Platelet-rich plasma

Platelet-rich plasma
Intervention
MeSH D053657

Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains several different growth factors and other cytokines that can stimulate healing of bone and soft tissue. As of 2016, no large-scale randomized controlled trials have confirmed the promise of PRP in basic science and preclinical trials to treat musculoskeletal injuries (including tendinitis, nerve injuries), help in bone grafting or androgenic hair loss.

History

PRP was first developed in the 1970s and first used in Italy in 1987 in an open heart surgery procedure. PRP therapy began gaining popularity in the mid 1990s. It has since been applied to many different medical fields such as cosmetic surgery, dentistry, sports medicine and pain management.

The number of peer reviewed publications studying the PRP 's efficacy has increased dramatically since 2007.[1]

Components

Whole blood placed in Centrifuge prior to two stage centrifugation

The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair.[2] The platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induces the release of the mentioned factors from alpha granules. The growth factors and other cytokines present in PRP include:[2][3]

Preparation

Blood drawn from patient
Removal of PRP after double centrifugation
PRP is Injected into area of injury via ultrasound guidance

As of 2009 there have been two PRP preparation methods approved by the U.S. Food and Drug Administration.[4] Both processes involve the collection of the patient's whole blood (that is anticoagulated with citrate dextrose) before undergoing two stages of centrifugation (TruPRP) (Harvest) designed to separate the PRP aliquot from platelet-poor plasma and red blood cells.[4] In humans, the typical baseline blood platelet count is approximately 200,000 per µL; therapeutic PRP concentrates the platelets by roughly five-fold.[5] There is broad variability in the production of PRP by various concentrating equipment and techniques.[6][7][8]

Clinical applications

In humans, PRP has been investigated and used as a clinical tool for several types of medical treatments, including nerve injury,[3] chronic tendinitis,[9][10] osteoarthritis,[11] cardiac muscle injury,[12] and androgenic alopecia,[13][14] for bone repair and regeneration,[15] in plastic surgery,[16] and oral surgery[17]

PRP has received attention in the popular media as a result of its use in treating sports injuries in professional athletes.[18][19][20][21]

The cost of a PRP treatment in the U.S. has been quoted as $1000 out-of-pocket expenses, as it is usually not covered by health insurance.[21]

Clinical validity

As of 2016 results of basic science and preclinical trials have not yet been confirmed in large-scale randomized controlled trials. A 2009 systematic review of the scientific literature found there were few randomized controlled trials that adequately evaluated the safety and efficacy of PRP treatments and concluded that PRP was "a promising, but not proven, treatment option for joint, tendon, ligament, and muscle injuries".[22]

A 2010 Cochrane analysis on PRP use in sinus lifts during dental implant placement found no evidence that PRP offered any benefit.[17]

As of 2011, PRP use for nerve injury and sports medicine has produced "promising" but "inconsistent" results in early trials.[3]

A 2013 review stated more evidence was needed to determine PRP's effectiveness for hair regrowth.[23]

A 2014 Cochrane analysis for PRT use to treat musculoskeletal injuries found very weak (very low quality) evidence for a decrease in pain in the short term, up to three months and no difference in function in the short, medium or long term. There was weak evidence that suggested that harm occurred at comparable, low rates in treated and untreated people.[24]

A 2016 systematic review and meta-analysis of randomized controlled clinical trials for PRP use to augment bone graft found only one study reporting a significant difference in bone augmentation, while four studies found no significant difference.[25]

Since 2004, proponents of PRP therapy have argued that negative clinical results are associated with poor-quality PRP produced by inadequate single spin devices. The fact that most gathering devices capture a percentage of a given thrombocyte count could bias results, because of inter-individual variability in the platelet concentration of human plasma and more would not necessarily be better.[5] The variability in platelet concentrating techniques may alter platelet degranulation characteristics that could affect clinical outcomes.[3]

Use in horses

Platelet-rich plasma is used in horses for treatment of equine lameness due to tendon and ligament injury, wounds, fractures, bone cysts, and osteoarthritis.

