Platelet-Rich Plasma (PRP) treatment is one of the most cutting-edge and potentially beneficial types of prolotherapy available today.
Prolotherapy is short for "proliferation therapy", which can be described as follows:
- Is an alternative medicine practice
- Is a nonsurgical treatment which stimulates healing
- Is also known as regenerative (injection) therapy
- Works by stimulating the body's own natural healing mechanisms to repair injured musculoskeletal, skin or connective tissues
In this article, we will focus on the use of PRP in regenerative medicine.
Use of PRP in Regenerative Therapies
Regenerative therapy uses a patient's own tissues to initiate the healing process. With PRP, it uses our platelet-rich plasma to initiate the healing in different treatments:
- Topical treatment[13-16]
- Orthopedic treatment[6,27,29-31,33-34,36,39]
- Periodontal treatment
- Cosmetic treatment[11,12]
- Fill (Face, Breast, Gynecologic, Urologic, etc)
- Skin Rejuvenation
- Hair Restoration[11,43]
- Wound Healing (post-laser, surgery, etc)
- Skin graft healing
Growth Factors Released from PRP
Platelets constitute a reservoir of critical growth factors (GFs) and cytokines which may govern and regulate the tissue healing process. The bioactive molecules secreted by platelet α-granules are involved in several cellular activities such as stem cell trafficking, proliferation, and differentiation, with a complex effect on pro/anti-inflammatory and anabolic/catabolic processes.
Moreover, with respect to purified individual GFs, platelets have the theoretical advantage of containing various bioactive molecules with a natural balance of anabolic and catabolic functions, possibly optimizing the tissue environment and favoring the healing process.
Based on this rationale, PRP is an easy, low-cost, and minimally invasive procedure to deliver high concentrations of autologous GFs and cytokines into injured tissues in physiological proportions. This blood-derived product, placed directly into the damaged tissue, either surgically or through injections, has been widely experimented in different fields of medicine.[27-34]
A variety of growth factors can be released from PRP, which could include:[11,12]
- PDGF (Platelet derived growth factor)
- Cell Growth, new generation and repair of blood vessels, collagen production
- FGF (Fibroblast Growth Factor)
- Tissue repair, cell growth, collagen production, hyaluronic acid production
- EGF (Epithelial Growth Factor)
- Promotion of epithelial cell growth, angiogenesis, promotion of wound healing
- VEGF (Vascular Endothelial Growth Factor)
- Growth and new generation of vascular endothelial cells
- TGF-β (Transforming Growth Factor Beta)
- Growth and neogenesis of epithelial cells and vascular endothelial cells, promotion of wound healing
Platelets are very rare as they take up only 0.4% of our blood cells. With the process of PRP harvesting, we can concentrate those platelets in plasma, which we then put platelet-rich plasma in the areas that need regeneration and rejuvenation. Below are the steps of harvesting PRP:
- Collecting blood
- Read the companion article "Heath Effects of Iron Overload and Benefits of Blood Donation"
- By using a centrifuge with proprietary tubes
- Separate the contents of our blood from the plasma and the platelets. Among the platelets, which areas are higher concentration or lower concentration
- One spin technique
- Two spin technique
- Platelet rich fibrin matrix
Among the several variables affecting PRP lysates (or releasates), platelet activation is a crucial step that might influence the availability of bioactive molecules and therefore tissue healing.[35-36]
The term “activation” refers to 2 key processes that are initiated during PRP preparation:
- Degranulation of platelets to release GFs from α-granules
- Fibrinogen cleavage to initiate matrix formation
- A clotting process which allows the formation of a platelet gel, and therefore to confine the secretion of molecules to the chosen site.
- CaCl2 (or Calcium Gluconate)
- Or a mixture of the above
An activation step before PRP administration is included in many of the protocols used, commonly by adding thrombin and/or calcium chloride (CaCl2), but some physicians prefer to inject PRP in its resting form, relying on the spontaneous platelet activation occurring after exposure to the native collagen present in the connective tissues.
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- Platelet-Rich Plasma: Pain Relief for Knee OA (Cleveland Clinic)
- Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review
- The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis
- PRP & Stem Cell Injections
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- Platelet Rich Plasma (PRP) for Facial Rejuvenation and Hair Growth - Dr. Vishad Nabili | UCLAMDCHAT
- To Fill or Not to Fill: Aesthetic Surgery of the Aging Midface | UCLAMDCHAT Webinars
- Sanchez-Avila, R.M., et al., Treatment of patients with neurotrophic keratitis stages 2 and 3 with plasma rich in growth factors (PRGF-Endoret) eye-drops. Int Ophthalmol, 2017.
- Anitua, E., et al., PRGF exerts more potent proliferative and anti-inflammatory effects than autologous serum on a cell culture inflammatory model. Exp Eye Res, 2016. 151: p. 115-21.
- Merayo-Lloves, J., et al., Autologous Plasma Rich in Growth Factors Eyedrops in Refractory Cases of Ocular Surface Disorders. Ophthalmic Res, 2015. 55(2): p. 53-61.
- Alio, J.L., A.E. Rodriguez, and D. WrobelDudzinska, Eye platelet-rich plasma in the treatment of ocular surface disorders. Curr Opin Ophthalmol, 2015. 26(4): p. 325-32.
- Burnouf, P.A., et al., A novel virally inactivated human platelet lysate preparation rich in TGF-beta, EGF and IGF, and depleted of PDGF and VEGF. Biotechnol Appl Biochem, 2010. 56(4): p. 151-60.
- Burnouf, T., et al., A virally inactivated platelet-derived growth factor/vascular endothelial growth factor concentrate fractionated from human platelets. Transfusion, 2010. 50(8): p. 1702-11.
- Burnouf, T., et al., Human blood-derived fibrin releasates: composition and use for the culture of cell lines and human primary cells. Biologicals, 2012. 40(1): p. 21-30.
- Burnouf, T., et al., Solvent/detergent treatment of platelet concentrates enhances the release of growth factors. Transfusion, 2008. 48(6): p. 1090-8.
- Shih, D.T., et al., Expansion of adipose tissue mesenchymal stromal progenitors in serum-free medium supplemented with virally inactivated allogeneic human platelet lysate. Transfusion, 2011. 51(4): p. 770-8.
- Su, C.Y., et al., Quantitative assessment of the kinetics of growth factors release from platelet gel. Transfusion, 2008. 48(11): p. 2414-20.
- Su, C.Y., et al., In vitro release of growth factors from platelet-rich fibrin (PRF): a proposal to optimize the clinical applications of PRF. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009. 108(1): p. 56-61.
- Platelet-Rich Plasma: The Choice of Activation Method Affects the Release of Bioactive Molecules
- When talking about PLTs and their products, a great number of variables have to be considered.
- These variables are mainly related to PRP preparation methods, the type of activators, intra- and inter-species variability, types of pathology to be treated, the ways and times of administration and the association of PRP or PG with other treatments.
- On the basis of this most recent Level I evidence review, PRP results in “significant clinical improvements” in patients with symptomatic osteoarthritis of the knee.