Regenerative medicine

Platelet-Rich Plasma - What is PRP?

Platelet Rich Plasma or PRP is a volume of plasma of autologous blood having a platelet concentration above the baseline (baseline for platelets in a human are 150,000 – 350,000 platelets per microliter). Platelets facilitate healing by stimulating the release of different growth factors. The growth factors recruit stem cells that facilitate healing, repair, or regeneration of the injured tissue. PRP is injected directly into injured tissue stimulating a healing response in a more powerful form.

Understanding PRP

The main components of blood are Red Blood Cells (carry oxygen from the lungs and deliver it to the body tissues), White Blood Cells (form our immune system and help the body to fight infection and foreign materials), Platelets and Plasma.

Platelets normally circulate within the blood stream and are responsible for blood clotting and initiating a healing response in an acute injury. Platelets have several functions, they help control bleeding (hemostasis), they help in the building of new tissue (act as scaffold for tissue regeneration called Extra Cellular Matrix or ECM), stem cell attraction and binding, without platelets undifferentiated stem cells would not know what to transform into until growth factors are released from the platelets, finally platelets divide, multiply and differentiate to become the healing cells for injured tissue. Platelets are activated by Thrombin and other factors which cause a change in their structure and the release of multiple growth factors. These growth factors bind themselves to the receptors of the cell causing intracellular changes down to the nucleus and affecting its DNA. The result is a change in the performance and function of the cell.

Application of PRP

PRP can be used in Surgical Procedures, Orthopaedics, Spine, MSK, Pain Management, Urology, Maxillofacial, Cardio, Aesthetics and other specialties. Platelets are the natural healing element for any damaged tissue. Delivery of the PRP can be injected or sprayed on the injured or damaged area. 

Ultrasound or fluoroscopy is recommended to be used in MSK or any injection of PRP where the injured area can't be visualised. Studies have shown that using ultrasound or fluoroscopy will increase the accuracy of delivering the PRP to the injured tissue.  

Risks associated with PRP treatments 

• Pain from the injections

• Skin redness, haematoma

• Muscle pain

• Joint pain

• Pain in the treated area lasting one to two weeks

• Infection

Number of treatments

How patients respond to treatment varies; in most cases 1-3, in some cases up to 6 treatments are necessary. 4-6 weeks should elapse between two treatments. There is no limit to the maximum number of treatments, and the probability of side effects does not increase with the number of injections.

Rehabilitation

PRP treatment helps to rebuild the tendons and ligaments, but it is not an immediate help. The intervention stimulates the growth and regeneration of ligaments and tendons, which requires time and rehabilitation. After the treatment, patients may feel mild to moderate pain at the injection site. In the two weeks following the intervention, it is recommended to only gradually load the limb, overexertion must be avoided. Starting physiotherapy as soon as possible is important and will further enhance the effectiveness of the PRP therapy.

Steroid injections

According to research, steroid injections can weaken tissues in the long term. Steroid injections can temporarily reduce pain and reduce inflammation, but they do not aid in healing. Platelet-rich blood plasma treatment heals and strengthens tendons and ligaments, making them up to 40% stronger and thicker in some cases.

Contraindications for PRP

Absolute Contraindications:

• Platelet dysfunction syndrome

• Critical thrombocytopenia

• Hemodynamic instability

• Septicemia

• Local infection at the site of the procedure 

Relative Contraindications:

• Consistent use of NSAIDs within 48 hours of procedure

• Corticosteroid injection at treatment site within 1 month

• Systemic use of coriticosteroids within 2 weeks

• Regular smoking

• Recent fever or illness

• Cancer- especially hematopoetic or of bone

• Chronic Liver Pathology

• Hypofibrinogenaemia

• HGB < 100 g/L

• Platelet count < 105 10*9/L 

Not all PRP systems are the same

Give your patient the best and only use a validated regenerative system. The stem cell and PRP protocol developed by APEX Biologix is approved by the US Food and Drug Administration (FDA). With the recommended preparation protocol, 6 to 9 times platelet concentration is achievable and the clinical quality of the product is guaranteed.

The platelet number in the PRP is essential

A certain number of platelet and growth factor concentration is needed for clinical efficacy. According to the Nature publication in 2021, ‘an absolute count of 10 billion platelets is crucial in a PRP formulation to have long sustained chondroprotective effect up to one year in moderate knee OA’. This quantity can only be made from larger amounts of blood. More blood means more platelets in the PRP. From 60 mL blood, 6 to 8 mL PRP can be produced having the necessary concentration.

Stroma cells or also known as: mesenchymal stem cells (MSC)

Mesenchymal stem cells (MSCs) are undifferentiated cells capable of self-renewal and differentiating into other types of cells. Stem cells can stimulate the recovery of damaged tissue, the formation of cartilage, tendons, ligaments, bones and fibrous connective tissue.

At the site of hematopoiesis in adulthood, in the bone marrow, we find the heterogeneously composed bone marrow stroma (which, in addition to hematopoietic cells, provides the microenvironment essential for their functioning). Multipotent stem cells, from which all the cell types of the stroma (the structural or connective part of a tissue or organ) can develop, are called mesenchymal stem cells or stromal stem cells. Cell types of the stroma can be:

• chronodcytes - cartilage generation (chondrocytes, cartilage generation),

• osteoblasts - bone formation (osteoblasts, bone formation),

• adipocytes - fat tissue (adipocytes, adipose),

• myocytes - muscle tissue (myocytes, muscle),

• endothelial cells - vascular system, circulation (endothelial cells), and

• fibroblasts - connective tissue (fibroblasts).

MSCs can have both anti-inflammatory and pro-inflammatory effects, enabling the treatment of a wide range of immune system disorders and inflammatory diseases.

Bone marrow-derived MSCs (BM-MSCs) are considered the best cell source and serve as a standard for comparing MSCs from other sources (e.g. adipose tissue) [Ullah I. et al., Human mesenchymal stem cells - current trends and future prospective, Bioscience Reports, 2015].

Stem cell therapy from bone marrow aspirate  

From a therapeutic point of view, the most promising of tissue stem cells seems to be the MSCs: these cells can be easily isolated and cultured - in addition to bone marrow, they can also be obtained from many other easily accessible tissues of mesenchymal origin, such as adipose tissue - and appear surprisingly plastic in in vitro and in vivo experiments .

The clinical application of MSCs can be basically attributed to their four key biological properties:

• after tissue damage, they can enter the inflammatory sites (during the injection),

• they can differentiate into several cell types, including cartilage, muscle, bone, connective tissue and fat cells,

• various bioactive molecules are secreted, thereby stimulating the regeneration of damaged cells,

• they suppress inflammation and have immunomodulating ability.

Because of the characteristics of bone marrow-derived MSCs, they play an important role in regenerative medicine. Its main features are:

• easy isolation from bone marrow without immunological problems, possibility of in vitro breeding within a short period of time,

• its biological durability with minimal loss of effect at the point-of-care,

• no serious side effects can be detected during autologous or allogeneic therapies.

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