Implications for doping

Some concern exists as to whether PRP treatments violate anti-doping rules.[2] As of 2010 it was not clear if local injections of PRP could have a systemic impact on circulating cytokine levels, affecting doping tests and whether PRP treatments have systemic anabolic effects or affect performance.[2] In January 2011, the World Anti-Doping Agency removed intramuscular injections of PRP from its prohibitions after determining that there is a "lack of any current evidence concerning the use of these methods for purposes of performance enhancement".[26]

According to the Baltimore Sun, Zach Britton had PRP injections in his left shoulder in March 2012, Orioles first baseman Chris Davis underwent two PRP injections to speed the healing and recovery of an oblique injury in April 2014, and Dylan Bundy had the procedure in April before undergoing Tommy John surgery in June 2014.[27]

See also

References

  1. ↑ platelet-rich plasma evidence Results by year graph, PubMed.gov, National Center for Biotechnology Information, U.S. National Library of Medicine, retrieved 23 March 2016
  2. 1 2 3 4 Borrione P, Gianfrancesco AD, Pereira MT, Pigozzi F (2010). "Platelet-rich plasma in muscle healing". Am J Phys Med Rehabil 89 (10): 854–61. doi:10.1097/PHM.0b013e3181f1c1c7. PMID 20855985.
  3. 1 2 3 4 Yu W, Wang J, Yin J (2011). "Platelet-Rich Plasma: A Promising Product for Treatment of Peripheral Nerve Regeneration After Nerve Injury". Int J Neurosci 121 (4): 176–180. doi:10.3109/00207454.2010.544432. PMID 21244302.
  4. 1 2 Arora NS, Ramanayake T, Ren YF, Romanos GE (2009). "Platelet-rich plasma: a literature review". Implant Dent 18 (4): 303–10. doi:10.1097/ID.0b013e31819e8ec6. PMID 19667818.
  5. 1 2 Marx RE (2004). "Platelet-rich plasma: evidence to support its use" (PDF). Journal of Oral and Maxillofacial Surgery 62 (4): 489–96. doi:10.1016/j.joms.2003.12.003. PMID 15085519.
  6. ↑ Dohan Ehrenfest DM, Rasmusson L, Albrektsson T (2009). "Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF)". Trends in Biotechnology 27 (3): 158–67. doi:10.1016/j.tibtech.2008.11.009. PMID 19187989.
  7. ↑ Gonshor A (2002). "Technique for producing platelet-rich plasma and platelet concentrate: background and process". The International Journal of Periodontics & Restorative Dentistry 22 (6): 547–57. PMID 12516826.
  8. ↑ Weibrich G, Kleis WK, Hafner G, Hitzler WE, Wagner W (2003). "Comparison of platelet, leukocyte, and growth factor levels in point-of-care platelet-enriched plasma, prepared using a modified Curasan kit, with preparations received from a local blood bank". Clinical Oral Implants Research 14 (3): 357–62. doi:10.1034/j.1600-0501.2003.00810.x. PMID 12755786.
  9. ↑ Mishra A, Pavelko T (2006). "Treatment of chronic elbow tendinosis with buffered platelet-rich plasma". The American Journal of Sports Medicine 34 (11): 1774–8. doi:10.1177/0363546506288850. PMID 16735582.
  10. ↑ Mishra A, Woodall J, Vieira A (2009). "Treatment of tendon and muscle using platelet-rich plasma". Clinics in Sports Medicine 28 (1): 113–25. doi:10.1016/j.csm.2008.08.007. PMID 19064169.
  11. ↑ Andia I, Sanchez M, Maffulli N (2012). "joint pathology and platelet-rich plasma therapies". Expert Opinion in Biological Therapies 12 (1): 7–22. doi:10.1517/14712598.2012.632765. PMID 22171664.
