Does Platelet Rich Plasma Really Work?

By Amy Price PhD

What is Platelet Rich Plasma Treatment (PRP)?


PRP has been around since the 1980s but mostly as an adjunct to surgical or dental procedures. PRP patients have a small amount of their own blood removed and then processed through a centrifuge machine. The high speed rotation separates red blood cells from the platelets. A teaspoon or two of the clear platelet rich concentrate (3 to 10 times that of regular blood) will be returned and injected into damaged areas to catalyze the growth of new cells.

Various methods are now commercially available for preparing PRP and a similar material called “autologous growth factor,” which is PRP plus the white blood cell buffy coat obtained during PRP preparation. As a result, assessment of these strategies in clinical orthopedic practice has accelerated.

The platelet rich mixture can be injected where the area does not normally have a rich blood supply and has the advantage of not triggering a clotting response. Patients are their own donors so there is little risk of rejection, allergy or transmissable infections Some stem cell companies are combining PRP with stem cell therapy to increase healing results. The theory and technique behind PRP is similar to that of Prolotherapy (proliferation therapy). Typically Prolotherapy treatments are offered first, and mostly resolve musculoskeletal problems. When results from traditional Prolotherapy treatments are not adequate, PRP may be employed. PRP and Prolotherapy, are office procedures.

How does PRP therapy help?

The body’s responds to injury by mobilizing platelet cells. Platelets are packed with multiple healing and growth factors which initiate repair while attracting stem cells the bodies built in construction managers. PRP intensifies the body’s healing efforts by delivering concentrated platelets. The technique appears to help regenerate ligament and tendon fibers, which shortens rehabilitation time.

How long will it take?

One to two hours, including preparation and recovery time is the average time for the procedure. Advantages include pain relief and speedy healing without the risk of surgery, Many individuals can return to work right after the procedure.

How often can a person have PRP done?

The norm is three injections within a six-month time frame, two to three weeks apart. Relief is usually recognized after the first or second injection.

What are the expected results?

Initial improvement may be seen within a few weeks, gradually increasing as the healing progresses. Some doctors describe PRP as a growth factor cocktail. MRI images after PRP have shown definitive tissue repair. It seems to work better on soft tissue areas like tendons and ligaments, in bone injury it may even slow healing. Results are donor dependent and certain health conditions such as diabetes, thyroid disease or habits like smoking and heavy drinking may hinder the effectiveness as can hormone deficiencies. Younger patients and athletes have more growth factors resident in platelets so this makes them better overall candidates Research into the effects of platelet-rich plasma therapy has accelerated in recent months, with most doctors cautioning that more rigorous studies are necessary before the therapy can emerge as scientifically proven. Even with a 20-40% failure rate many researchers suspect that the procedure could grow in attractiveness treatment for reasons both medical and financial. PRP is about 2000.00 dollars, stem cell therapy is about 8000.00 per site plus travel, diagnostics, preparation and time whereas surgery is much more expensive with extensive recuperation time. PRP has also been used to augment surgery with promising results.

References

1. Rai B, Oest ME, Dupont KM, Ho KH, Teoh SH, Guldberg RE: Combination of platelet-rich plasma with polycaprolactone-tricalcium phosphate scaffolds for segmental bone defect repair. J Biomed Mater Res A 2007;81:888-899.

2. Sipe JB, Zhang J, Waits C, Skikne B, Garimella R, Anderson HC: Localization of bone morphogenetic proteins (BMPs)-2, -4, and -6 within megakaryocytes and platelets. Bone 2004;35:1316-1322.

3. Kark LR, Karp JM, Davies JE: Platelet releasate increases the proliferation and migration of bone marrow-derived cells cultured under osteogenic conditions. Clin Oral Implants Res 2006;17:321-327.

4. Gruber R, Kandler B, Fischer MB, Watzek G: Osteogenic differentiation induced by bone morphogenetic proteins can be suppressed by platelet-released supernatant in vitro. Clin Oral Implants Res 2006;17:188-193.

