One of the main things that causes many people cosmetic distress and low self esteem is acne scarring. Most of us have some kind of experience when it comes down to scarring, but the most embarrassing scars are the ones that are out in the open. Such as on our faces. So what can Platelet Rich Plasma do for this?
Well, both the Department of Dermatology, Venereology, and Leprosy, as well as the National Institutes of Medical Sciences have indicated that it can be used as a viable treatment for eliminating scars. One study, done by the Department of Dermatology, Venereology, and Leprosy, sought to evaluate just how effective and safe PRP therapy can be, especially when combined with microneedling. Microneedling has been a common treatment on its own for acne scars, using distilled water, for a long time.
The way that Microneedling works is that it is used to initiate collagen synthesis on the face, thus allowing the skin to heal itself. What it does is cause micro injuries to the skin of the face using small needles. However, since the needles are so small and fine, that it does not cause any serious injury. The initiation transmits electrical signals, which calls on the body to begin a healing process, by causing small inflammation and bringing growth factors to the area.
This healing process causes new blood cells to form, and thus helps to remove the scarring over time. General treatment times are known to take from just a couple of weeks up to a year in many cases. 50 patients were involved in this study, all aged 17-32, and all suffering from acne scars.
On one side of the face, they used regular distilled water combined with the microneedling procedure, and on the right they used a topical solution of PRP. After 3 treatments giving withing the time span of a 3 months, each treatment being 1 month apart, the results that used PRP was much more likely to show improvement over the distilled water group. This would be 62.2% improvement vs 45.8% respectively. This showed that PRP can have great success in managing acne scars, and helping to make them go away.
This shows that when it comes to PRP therapy, the science again shows that there is a good and significant use for it. So what is stopping you from implementing this therapy for your patients?
Despite what the name may imply, not all people who suffer from Tennis Elbow even play tennis. In fact, most of them aren’t. Many of them can be painters, butchers, plumbers, carpenters, and even much any career which can overuse the muscles in the forearm. This can cause the tendons elbow to become painful and inflamed.
The most common treatment for Tennis Elbow after the injury has taken place is rest, anti-inflammatory medicines, and generally physical therapy if it is needed. However, this is more of a temporary fix than a longstanding one. In many cases, if untreated, the pain will worsen, and many need things such as braces for their arm, injects of steroids, and shock wave therapy. Sometimes, although not often, they might even need surgery.
Most insurance companies are able to cover this surgery, as it is deemed medically necessary. However, it does not always end up with the best results. On occasion, surgery may even leave you in more pain than you were in before, potentially causing the need for more surgeries.
So as an alternative for surgery, perhaps try PRP, or Plasma Rich Platelet Therapy? This is a pretty simple procedure that utilizes the platelets and cells in your own body to heal your arm from the inside out. We just take out a bit of your blood, put it in a centrifuge, and extract the PRP to use on your injury. After awhile, it become good as new, without any need for surgery. It also does not need any anti-inflammatory medications, which can lower the side effects that you will see from medications and multiple surgeries.
So try it out if you would like a more holistic way of healing yourself.
In popular media, the term Regenerative Medicine, or Stem Cell Therapy, are becoming buzz words. This is because the field of medicine and healthcare is expanding and advancing every day, and many new treatments for otherwise common ailments are being discovered. These conditions range from burns, joint pain, strain, and pretty much every other common ailment out there
Many patients have given up hope with trying to find traditional medicines that work. This is why many people are flocking to try Regenerative Medicine. This is also something that many people who are into holistic healing are trying, as it is simply the body working to heal itself.
Regenerative Medicine works as it takes a sample of your own blood, bone marrow, and other tissues, and then it goes through a process in which to take out a certain material known as Platelet-Rich Plasma. This PRP is then applied to the infected area, so that your body’s own platelets can work to heal your body back to full health, without having to worry about any invasive surgeries.
