Biologics

Platelet-Rich Plasma (PRP)
What is PRP?

PRP is an autologous biologic derived from whole blood that is preferentially enriched with platelets and growth factors. It is a commonly used to accelerate the healing of injured tendons, ligaments, muscles and joints.

 

While platelets are the primary component of PRP, preparations may also contain other cellular components such as white blood cells (WBCs) and peripheral stem cells. These components all play a biological role in the healing process and are provided at concentrated levels in PRP. Thus, PRP may help optimize the conditions for healing of bone and soft tissue.

Components of PRP

Platelets - Platelets play a critical role in several aspects of the healing process. Activated platelets express adhesion molecules that support clot formation for hemostasis. They also release several antimicrobial peptides that deliver properties for infection control. Most importantly as it relates to healing, platelets also release chemokines and numerous growth factors, including SDF-1α, PDGF, TGF-β and VEGF, that have been shown to orchestrate key biological processes, including angiogenesis, inflammation resolution and tissue regeneration ¹ ² ³ ⁴

White Blood Cells - WBCs (leukocytes) play a key role in protecting the body from infection and coordinating the inflammatory response. The three primary classes of cells found in the WBC population each provide unique biological functionalities:​

GRANULOCYTES (NEUTROPHILS)

  • The “immediate response” cells for prevention of infection

  • Key mediators of inflammatory response through phagocytosis and release of reactive oxygen species (ROS)

LYMPHOCYTES

  • T-lymphocytes help regulate the function of other immune cells and directly attack various infected cells and tumors

  • B-lymphocytes make antibodies, which are proteins that target unwanted bacteria, viruses and other foreign material

MONOCYTES

  • Assist in pathogen recognition

  • Eventually become macrophages, which engulf and destroy pathogens

Progenitor Cells - Progenitor cells convert to terminal tissue and support angiogenesis. Endothelial progenitor cells also retain the ability to differentiate into other cell types, but to a lesser extent than stem cells ⁵ ⁶

Help Optimize The Conditions For Healing

The concept behind the clinical use of PRP is to harness the natural biological components of a patient’s blood―primarily platelets―which may help optimize the conditions for healing, improve inflammatory response, control infection and promote angiogenesis. ⁷ ⁸ ⁹

Platelets facilitate healing through release of many growth factors actively involved in this process. Thus, PRP offers the physician an alternative to other widespread options, such as steroid or hyaluronic acid injections that provide short-term relief by masking symptoms such as pain and inflammation that are the result of an injury, rather than actually addressing the cause of the injury directly through repair of damaged tissue. ¹⁰ ¹¹ ¹²

Commonly used applications

Because of PRP's ability to optimize the conditions of bone and soft tissue healing, it is commonly used in the following applications:

  • Orthopedics & Sport Medicine

  • Pain Rehabilitation & Pain Management

  • Cosmetic & Aesthetic Medicine 

  • Dentistry

  • Oral & Maxillofacial Surgery

  • Veterinarian

Watch the power of Platelet-Rich Plasma
Not All PRP Preparation Systems Are Equal 

With the rise in popularity of PRP in regenerative medicine, many systems and methods of preparation have been proposed. However, it is important to understand that not all PRP preparations are created equal and therefore may not provide the optimal conditions for healing. 

 

When selecting a PRP system, it is important to consider the following items -

1. Platelet Concentration
  • When more platelets are concentrated in a PRP preparation, more growth factors are delivered to the application site. These growth factors support several key processes, including stem cell recruitment, angiogenesis, cell proliferation and differentiation ¹³.  A platelet concentration of 4x above baseline is the consensus threshold for a solution to be considered Platelet-Rich Plasma.

 

  • Pioneering work by Giusti has determined the most effective concentration of platelets for the stimulation of angiogenesis was 1.5 million platelets/μL ⁷, which is roughly ~6x above baseline. 

  • PRP should not be defined as a plasma fraction of a whole blood sample that has a platelet concentration above baseline. Platelet concentration of <500 x 103/μL supports proliferation (or angiogenesis determinant) no better than platelet poor plasma ¹⁴.

2. White Blood Cells (WBCs)
  • PRP preparations should include the correct composition of WBCs to effectively modulate the healing response. 