5. Ranly DM, McMillan J, Krause WF, Lohmann CH, Boyan BD, Schwartz Z: Platelet-rich plasma: A review of its components and use in bone repair, in Akay M (ed): Encyclopedia of Biomedical Engineering, vol 5. Hoboken, NJ: John Wiley & Sons, Inc., 2006, pp 2804-2815.

6. Ranly DM, Lohmann CH, Andreacchio D, Boyan BD, Schwartz Z. Platelet-rich plasma inhibits demineralized bone matrix-induced bone formation in nude mice. J Bone Joint Surg Am 2007;89:139-147.

7. Schwartz Z, Somers A, Mellonig JT, et al: Ability of commercial demineralized bone allograft to induce bone formation is donor age-dependent but not gender-dependent (abstract). Trans Orthopaed Res Soc 1997;22:230.

8. Weibrich G, Kleis WK, Hitzler WE, Hafner G. Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: A technical report. Int J Oral Maxillofac Implants 2005;20:118-123.

9. Thibault L, Beausejour A, de Grandmont MJ, Lemieux R, Leblanc JF: Characterization of blood components prepared from whole-blood donations after a 24-hour hold with the platelet-rich plasma method. Transfusion 2006;46:1292-1299.

10. Li H, Zou X, Xue Q, Egund N, Lind M, Bunger C: Anterior lumbar interbody fusion with carbon fiber cage loaded with bioceramics and platelet-rich plasma: An experimental study on pigs. Eur Spine J 2004;13:354-358.

11. Weiner BK, Walker M: Efficacy of autologous growth factors in lumbar intertransverse fusions. Spine 2003;28:1968-1970.

12. Muschler GF, Nitto H, Matsukura Y, et al: Spine fusion using cell matrix composites enriched in bone marrow-derived cells. Clin Orthop Relat Res 2003;(407):102-118.

13. Muschler GF, Matsukura Y, Nitto H, et al: Selective retention of bone marrow-derived cells to enhance spinal fusion. Clin Orthop Relat Res 2005;(432):242-251.

14. Brodke D, Pedrozo HA, Kapur TA, et al: Bone grafts prepared with selective cell retention technology heal canine segmental defects as effectively as autograft. J Orthop Res 2006;24:857-866.

15. Murray MM, Spindler KP, Ballard P, Welch TP, Zurakowski D, Nanney LB: Enhanced histologic repair in a central wound in the anterior cruciate ligament with a collagen-platelet-rich plasma scaffold. J Orthop Res 2007;25:1007-1017.

Hip Replacement Alternative

By Amy Price PhD
My husband underwent adult stem cell therapy in hopes of staving off hip replacement. The technique in the USA was in the early stages and his hip degeneration was acute. In the end he underwent bilateral hip resurfacing in the UK. The procedure was successful and gave him his life back. The UK surgeons were most interested in stem cell therapy and they were working on getting stem cells federally funded particularly for revision surgery which happens when the artificial hip wears out after about fifteen years.

It was exciting to learn about six hip patients who underwent a very creative stem cell procedure in Spire Hospital, Southhampton UK. This procedure could prevent thousands of people from needing to have an artificial hip fitted.

Here is a short breakdown on how they are doing this. Surgeons are using the patient’s own stem cells to rejuvenate the affected bone and donor bone to speed the process. The stem cells are extracted from the patient’s pelvis, purified and cultured in an organic mixture that promotes growth. When the cells had multiplied they were mixed with cleaned, ground-up hip bone from other patients who had hips replaced.Surgeon then excised dead tissue from the ball of the hip and filled the cavity with the mixture of stem cells and donated bone.

Professor Richard Oreffo of Southampton University explains that stem cells send out chemical signals to attract blood vessels. "Bone is a living vibrant tissue. These stem cells generate new tissue and drive new blood vessel formation to bring in nutrients," he said.

Dr Dunlop is hopeful that this therapy will fix the hip for life. Early reports look promising with good results in 5 out of 6 study participants. The television footage on this was stunning. One patient who had his procedure a year ago looked like he had never experienced a hip problem.
Scientists and doctors are working together to expand this study and to explore the viability of using artificial bone. This would eliminate the problem of donor generated deficits being passed on although I suspect those already in need of new body parts are happy to take their chances.