A good question to ask is why our body does this do this itself. Well, this is because research has shown that by isolating them, they activate, and as a result when injected back into the body start to work harder to fix the issues, such as in a joint, or helping to relieve pain. Many patients who try it say they have gotten good results from the treatment.
Many doctors predict that this therapy will help physicians provide a more non-intrusive treatment that has fewer side effects, and can be big within the coming years. Many compare it to the invention of penicillin with how important it is. It is even growing in popularity with many physicians using training courses to help their patients, leaving many of them happier and healthier.
Fact: According to research, PRP treatments are one of the most in-demand treatments available in healthcare.
This is impressive considering the following.
PRP is not supported by the medical industry. No big pharma funding on extensive research or marketing. No medical associations lobbying to increase its awareness.
PRP is shunned by the insurance companies. No reimbursements from them. So getting patients to pay is difficult. Especially for a treatment that’s relatively “unproven” like this.
The cost of PRP treatments are actually rising. In 2006, you can get a PRP treatment for $450. Today it costs $800. The cheapest we’ve seen is $650. The prices are still robust as demand keeps up.
However, we believe the best of PRP is not even here yet. We’re just one breakthrough study away from exploding into mainstream hospitals and clinics. We see the biggest growth in Platelet-Rich Plasma happening in Asia.
Strongly based on fundamental healing theory
The growth can be attributed to PRP’s fundamental healing property. More platelets. More growth factors and cytokines. And therefore more healing. It’s as simple as that. And no one can argue this fact.
Our body’s natural healing mechanism operates with 150,000/ul-350,000/ul platelets in blood. Using Platelet-Rich Plasma means this number is amplified by 3X to 5X. How can this be not translated into better healing?
Believe it or not, the best orthopedic doctors use Platelet-Rich Plasma. And do so regularly.
PLATELET-RICH PLASMA TRENDS
PRP can be used to promote healing of injured tendons, ligaments, muscles, and joints, can be applied to various musculoskeletal problems. And they conduct regular studies to test it’s effectiveness.
One landmark study involved double-blind randomized controlled trials to see the effect of PRP on patients with chronic low back pain caused by torn discs. The study outcome says 60% of the patients felt significant improvements.
Some were cured. CURED!
Platelet-Rich Plasma Variants
So far, there are the following type of PRP variants.
Plasma Rich in Growth Factors (PRGF)
Plasma Rich in Platelets and Growth Factors (PRPGF)
Platelet-Rich Plasma (PRP); Platelet Poor Plasma (PPP)
Plasma Rich in Platelets and Rich in Leukocytes (LR-PRP)
Plasma Rich in Platelets and Poor in Leukocytes (LP-PRP)
Platelet-Rich Fibrin Matrix (PRFM)
All of them involve Plasmapherisis — the two stage centrifugation process to separate platelets from blood. However, what happen what happens after that can be different. And the industry hasn’t found it’s middle ground as to which variant to be standardized. We believe the confusion will clear up in 3-5 years.
PLATELET-RICH PLASMA TRENDS
No matter which variant you end up using, the bio-factors at play are the following:
Growth factors: TGF-B, PDGF, IGF-I,II, FGF, EGF, VEGF, ECGF
Adhesive proteins: Fibrinogen, Fibronectin, Vitronectin, Thrombospondin-1
Clotting & Anti-Clotting factors: Proteins, Antithrombin, Plasminogen, Proteases, Antiproteases
How Platelet-Rich Plasma Actually Work
Why is the treatment commonly used for wound healing and pain management? The answer is because the platelets’ main job is to aid coagulation, act as a biological glue and support stem or primary cell migration. In addition, it also helps in restoring hyaluronic acid and accelerates the synthesis of collagen and glycosaminoglycans and increases cartilage matrix.
Not only that, the platelets are delivered in a clot which means it can immediately act as a scaffold to enable the healing process. 95% of the bio-active proteins are released within 1 hour of injecting Platelet-Rich Plasma. The platelets continue to release growth factors for 7-10 days. Thus it’s recommended to re-inject PRP every 7 days.
