Monoshot™ HA+PRP is a combination of hyaluronic acid (HA) with platelet-rich plasma (PRP), intended for intra-articular injection. Product provides simultaneous mechanical and anti-catabolic action of HA with optimally selected physicochemical parameters and the anabolic action of growth factors secreted by platelets from PRP. Thus, clinical effectiveness of the therapy based on Monoshot™ HA+PRP is strictly linked to the combined action provided by each of its component- HA and growth factors released by PLTs.
Monoshot™ HA, with selected optimal viscoelastic properties provides not only the mechanical effect, like improved lubrication and adsorption of forces acting in the joint, but it also offers the antiinflammatory effect by reduction of tissue-degrading enzymes production, such as matrix metalloproteinases¹. On the other hand, PRP obtained with the Monoshot™ PRP separation device is a highly concentrated PLT solution, characterized by platelets concentration way above 1 000 000 PLT/µl- a threshold of a therapeutical effectiveness for PRP². Growth factors secreted by such high number of PLTs in PRP provide a robust anabolic effect, initiating regeneration and rebuilding process of damaged tissues³.
Simultaneous intra-articular injection of HA and PRP delivers the combined and strengthened action of both kit components.

Osteoarthritis (OA) is severe synovial joint degradation disease, characterized with degradation of cartilage, subchondral bone hyperplasia and synovium inflammation. OA leads to serious impairment in joint instability and functional limitations¹. For the past years, number of intraarticular therapies emerged as an effective treatment options for OA patients. Those include two most popular ones- intra-articular injections of HA or PRP.
However, the latest meta-analysis show that simultaneous intra-articular injection of HA and PRP into the OA affected joint can provide a number of biological and mechanical actions, merged in one therapy. This include but is not limited to:

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Monoshot™ HA+PRP kit provides a combined intra-articular injection of HA and PRP in the 4.8 mL volume final volume of the product. In details, the kit contains a pre-filled syringe with a high dose of sodium hyaluronate (95 mg) in 3.8 mL volume, characterized with molecular weight ranging between 1.2-3.2 MDa. Furthermore, Monoshot™ kit contains a particularly efficient separation device that aims to deliver a highly concentrated PRP. This is possible due to the fact that Monoshot™ PRP separation device is made of Makrolon® polycarbonate and is characterized with unique design and construction, allowing the separation and further isolation of a very high number of platelets (PLTs) in the final injectable product. The separation device allows to obtain PLTs concentration way above the threshold of a therapeutical effectiveness stated by PRP definition on 1 000 000 PLT/µl. This is due to ability of Monoshot PRP separation device to concentrate PLTs 7 times more than in patients peripheral blood4. Such effectiveness delivers 1 mL of highly concentrated PRP from 13.5 mL of patient’s peripheral blood. 

Simultaneous intra-articular injection of the HA and PRP will deliver the strengthened and complete therapeutic action of the combined kit components. The vital advantages of Monoshot™ HA+PRP is also its safety as well as simple preparation and administration methods. Moreover, due to bacterial fermentation origin of the HA and the autologous characteristics of PRP, no unintentional immune response can be triggered after the injection of the product and no donor-recipient disease transmission is possible⁶. 

There are also number of practical benefits of the therapy based on Monoshot™ HA+PRP when compared to HA and PRP separate injection. This includes but is not limited to: 

• more economical solution,
• shortened injection procedure, 
• reduced patient’s traumatization.
  

The product is meant to use by medical practitioners only.

1. Pereira, D., Peleteiro, B., Araujo, J., Branco, J., Santos, R. A., & Ramos, E. (2011). The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis and cartilage, 19(11), 1270-1285.
2. Lana, J. F., Weglein, A., Sampson, S. E., Vicente, E. F., Huber, S. C., Souza, C. V., ... & Belangero, W. D. (2016). Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. Journal of stem cells & regenerative medicine, 12(2), 69.
3. Anitua, E., Andia, I., Ardanza, B., Nurden, P., & Nurden, A. T. (2004). Autologous platelets as a source of proteins for healing and tissue regeneration. Thrombosis and haemostasis, 91(01), 4-15.
4. Data on file Biovico / Biovico Research Report Series - Xerthra™ PRP kit – concentration performance test
5. Zhao, J., Huang, H., Liang, G., Zeng, L. F., Yang, W., & Liu, J. (2020). Effects and safety of the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 21(1), 1-12.
6. Guillibert C, Charpin C, Raffray M, Benmenni A, Dehaut FX, El Ghobeira G, Giorgi R, Magalon J, Arniaud D. Single Injection of High Volume of Autologous Pure PRP Provides a Significant Improvement in Knee Osteoarthritis: A Prospective Routine Care Study. Int J Mol Sci. 2019 Mar 15;20(6):1327.

   Since OA is a very complex and at the same time a rapidly progressive disease- involving metabolic, genetic, and biomechanical risk factors, no effective therapies, able to fully cure the disease have been found yet. Nevertheless, modern medicine offers a several intraarticularly injectable products, able to relieve symptoms and finally delay the progression of the disease. From those the most efficient ones are hyaluronic acid (HA) and platelet-rich plasma (PRP) injections- therapies with the highest number of clinical verifications¹.
   HA is one of the major fundamental component of articular cartilage extracellular matrix and synovial fluid. HA is a biopolysacharide- it consists of a number of sugar molecules bonded together into a long chain². HA as a crucial functional element of synovial joint acts as a lubricant, shock absorber, filler and metabolic agent³. Importantly, during OA development the lubricating and shock absorbing abilities of synovial fluid are diminished- mainly by distinctive degradation of naturally produced HA⁴. Thus, clinical data show that viscosupplementation, so intra-articular injection of HA, is scientifically and clinically approved practice for reducing joint pain, improving functional condition of OA-affected joint, protecting cartilage and finally delaying progression of the disease⁵.

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PRP is a concentrated and isolated fraction of the blood, which contains a high amount of platelets (PLTs). In turn, the growth factors released by the PLTs, act as a natural signaling molecules for the cells and tissues and thus provide the necessary molecular information at the injury and damage site. Up to date, more than 300 biologically active molecules were identified in the platelet secretome⁶. Among all, the signaling proteins like growth factors are closely linked with the beneficial effects of the PRP therapy – including platelet derived growth factors (PDGF), transforming growth factor β1 (TGF- β1), insulin-like growth factor 1 (IGF-1), fibroblast growth factor 2 (FGF-2), hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF)⁷ and many more.

One of the crucial effects of PLT-derived growth factors in general can be describes as anti-inflammatory when applied into the OA affected joint. This anti-inflammatory effect lays mainly in the ability of PRP to inhibit the production of proinflammatory cytokines, such as IL-6 and IL-8⁸.

Foremost, PRP with high concentration of PLTs and thus loads of different growth factors has been described as potent modulator of cell metabolism in OA affected joint. Growth factors secreted by the PLTs can induce the production and secretion of articular cartilage tissue extracellular matrix (ECM) components like ACAN, COL2A1 and HA, leading to the elevated biosynthesis of ECM components⁹. By this mechanism PRP will contribute significantly to the increase in regeneration processes of the articular cartilage tissue.

All of the mentioned effects makes the combined injections of HA and PRP a highly recommendable therapy for OA affected joints. Based on recent meta-analysis, the therapy based on combined HA and PRP intra-articular injection was presented as an therapeutically effective against OA with reduction of the level of perceived pain as well as improvement of the joint mobility and physical function more effectively than both preparations administered independently, up to 52 weeks¹⁰.