This news is hot on the heels of research by scientists in New Jersey USA who have successfully isolated nerve growth factors in mesynchemal stem cells and grown them out as published in the latest issue of the Journal of Neurochemisty. Cell biology and Genetic engineering advances may soon provide real answers for those with untreatable neurodegenerative conditions and even those who have sustained brain injury.
Scientist and doctor teams are now considering how this therapy could be applied to other degenerative conditions.

Predictive Medicine

By Amy Price PhD

Predictive medicine can change our tomorrows today. Regenerative medicine can replace artificial body parts with lab grown technologies while genetic breakthroughs can save families from generations of genetic disability. It is possible that new knowledge of human genetics and cell biology is likely to transform medical practice. Three likely scenarios could evolve:

•Genetics will lead to the classification of diseases on the basis of the underlying genetics or biochemistry, rather than by symptoms alone leading to preventive rather than crisis orientated treatments.
•Genetic information will identify people who are likely to respond to drugs, or to be harmed by them (pharmacogenetics). This is already possible with certain psychotropic drugs on an experimental level but has not trickled down into mainstream medicine.
•Genetic variation will be a new ‘susceptibility factor’, permitting monitoring and early treatment or, perhaps prevention, of an increasing proportion of common, multifactorial diseases, such as coronary heart disease, hypertension, stroke, cancer, diabetes and Alzheimer's disease. Even stress management can be amplified with knowledge of individual genotypes

It is the genetic variation susceptibility factor which is considered to be the change maker for the advent of predictive medicine. This could lead to regenerative medicine on a cellular (somatic) level or even in vitro gene manipulation (germ line therapy) which could prevent intergenerational transfer of genetic disabilities.
Predictive medicine, when it comes, will be based on a much wider use of genetic testing, at present the gap between what the healthcare system is geared up and trained to deliver and what is scientifically viable is huge. For example there are treatments approved for traumatic brain injury that are effective but most be given within a couple of hours of trauma. This can’t happen now because emergency room personnel are not adequately trained or equipped to diagnose MTBI... As with any new technology applied to health in the context of a complex delivery system, implementation is not going to be simple.

First, of course, there needs to be demand from medical personnel and the general public. Typically wide spread change will only take place after the following criteria are established:

•Demonstration of clinical effectiveness and patient safety – through statistically valid clinical trials
•Cost-effective for general use – through economic analysis of trials and other data;
•Standardization of technology, and quality control – generally through outside regulation of suppliers and laboratories;
•Allocation of resources;
•Recruitment and education and training (or retraining) for health workers – including specialists, MDs, nurses, counselors and technicians. For instance a surgeon who makes a good living performing spinal fusions and cervical repairs will need significant convincing, retraining and motivation to become an early adopter of treatment that makes the previous way of doing business obsolete.

Predictive, regenerative medicine may be the wave of the future. History teaches us that the way to greatness is to find a way to serve many. My dream is to witness a generation of scientists and medical professionals join in unity with a foundation of integrity to build a tomorrow for the patients and public who have make their careers possible.

References:

Materials adapted from Open University Course Materials (accessed july,2009)

I Need Stem Cells!

By Amy Price PhD

Adult stem cell viability is on many minds. I have had queries from UN ambassadors to children of only nine asking me about stem cells. The curiousity is international but the questions are the same. People are not sure who to trust and they need stem cells now. Many can not travel to other countries because they are too ill and others lack funding for private stem cell clinics. Some of these feel the FDA or the NHS is unreasonable in thier demands for testing while others feel patient testimonials should be outlawed. My own training is in mental health/psychology so patient to patient information is all I can offer.

I personally like patient testimonials especially when they are accompanied by forums where people discuss how and if the treatment worked and what the hurdles were in getting treatment. I have often learned more from groups of patients with an experience than from professionals with just a theory. Forums are not meant to be professional research, they are peer to peer information only. Google stem cell or regenerative medicine forums and you will get many choices.