PLATELET-RICH PLASMA TRENDS
Why are patients coughing up their hard earned money for this?
This reminds me of hundreds of thousands of PRP treatments paid from patient’s own pocket even though they’ve been paying for years to get covered by their respective insurance provider. In 2015, PRP costs were anywhere between $600 and $800 per site per treatment. And most patients go for repeated treatments. So why were they forking up their hard earned money if the treatment was not working? Weren’t there any better alternatives under the “coverage” of their insurance provider? The answer is 1) the treatment works. 2) there’s nothing else out there that’s as natural and side-effect-free as PRP.
Consider the case of osteoarthritis. 27 millions Americans are impacted by it. 33.6% of people older than 65 are victims. All of them experience gradual degeneration of cartilage and bones — they lose roughly 5% cartilage per year. Yet, our medical industry doesn’t have a fix to stop it.
However, when doctors started doing PRP treatments for their osteoarthritis patients, they found a large majority of them had no further cartilage loss.
To me, it means we should make PRP treatments the default first-line treatment for osteoarthritis across the country.
Another huge market is hair loss and cosmetic facial applications. I know there are many people who believe PRP doesn’t work for hair. Here’s what one of the Platelet-Rich Plasma studies found were the effect of the treatment on hair loss.
“Hair loss reduced and at 3 months it reached normal levels. Hair density reached a peak at 3 months (170.70 ± 37.81, P < 0.001). At 6 months and at 1 year, it was significantly increased, 156.25 ± 37.75 (P < 0.001) and 153.70 ± 39.92 (P < 0.001) respectively, comparing to baseline. Patients were satisfied with a mean result rating of 7.1 on a scale of 1-10. No remarkable adverse effects were noted.”
I’ll take that.
That’s me getting PRP for hair. ??
PLATELET-RICH PLASMA TRENDS
PRP market is expected to hit $126 million in 2016
That number looks paltry. But that’s an 180% increase over the 2009 figure of $45 million.
Consider this. Just for osteoarthritis alone, if all the 27 million Americans receive 1 PRP shot a year at a conservative $400 per treatment, it would be a market of $10 billion. And that’s one condition out of the many that Platelet-Rich Plasma injections are proven to work.
Another condition that PRP is known to work very well is Tennis Elbow. It affects on average 1% to 3% of the overall population. That number is as high as 50% among tennis players.
Do the math.
Just getting Platelet-Rich Plasma covered by insurance will unleash the market big time and will help heal millions of patients naturally, more effectively.
Oh ya, that means the insurance companies will have to pay more. Why would they?
HOWEVER, if this treatment could reduce further expensive intervention like surgery then it may actually be a blessing for the insurance guys in terms of savings. One surgery avoided by a patient through right intervention through PRP treatments will save the insurance companies at least $25,000. Now, that’s a win-win for both patients and insurance.
I believe it’s a matter of time before insurance companies start realizing their folly of not supporting this treatment.
PLATELET-RICH PLASMA TRENDS
After all is said and done, it’s still “unproven”
The problem with PRP is that it can be used for just about everything, which is a good problem to have until health care officials (and insurance companies) start realizing that people are going to misuse it.
So it’s classified as unproven. The VAST scope of the treatment calls for urgent structure and guidelines. There are some 20+ conditions where researchers have found it “helps” in one way or another. It’s a daunting task to prove its efficiency in all the areas. Nevertheless, we’ll get there.
Though we’ll need a lot of funding for that.
And yes, we need to standardize the procedure. As well as come up with optimized protocols for each conditions. Someone need to take initiative on that. We’re counting on independent doctors and medical institutions. The big pharma won’t jump in because what’s in it for them, right?
It’s so simple, you’d be an idiot to not try it.
You only need a vacuum blood harvesting tube like what we offer here, a centrifuge with adapter for the tube, pipettes and 10ml ampules of 10% calcium chloride.
