Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy
Background: D-glucose (dextrose) is used as a 5000–25,000 mg% solution in the injection-based pain therapy known as dextrose prolotherapy (DPT). The number of peer-reviewed clinical trials supporting its use is growing. However, the mechanism of action is unknown, limiting further research. A common...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-02-01
|
| Series: | Biomedicines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9059/13/2/350 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849719348276494336 |
|---|---|
| author | Kenneth Dean Reeves Jordan R. Atkins Clare R. Solso Chin-I Cheng Ian M. Thornell King Hei Stanley Lam Yung-Tsan Wu Thomas Motyka David Rabago |
| author_facet | Kenneth Dean Reeves Jordan R. Atkins Clare R. Solso Chin-I Cheng Ian M. Thornell King Hei Stanley Lam Yung-Tsan Wu Thomas Motyka David Rabago |
| author_sort | Kenneth Dean Reeves |
| collection | DOAJ |
| description | Background: D-glucose (dextrose) is used as a 5000–25,000 mg% solution in the injection-based pain therapy known as dextrose prolotherapy (DPT). The number of peer-reviewed clinical trials supporting its use is growing. However, the mechanism of action is unknown, limiting further research. A commonly expressed theory is that hyperosmotic dextrose injection induces inflammation, initiating a healing-specific inflammatory cascade. In vitro study models have used continuous exposure to high concentration dextrose. But the rate of dextrose clearance after intra-articular injection, and, therefore, the duration of exposure of tissues to any particular dextrose concentration, remains unknown. We therefore determined the rate of dextrose concentration diminution in one human participant’s knees after intra-articular dextrose knee injection. Method: In this pre–post N-of-1 study, the first author (KDR), a well 70-year-old male without knee-related pathology, injected his own knees with 30 mL of 12,500 mg% dextrose on three occasions; performed serial aspirations of 1.2 mL of intra-articular fluid from 7 to 360 min post-injection; and assessed synovial dextrose concentration. Dextrose clearance kinetics were determined using Minitab and GraphPad Prism software. Results: Dextrose concentration dropped rapidly in all three trials, approximating an exponential or steep S curve. A third order chemical reaction pattern was found, suggesting factors other than dilution or glucose transporter activity, such as rapid diffusion of dextrose across the synovial membrane, may have contributed to the rapid drop in dextrose concentration. Conclusion: This pre-post N-of-1 study shows that, after intraarticular injection of 30 mL of 12,500 mg% dextrose injection into a well knee, the concentration of dextrose diminished rapidly, suggesting that intra-articular cells, tissue, and anatomic structures are exposed to an initially high dextrose concentration for a very short time. This likely affects the mechanism of action of DPT and should inform in vitro study methods. |
| format | Article |
| id | doaj-art-a80a3dbfb8784936980ea1d4f9cf4d33 |
| institution | DOAJ |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj-art-a80a3dbfb8784936980ea1d4f9cf4d332025-08-20T03:12:10ZengMDPI AGBiomedicines2227-90592025-02-0113235010.3390/biomedicines13020350Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose ProlotherapyKenneth Dean Reeves0Jordan R. Atkins1Clare R. Solso2Chin-I Cheng3Ian M. Thornell4King Hei Stanley Lam5Yung-Tsan Wu6Thomas Motyka7David Rabago8Independent Researcher, Roeland Park, KS 66205, USAMedical School, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USAIndependent Researcher, Mission, KS 66202, USADepartment of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48859, USADepartment of Internal Medicine, Pappajohn Biomedical Institute, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USAThe Hong Kong Institute of Musculoskeletal Medicine, Hong Kong 999077, ChinaDepartment of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 11490, TaiwanDepartment of Osteopathic Manipulative Medicine, School of Osteopathic Medicine, Campbell University, Lillington, NC 27506, USADepartment of Family and Community Medicine, Penn State College of Medicine, Hershey, PA 17003, USABackground: D-glucose (dextrose) is used as a 5000–25,000 mg% solution in the injection-based pain therapy known as dextrose prolotherapy (DPT). The number of peer-reviewed clinical trials supporting its use is growing. However, the mechanism of action is unknown, limiting further research. A commonly expressed theory is that hyperosmotic dextrose injection induces inflammation, initiating a healing-specific inflammatory cascade. In vitro study models have used continuous exposure to high concentration dextrose. But the rate of dextrose clearance after intra-articular injection, and, therefore, the duration of exposure of tissues to any particular dextrose concentration, remains unknown. We therefore determined the rate of dextrose concentration diminution in one human participant’s knees after intra-articular dextrose knee injection. Method: In this pre–post N-of-1 study, the first author (KDR), a well 70-year-old male without knee-related pathology, injected his own knees with 30 mL of 12,500 mg% dextrose on three occasions; performed serial aspirations of 1.2 mL of intra-articular fluid from 7 to 360 min post-injection; and assessed synovial dextrose concentration. Dextrose clearance kinetics were determined using Minitab and GraphPad Prism software. Results: Dextrose concentration dropped rapidly in all three trials, approximating an exponential or steep S curve. A third order chemical reaction pattern was found, suggesting factors other than dilution or glucose transporter activity, such as rapid diffusion of dextrose across the synovial membrane, may have contributed to the rapid drop in dextrose concentration. Conclusion: This pre-post N-of-1 study shows that, after intraarticular injection of 30 mL of 12,500 mg% dextrose injection into a well knee, the concentration of dextrose diminished rapidly, suggesting that intra-articular cells, tissue, and anatomic structures are exposed to an initially high dextrose concentration for a very short time. This likely affects the mechanism of action of DPT and should inform in vitro study methods.https://www.mdpi.com/2227-9059/13/2/350glucoseprolotherapymonosaccharide transport proteins |
| spellingShingle | Kenneth Dean Reeves Jordan R. Atkins Clare R. Solso Chin-I Cheng Ian M. Thornell King Hei Stanley Lam Yung-Tsan Wu Thomas Motyka David Rabago Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy Biomedicines glucose prolotherapy monosaccharide transport proteins |
| title | Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy |
| title_full | Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy |
| title_fullStr | Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy |
| title_full_unstemmed | Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy |
| title_short | Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy |
| title_sort | rapid decrease in dextrose concentration after intra articular knee injection implications for mechanism of action of dextrose prolotherapy |
| topic | glucose prolotherapy monosaccharide transport proteins |
| url | https://www.mdpi.com/2227-9059/13/2/350 |
| work_keys_str_mv | AT kennethdeanreeves rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT jordanratkins rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT clarersolso rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT chinicheng rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT ianmthornell rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT kingheistanleylam rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT yungtsanwu rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT thomasmotyka rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy AT davidrabago rapiddecreaseindextroseconcentrationafterintraarticularkneeinjectionimplicationsformechanismofactionofdextroseprolotherapy |