I agree clinical trials and time are important to assess treatments but realistically it will be 15 or 20 years before long term results are on the table for clinical trials. There are some companies that have obtained FDA approval for trials, others are listed at clinicaltrials.gov It may be useful to look at this Doctor's description of FDA off label drug use for drugs to understand how the rules were set up and to get an inkling of how this could all translate to cell biology.

My concerns are that engineering any living object is not a simple process and what looks simple from the outside in a needle in/needle out sort of process is very complex from a laboratory perspective and all the answers may not be in. Some clinics are reputable, give good patient care and patients are reporting good long-term results. Some patients are fortunate enough to get into a university sponsored trial that is tied to a major research hospital. Other clinics are still using methods that were proven ineffective many years ago. Patients are vulnerable and need protection sometimes even from themselves. I can no longer count the number of friends I have lost to questionable therapies after spending family fortunes in a quest for a cure. There are no easy answers...

Having said this and knowing from personal experience the agony of chronic unrelenting pain and the sadness of life lost because of disability I would not likely wait until the votes were in but would join in the age old clamor of patients trapped by pain "Just fix me!" The International Society for Stem Cell Research has released guidelines which are helpful to use when considering any new therapy. The PDF is available here

Instant stem cells...Freeze Dried Anyone?

By Amy Price PhD

I recently shared some posts on umbilical cord banking information. Dr Fran Verter of the Parent’s Guide to Cord Blood Foundation shared with us how this works. It seems storage and transport can introduce complications so I wondered what would happen if we eliminated those high tech freezers and freeze dried the stem cells instead. Could they be reconstituted and retain the integrity needed to reproduce?

I located a journal article on Plos One along with others who are using these techniques. Apparently the first generation reproduced DNA accurately which is no surprise as this is a forensics basics but the other portions of the cell needed for healthy growth didn't survive. They are now getting success rates in the 90% range for cells they have reconstituted and then reproduced. The University of Rochester, Image above, is showing some interesting research on using freeze dried cells for bone repair and tissue engineering

This solves a lot of storage problems, should reduce costs and cells could last for years. The ones used in the studies were three years old and over. It is anyone's guess how long this could take to become a viable option for human adult stemcell storage but what a great concept...Stemcells To Go

Your Own Stem Cells Cultured On Contact Lens Can Restore Sight

By Amy Price PhD

“The procedure is totally simple and cheap,” reports UNSW’s Dr Nick Di Girolamo (lead author of research study), “Unlike other techniques, it requires no foreign human or animal products, only the patient’s own serum, and is completely non-invasive. This preliminary trial was conducted on three people, two with extensive corneal damage resulting from multiple surgeries to remove ocular melanomas, and one with the genetic eye condition aniridia. The patient with aniridia had damage in both eyes so stem cells were taken from the conjunctiva area. Because stem cells have not yet differentiated into specific cells they could grow into the cells that were needed. Each patient’s sight improved significantly after only a couple of months

Here is how it works. Less than a millimeter of tissue is taken from the ocular surface of the patients own eye. It takes a couple of hours to prepare the eye and put the contact lens with the baby cells in place and the patient goes home. The stem cells are cultured on a post surgical contact lens which is then placed onto the damaged cornea for 10 days, during which time the cells are able to re-colonise and heal the damaged eye surface. Apparently it took some experimentation to find a lens that could be successfully used as a scaffold for the cells.

The scientists on this research project see this therapy as a simple way to restore sight for eyes damaged by scarring, chemotherapy and a range of other disorders. They suggest that all is needed is a simple lab and qualified medical personnel putting it within reach of even third world countries

Di Girolamo, Nick; Bosch, Martina; Zamora, Katherine; Coroneo, Minas T.; Wakefield, Denis; Watson, Stephanie L. A Contact Lens-Based Technique for Expansion and Transplantation of Autologous Epithelial Progenitors for Ocular Surface Reconstruction. Transplantation, 2009; 87 (10): 1571 DOI: 10.1097/TP.0b013e3181a4bbf2