The only complexity comes from not following a standard PRP system. Because the final platelet count can depend on a variety of factors. Like initial volume of blood, the technique used and relative concentration of WBC and/or RBC. As well as on the patient’s side, there are factors such as age, growth factor and WBC content.
However, concentration-wise, there’s little confusion as once a sufficiently high range is reached, more doesn’t have any adverse or enhancing effect — it saturates at a certain point. So that’s the minimum. Once you reach that, you’re good. Although the outcome is not always guaranteed to be same, with the right number of platelets, platelet activation and cytokine release, you can get a consistency in your PRP offerings.
There’s still some uncertainty over the number of injections, the timing and delivery method of Platelet-Rich Plasma. But with wide-spread adoption, some kind of structure will emerge.
Let’s hope the first glimpses of it will arrive this year.
Do you know in 2015, the world saw approximately 1 million knee arthroplasties for osteoarthritis? At $25,000 apiece, $25 billion.
How many of these patients had the good fortune of their doctor recommending PRP early on?
Yep, it’s Platelet-Rich Plasma. There has been numerous speculations about which one among the latest Platelet-Rich family was the greatest—is it the plasma or the fibrin or even latest the A-fibrin? That confusion is somewhat over now.
Platelet-products are known to facilitate angiogenesis, hemostasis, osteogenesis, and bone growth. But see, the only reason plasma can do that is because of the growth factors it carries. Let’s review the specific roles of these growth factors in the healing process.
Growth Factors In Platelet-Rich Plasma
These are growth factors that are traditionally known to have played a vital healing role in PRP. If you’re seeing your patients get better as a result of that injection you gave, these are guys you need to thank for.
Platelet-Derived Growth Factor (PDGF): Regulates cell growth and division. Especially in blood vessels. In other words, this guy is the reason the blood vessels in our body reproduces.
Transforming Growth Factor Beta(TGF-b): Responsible for overall cell proliferation, differentiation, and other functions.
Fibroblast Growth Factor (FGF): Plays a vital role in the wound healing process and embryonic development. Also behind the proliferation and differentiation of certain specialized cells and tissues.
Vascular Endothelial Growth Factor: Responsible for vasculogenesis and angiogenesis. Restores oxygen supply in cells when inadequate. It also helps create new blood vessels after injury.
Keratinocyte Growth Factor (KGF): Found in the epithelialization-phase of wound healing. In other words, it causes the formation of epithelium immediately after a wound or injury occurs.
Connective Tissue Growth Factor: Major functions in cell adhesion, migration, proliferation, angiogenesis, skeletal development, and tissue wound repair.
These growth factors are what enables a Platelet-Rich product in tissue regeneration.
Platelet-Rich Plasma Rules
However, this new study suggests Platelet-Rich Plasma and it’s gelled cousin Platelet-Rich Fibrin both differ in the release of these growth factors which can significantly affect the healing outcome.
Here’s the takeaway:
“The advantage of PRP is the release of significantly higher proteins at earlier time points whereas PRF displayed a continual and steady release of growth factors over a 10-day period.”
Some argue that PRP enriched with large number of growth factors (a portion of it may even be excess) produce short-term effect and so is less desirable than a PRF whose release is slower and thus more beneficial in the long run.
That being said, PRF do have some advantage over PRP. Mainly:
It doesn’t need thrombin and anticoagulants.
It results in better healing due to its slow polymerization process.
And it helps in hemostasis.
How Platelet-Rich Plasma Differs From Platelet-Rich Fibrin
Platelet-Rich Plasma is a result of double spin method — a hard spin to separate red blood cells from everything everything else in the autologous (or whole) blood and a soft spin to separate the platelets and white blood cells. The result is Platelet-Rich Plasma (PRP), Platelet-Poor Plasma (PPP) and Red Blood Cells.
