title: Elevated CRP level could herald less efficient autologous conditioned serum (ACS) treatment.
abstract: Autologous conditioned serum (ACS) is a biologically based local treatment aiming to influence the cytokine imbalance and is used in a variety of orthopedic diseases and conditions. The ACS contains elevated levels of various anti-inflammatory cytokines, such as IL-1 RA (receptor antagonist), IL-4 and IL-10 and several growth factors. It contains a combination of cytokines and growth factors, and their specific contribution to clinical effects have yet to be determined. Serum conditioned in that specific way does not always have the same content and concentration of the anti-inflammatory cytokines and growth factors. We hypothesize that ACS should not be prepared and administered if elevated C-reactive protein (CRP) levels are present at the moment of obtaining the patient's blood because of the potential detrimental effect of elevated pro-inflammatory cytokines in the same blood, namely IL-1 and TNF. We propose introduction of CRP measuring before any ACS treatment. The cut off value would be set at 5mg/dL as an usual value suggesting inflammation. Avoidance of collecting and administering ACS if elevated CRP is present would potentially eliminate low quality ACS.
authors.affiliation: Clinical Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia.
authors.forename: Kresimir
authors.initials: K
authors.lastname: Crnogaca
authors.affiliation: University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia. Electronic address: gbic@mef.hr.
authors.forename: Goran
authors.initials: G
authors.lastname: Bicanic
authors.affiliation: University of Zagreb School of Medicine, Clinical Hospital Centre Zagreb, Department of Orthopaedic Surgery, Zagreb, Croatia.
authors.forename: Domagoj
authors.initials: D
authors.lastname: Delimar
mesh_terms: D015415:Biomarkers / Q000097:blood; D001804:Blood Transfusion, Autologous / Q000379:methods*; D002097:C-Reactive Protein / Q000032:analysis* / Q000276:immunology*; D016207:Cytokines / Q000276:immunology* / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000276:immunology* / Q000517:prevention & control*; D018448:Models, Immunological; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D016207:Cytokines; D002097:C-Reactive Protein