamura SA, Cenacchi A, et al. Leukocyte-rich versus leukocyte-poor platelet-rich plasma for the treatment of knee osteoarthritis: a double-blind randomized trial. Am J Sports Med. 2022;50(3):609–617. doi:10.1177/03635465211064303 DOI: https://doi.org/10.1177/03635465211064303

King W, van der Weegen W, Van Drumpt R, Soons H, Toler K, Woodell-May J. White blood cell concentration correlates with increased concentrations of IL-1ra and improvement in WOMAC pain scores in an open-label safety study of autologous protein solution. J Exp Orthop. 2016;3(1):9. doi:10.1186/s40634-016-0043-7 DOI: https://doi.org/10.1186/s40634-016-0043-7

Wehling P, Moser C, Frisbie D, McIlwraith CW, Kawcak CE, Krauspe R, et al. Autologous conditioned serum in the treatment of orthopedic diseases: the orthokine therapy. BioDrugs. 2007;21(5):323–332. doi:10.2165/00063030-200721050-00004 DOI: https://doi.org/10.2165/00063030-200721050-00004

O’Shaughnessey K, Matuska A, Hoeppner J, Farr J, Klaassen M, Kaeding C, et al. Autologous protein solution prepared from the blood of osteoarthritic patients contains an enhanced profile of anti-inflammatory cytokines and anabolic growth factors. J Orthop Res. 2014;32(10):1349–1355. doi:10.1002/jor.22671 DOI: https://doi.org/10.1002/jor.22671

Clinchy B, Gunnerås M, Håkansson A, Håkansson L. Production of IL-1Ra by human mononuclear blood cells in vitro: influence of serum factors. Cytokine. 2006;34(5-6):320–330. doi:10.1016/j.cyto.2006.06.010 DOI: https://doi.org/10.1016/j.cyto.2006.06.010

Youn C, Pontaza C, Wang Y, Dikeman DA, Joyce DP, Alphonse MP, et al. Neutrophil-intrinsic TNF receptor signaling orchestrates host defense against Staphylococcus aureus. Sci Adv. 2023;9(24):eadf8748. doi:10.1126/sciadv.adf8748 DOI: https://doi.org/10.1126/sciadv.adf8748

Uchiyama R, Toyoda E, Maehara M, Wasai S, Omura H, Watanabe M, et al. Effect of Platelet-rich plasma on M1/M2 macrophage polarization. Int J Mol Sci. 2021;22(5). doi:10.3390/ijms22052336 DOI: https://doi.org/10.3390/ijms22052336

Arnold CE, Gordon P, Barker RN, Wilson HM. The activation status of human macrophages presenting antigen determines the efficiency of Th17 responses. Immunobiology. 2015;220(1):10–19. doi:10.1016/j.imbio.2014.09.022 DOI: https://doi.org/10.1016/j.imbio.2014.09.022

Mantovani A, Sica A, Sozzani S, Allavena P, Vecchi A, Locati M. The chemokine system in diverse forms of macrophage activation and polarization. Trends Immunol. 2004;25(12):677–686. doi:10.1016/j.it.2004.09.015 DOI: https://doi.org/10.1016/j.it.2004.09.015

Woodell-May J, Steckbeck K, King W. Potential mechanism of action of current point-of-care autologous therapy treatments for osteoarthritis of the knee-a narrative review. Int J Mol Sci. 2021;22(5). doi:10.3390/ijms22052726 DOI: https://doi.org/10.3390/ijms22052726

Goldring SR, Goldring MB. The role of cytokines in cartilage matrix degeneration in osteoarthritis. Clin Orthop Relat Res. 2004(427 Suppl):S27–36. doi:10.1097/01.blo.0000144854.66565.8f DOI: https://doi.org/10.1097/01.blo.0000144854.66565.8f

Peña AN, Sommerfeld SD, Anderson AE, Han J, Maestas DR, Jr., Mejias JC, et al. Autologous protein solution processing alters lymphoid and myeloid cell populations and modulates gene expression dependent on cell type. Arthritis Res Ther. 2022;24(1):221. doi:10.1186/s13075-022-02875-x DOI: https://doi.org/10.1186/s13075-022-02875-x

Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G. Clinical outcomes of knee osteoarthritis treated with an autologous protein solution injection: a 1-year pilot double-blinded randomized controlled trial. Am J Sports Med. 2018;46(1):171–180. doi:10.1177/0363546517732734 DOI: https://doi.org/10.1177/0363546517732734

van Drumpt RA, van der Weegen W, King W, Toler K, Macenski MM. Safety and treatment effectiveness of a single autologous protein solution injection in patients with knee osteoarthritis. Biores Open Access. 2016;5(1):261–268. doi:10.1089/biores.2016.0014 DOI: https://doi.org/10.1089/biores.2016.0014

Hix J, Klaassen M, Foreman R, Cullen E, Toler K, King W, et al. An autologous anti-inflammatory protein solution yielded a favorable safety profile and significant pain relief in an open-label pilot study of patients with osteoarthritis. Biores Open Access. 2017;6(1):151–158. doi:10.1089/biores.2017.0027 DOI: https://doi.org/10.1089/biores.2017.0027

Kon E, Engebretsen L, Verdonk P, Nehrer S, Filardo G. Autologous protein solution injections for the treatment of knee osteoarthritis: 3-year results. Am J Sports Med. 2020;48(11):2703–2710. doi:10.1177/0363546520944891 DOI: https://doi.org/10.1177/0363546520944891

Kuwasawa A, Okazaki K, Noda K, Nihei K. Clinical results of autologous protein solution injection for knee osteoarthritis with severe disease grade is inferior to mild or moderate grade. Sci Rep. 2023;13(1):6404. doi:10.1038/s41598-023-33659-1 DOI: https://doi.org/10.1038/s41598-023-33659-1

Van Genechten W, Vuylsteke K, Swinnen L, Martinez PR, Verdonk P. Autologous protein solution as selective treatment for advanced patellofemoral osteoarthritis in the middle-aged female patient: 54% response rate at 1 year follow-up. Knee Surg Sports Traumatol Arthrosc. 2021;29(3):988–997. doi:10.1007/s00167-020-06064-8 DOI: https://doi.org/10.1007/s00167-020-06064-8

Downloads

Published

2025-10-30

How to Cite

1.
Abouali J. Autologous Protein Solution (nSTRIDE) as a Novel Therapeutic Option in Osteoarthritis: Implications for Clinical Practice. Can Prim Care Today [Internet]. 2025 Oct. 30 [cited 2025 Nov. 2];3(s02):2–7. Available from: https://canadianprimarycaretoday.com/article/view/3-s02-Abouali

Issue

Section

Articles