PRF is a newer method. Here after the first centrifugation, the middle layer is taken—which contains less platelets but more clotting factors. This gradually forms into a fibrin network and traps in the cytokines. It is then centrifuged in a PRF centrifuge resulting in PRF, a fibrin layer containing platelets and plasma.
What Matters In Healing
Obviously, when it comes to accelerating healing, immediate availability of growth factors and cytokines matter. So I believe PRP does a better job in this than PRF. Also the immediate release of growth factors for PRP means we can repeat the PRP injections for more healing factors just days after initial injection.
Platelet-derived products are in it’s infancy now. However, considering the huge potential benefits, there’s still a lot more research to be done. How about you? Which of these do you find beneficial?
If you’re a physician using any or both of these, do write to us and let us know of your experiences. Use the contact form here.
Almost all sports medicine doctors would agree that there’s no harm in trying Platelet Rich Plasma Injections (PRP Injections) for their patients. After all, there are hundreds of thousands of cases of positive results. All it needs is research to prove it’s worth. Currently there are many independent researches going on from private funding like the one conducted by Dr. Kimberly G. Harmon M.D., director of the Primary Care Sports Medicine fellowship at University of Washington. She just recently received a gift to support her research from UW alumni who I’m guessing firmly believes in Platelet-Rich Plasma (PRP).
While the process of extracting PRP is fairly simple — there are many variants as long as platelets are above baseline levels with at least seven growth factors — many physician are still unsure about what they can and can’t do when it comes to this marvelous procedure. So today I want to take the time to shine light on the fine print.
Platelet-Rich Plasma Injections Protocol
PRP: Protocols, Technique and Safety Endorsements
Usually, the procedure requires the physician/surgeon and an assistant or two to help with the preparation of graft, the maintenance of sterile technique and saving the ultrasound images (if relevant).
There should always be a specific indication associated with a physical exam with confirmed imaging studies such as an ultrasound, Cat Scan, or an MRI before treatment.
Proper patient education and a discussion must be had with the patient as well as a signed informed consent prior to the procedure.
Contraindications reviewed prior to procedure.
The patient is to positioned in a comfortable seated or reclining position.
Sterile single needles and syringes must be used with proper handling and disposal.
Using an aseptic procedure, the proper amount of blood is then drawn from the vein for the PRP procedure.
If the blood cannot be obtained from the site the first, time a new site must be used to prevent early activation.
Using a sterile technique, transfer the tube of venous blood to the centrifuge. Platelet Rich Plasma should be acquired using a separating device created for autologous blood. Preference is always given to a closed system that will prevent exposure of the blood and its cellular modules to the open air, and permits minimal use of the tissue.
Image Guidance PRP Therapy
Real time imaging guidance using ultrasound CT, or fluoroscopy should always be used when performing a PRP injection.
If ultrasound is going to be used, the subsequent considerations need to be decided on in advance: For lengthy procedures, PRP injections near the spine and intra-articular injections sterile gel is recommended.
Always use sterile probe covers. Cleansing the probe before and after the PRP procedures and observance to sterile technique is sufficient.
Guided images and ineradicable markings of the site of the probe position and the needle entry always needs to be made before cleaning the skin where the probe and needle will be inserted.
Always apply a bandage or a dressing after the procedure to protect the entry site from germs.
The patient should be monitored for any post PRP procedure complications such as vaso-vagal.
The patients should be given their post procedure directions and precautions and any questions should be answered before they leave, they should also have emergency contact information.
Patients should also be instructed about the immobilization and any post procedure activity that is allowed and/or not allowed.
Post PRP procedure pain prescriptions need to be given to the patient before discharge and any questions they may have about the medication(s) should be answered at this time. The patient also needs to be instructed to avoid NSAIDs till they have healed, are pain free, has full function has returned to the area being treated (or at least to the limited area being treated.
Per OSHA guidelines contaminated areas must be disinfected, before the next patient uses the room (area.)