  12. ↑ Mishra A, Velotta J, Brinton TJ, et al. (2010). "RevaTen platelet-rich plasma improves cardiac function after myocardial injury". Cardiovasc Revasc Med 12 (3): 158–63. doi:10.1016/j.carrev.2010.08.005. PMID 21122486.
  13. ↑ Khatu, Swapna S; More, Yuvraj E; Gokhale, Neeta R; Chavhan, Dipali C; Bendsure, Nitin (2014). "Platelet-Rich Plasma in Androgenic Alopecia: Myth or an Effective Tool". Journal of Cutaneous and Aesthetic Surgery 7 (2): 107–110. doi:10.4103/0974-2077.138352. ISSN 0974-2077. PMC 4134641. PMID 25136212.
  14. ↑ Chaudhari, Nitin D; Sharma, Yugal K; Dash, Kedar; Deshmukh, Palak (2012). "Role of Platelet-rich Plasma in the Management of Androgenetic Alopecia". International Journal of Trichology 4 (4): 291–292. doi:10.4103/0974-7753.111222. ISSN 0974-7753. PMC 3681120. PMID 23766623.
  15. ↑ Griffin XL, Smith CM, Costa ML (2009). "The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review". Injury 40 (2): 158–62. doi:10.1016/j.injury.2008.06.025. PMID 19084836.
  16. ↑ Por YC, Shi L, Samuel M, Song C, Yeow VK (2009). "Use of tissue sealants in face-lifts: a metaanalysis". Aesthetic Plastic Surgery 33 (3): 336–9. doi:10.1007/s00266-008-9280-1. PMID 19089492.
  17. 1 2 Esposito M (Spring 2010). "Effectiveness of sinus lift procedures for dental implant rehabilitation: a Cochrane systematic review.". Eur J Oral Implantol. 3 (1): 7–26. PMID 20467595.
  18. ↑ Alan Schwarz (2009-02-16). "A Promising Treatment for Athletes, in Blood". New York Times (New York).
  19. ↑ Gretchen Reynolds (2011-01-26). "Phys Ed: Does Platelet-Rich Plasma Therapy Really Work?". New York Times.
  20. ↑ Carina Storrs (2009-12-18). "Is Platelet-Rich Plasma an Effective Healing Therapy?". Scientific American.
  21. 1 2 Gina Kolata (2010-01-12). "Popular Blood Therapy May Not Work". New York Times.
  22. ↑ Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009). "Platelet-rich plasma: from basic science to clinical applications". Am J Sports Med 37 (11): 2259–72. doi:10.1177/0363546509349921. PMID 19875361.
  23. ↑ Valente Duarte de Sousa, Isabel Cristina; Tosti, Antonella (May 2013). "New investigational drugs for androgenetic alopecia". Expert Opinion on Investigational Drugs 22 (5): 573–589. doi:10.1517/13543784.2013.784743. ISSN 1744-7658. PMID 23550739.
  24. ↑ Moraes VY (April 2014). "Platelet-rich therapies for musculoskeletal soft tissue injuries". Cochrane Database Syst Rev. 29 (4): CD010071. doi:10.1002/14651858.CD010071.pub3.
  25. ↑ Pocaterra A, Caruso S, Bernardi S, et al. Effectiveness of platelet-rich plasma as an adjunctive material to bone graft: a systematic review and meta-analysis of randomized controlled clinical trials.Int J Oral Maxillofac Surg. 14 March 2016. pii: S0901-5027(16)00072-2. DOI: 10.1016/j.ijom.2016.02.012.
  26. ↑ "World Anti-Doping Agency announces changes to Prohibited List". Irish Medical Times. 2011-01-10.
  27. ↑ Dan Connolly Orioles first baseman Chris Davis receives two PRP injections Baltimore Sun, April 29, 2014
This article is issued from Wikipedia - version of the Thursday, April 28, 2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.