  • Leukocyte Poor (LP) - PRP - also known as "Clear" or "Pure" PRP. Removing all WBCs may be desirable for certain indications when clinicians wish to control localized inflammation, such as Intra-articular joint injections.

  • Leukocyte Rich (LR) - PRP - In soft tissue applications, reducing Granulocytes (Neutrophils) and increasing Mononuclear cells (Lympocytes & Monocytes) contributes to the efficacy of a PRP solution ¹⁵.

3. System Technology and Dynamics
  • Technology - PRP preparation systems with an automated double-spin process and platelet separation technology enable both the isolation and concentration of platelets. This increases both platelet capture efficacy and total platelet concentration over single-spin systems ¹⁵.

  • Flexibility - as the science of PRP evolves, clinicians should look towards a PRP system that allows them to effectively modulate the individual components of PRP to provide the optimal solution for their patient. 

  • Sterility - Systems containing injection ports allow clinicians to maintain sterile technique as they can be disinfected between use, unlike luer locks.

Product Information
Harvest Terumo PRP

The Harvest Terumo SmartPrep Platelet Concentrate System was the first commercial, point-of-care system approved for the rapid preparation of Platelet-Rich Plasma (PRP). Excellence in technology and outcomes is why the SmartPrep Platelet Concentrate System is relied upon all over the world to produce highly concentrated Platelet-Rich Plasma with the optimal cellular composition.

References
  1. Tang Y, Yeaman M, Selsted M. Antimicrobial peptides from human platelets. Infect Immun. 2002;70(12):6524-6533.

  2. Drago L, Bortolin M, Vassena C, et al. Antimicrobial activity of pure platelet-rich plasma against microorganisms isolated from oral cavity. BMC Microbiol. 2013:13(47):1-5.

  3. Amable P, Carias R, Teixeira M, et al. Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther. 2013;4(3):67.

  4. Ríos D, López C, Carmona J. Platelet-rich gel supernatants stimulate the release of anti-inflammatory proteins on culture media of normal equine synovial membrane explants. Vet Med Int. 2015;2015:547052.

  5. Jung Y, Song J, Shiozawa Y, et al. Hematopoietic stem cells regulate mesenchymal stromal cell induction into osteoblasts thereby participating in the formation of the stem cell niche. Stem Cells. 2008;26(8):2042-2051.

  6. Kuroda R, Matsumoto T, Kawakami Y, Fukui T, Mifune Y, Kurosaka M. Clinical impact of circulating CD34-positive cells on bone regeneration and healing. Tissue Engineering Part B: Reviews. 2014;20(3):190-199.

  7. Giusti I, Rughetti A, D’Ascenzo S, et al. Identification of an optimal concentration of platelet gel for promoting angiogenesis in human endothelial cells. Transfusion. 2009;49(4):771-778.

  8. El-Sharkawy H, Kantarci A, Deady J, et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78(4):661-669.

  9. Fiore S, Serhan C. Lipoxin A4 receptor activation is distinct from that of the formyl peptide receptor in myeloid cells: inhibition of CD11/18 expression by lipoxin A4-lipoxin A4 receptor interaction. Biochemistry. 1995;34(51):16678-16686.

  10. Dai W, Zhou A, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy. 2017;33(3):659-670.e1.

  11. Cai Y, Zhang C, Lin X. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. J Shoulder Elbow Surg. 2015;24(12):1852-1859.

  12. Fitzpatrick J, Bulsara M, Zheng M. The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. Am J Sports Med. 2016;45(1):226-233.

  13. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114(6):1502-1508.

  14. Kevy, S, Jacobson, M. and Mandle, B., Defining the Concentration and Composition of Platelet-Rich Plasma (PRP). Presented at the North America Platelet-Rich Plasma Symposium, September 9, 2011, Toronto, ON, Canada.

  15. Kevy, S, Defining the Concentration and Composition of Platelet-Rich Plasma (PRP) and Bone Marrow Concentrate (BMAC) for use in Regenerative Medicine. Presented at the Bone Marrow Stem Cell Platelet-Rich Plasma Symposium – The Natural Choice for Optimizing Healing, March 27, 2011, Seoul, Republic of Korea.

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