The PRP procedure must be documented in detail, which includes a procedure note that contains the following information: date, pre and post procedure diagnosis, name of the procedure, physician/surgeon(s), any assistants, whether or not anesthesia was used, and if so what type, short-term indication of the procedure, a description of the graft preparation, a description of the procedure that includes any/all guidance and instruments used.
Platelet-Rich Plasma Injections Protocol
Patients are normally re-examined in 2-6 weeks after the PRP procedure to follow-up on pain, use, the injection site and to discuss any concerns and any future course of action.
The patient response of the treatment should be recorded using authenticated outcome measures.
Any complications responses and all other relevant information should be logged into in the ICMS tracking system.
The consideration for another PRP injection should be the center of the discussion and the patient will be able to make a decision based on the outcome.
With every medical procedure universal precautions must be used including before, during and after the procedure.
Risk of infection – PRP is antimicrobial and provides effective protection against most bacterial infections except for Klebsiella, Pseudomonas, and Enterococcus.
With the graft being made entirely out of autologous it basically eliminates the apprehension for the transmission of disease unless the graft became contaminated.
Risks to Patient from the Procedure
Lack of result
Loss of limb and death are very rare but possible.
Platelet Rich Plasma: Indications
Musculoskeletal complaints, require a complete history and exam to find a diagnosis. Often times, diagnostic studies may be needed and reviewed to understand why prior treatments failed. PRP is usually considered an optional treatment for chronic and subacute conditions. Commonly, healing slows down or stops all together at the 6-12 weeks’ period following an acute or traumatic injury. If the patient has not had any improvement for over the first six weeks, it’s probable the healing period has stopped.
Platelet-Rich Plasma Injections Protocol
Platelet Rich Plasma: Contraindications
Platelet dysfunction syndrome
Localized infection at the procedure site
Patient not willing to take the risks involved with the procedure
Regular use of NSAIDs within 48 hours of the PRP procedure
HGB of < 10 g/dl
Platelet count of < 105/ul
Systemic use of corticosteroids within 2 weeks
Recent illness or fever
Cancer – particularly hematopoietic or of the bone
HGB < 10 g/dl • Platelet count < 105/ul
Corticosteroid injection at treatment site within 1 month
For most women, a tiny pimple on the face is enough to ruin their day. Or week. Even the slightest imperfection that may have a 1% chance of getting noticed by others will freak them out. For these women, Melasma is their darkest nightmare. It’s a pretty common issue, a result of exposure to sun, that causes brown patches on the face. Permanent patches, I should add.
If you’re suffering from Melasma, the road to “recovery” usually looks like this.
- You hope that it’ll fade away.
- Your friend suggests you try apple cider vinegar and lemon juice treatment.
- Slightly disappointed.
- You visit a dermatologist who’ll prescribe a bleaching cream (hydroquinone or similar).
- Full-on disappointment.
- You Google the hell out of the topic.
- Concealers and makeup becomes your best friend.
At this point, no one can convince you there is a treatment for getting rid of melasma. Trying more and more treatment only runs the risk of making the condition worse. So what would you do?
Platelet-Rich Plasma For Melasma
What about Platelet-Rich Plasma For Melasma?
According to recent Turkish and Malaysian studies, Platelet-Rich Plasma is showing great promise for melasma. The one good thing about PRP for Melasma is the fact that PRP won’t make the condition worse unlike IPL, fraxel or other treatments. So that’s one of the treatment you can confidently try without worry. It’s like getting a natural facial treatment that has a whole lot of potential benefits even if it didn’t help cure melasma.
PRP injections work by supplying growth factors to reduce the pigmentation. And being an independant treatment with no downtime, it can be done in conjunction with conventional treatments for melasma to add and enhance the effects. There are more than 30 bioactive substances in Platelet-Rich Plasma that has separate roles like increasing skin volume and adding new blood vessels to name a few.
Platelet-Rich Plasma with Microneedling
This is the most common combination for Platelet-Rich Plasma therapy. Here’s a video of Dr. Michael Somenek performing PRP injection on a patient of his immediately after microneedling. The combination is known to have produced results for a lot of varieties of skin pigmentation issues that it’d not be wise for anyone to ignore it for melasma, especially when creams and peels didn’t help. More important is PRP’s ability to stimulate collagen production in the area so it tightens the pores and makes your skin glowing.
Why Platelet-Rich Plasma?
PRP is primarily a healing vehicle. It needs to be injected into the membrane below the skin. The way it works is by supplying the underlying skin membrane with collagen and tenascin stimulated by the transforming growth factors in PRP. These growth factors also promote formation of new blood vessels that in some cases results in disappearance of spider veins.
The released growth factors (mainly platelet derived growth factor (PDGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF) and transforming growth factor-beta (TGF-ß)) can stimulate proliferation of fibroblast and epidermal cell, and collagen synthesis. In addition, the transforming growth factor-beta (TGF-ß) has been proven to inhibit melanogenesis — or reverse skin pigmentation — the exact opposite effect of exposure to UV-B radiation.
Typically, patients see excellent results with 2-3 PRP injections in the first 3 months. And clinical studies have shown that it will maintain after 6 months.
However, Melasma is known to recur even after successful treatments. So you must take precautions against it by using sunscreen with broad-spectrum protection and an SPF of 30 or higher. And avoid skin care products that are harsh as they can exacerbate melasma.
To understand why stem cell platelet-rich plasma or co-transplantation of Adipose-derived mesenchymal stem cells and PRP, is such a remarkable idea in regenerative medicine, let’s spend a little time looking at the mechanics of PRP.
Platelet-Rich Plasma’s Role As Repairmen
The one thing that makes Platelet-Rich Plasma a hero in several fields (if not all) of medicine is the fact that the diverse growth factors in it are able to stimulate stem cell proliferation and cell differentiation (the factors that determine effective tissue regeneration and healing) on any part of the body.
These growth factors are abundant in the blood and act as the natural repairmen of tissues.
In the perfect scenario, there’s plenty of blood flow to every part of the body and these “repairmen” are always on-call to address any healing needs that may arise. However, if the injured area has a poor blood supply — especially areas that are constantly move like tendons, ligaments and joints — demand for these repairmen can outgrow supply. Meaning, healing (or regeneration of tissues) is put on hold till further repairmen are available.
The train of Platelet-Rich Plasma then arrives with enough of these repairmen to warrant resumption of healing.
There’s another part of this picture we haven’t talked about so far: stem cells.
As far as Platelet-Rich Plasma and it’s growth factors are concerned, they are mere repairmen. They can’t do the work by themselves. They need the basic raw materials to work with. And that raw material here is the stem cells.
Stem cells are the ones actually being regenerated to form new tissues for healing.
Stem Cells As The Raw Materials For PRP
Stem cells are the only raw materials that PRP works with for regeneration. These are like the fundamental building blocks of all other cells. These cells can be can be guided into becoming specialized cells under the right conditions.
In addition, they can also divide themselves to form new stem cells or new specialized cells.
So for Platelet-Rich Plasma to work well, it needs to be applied to an area with lots of stem cells like the heart, liver, blood vessels etc. Incidentally Platelet-Rich Plasma’s healing properties were first discovered by cardiac surgeons who played with concentrated blood for faster healing of heart after surgery and it showed tremendous promise because stem cells are abundant in heart tissues.
But what if healing is needed in an area where there are not much stem cells?
With the new developments in stem cell technology that can be solved too. Because now we can supply the stem cells to areas where there are less like the joints, ligaments and tendons. For this, scientists usually use “mesenchymal stem cell” or MSCs. These are cells isolated from stroma and can differentiate to form adipocytes, cartilage, bone, tendons, muscle, and skin.
The most easiest way is to harvest it from adipose tissue or fat that we call Adipose-derived mesenchymal stem cells or ADSC.
Stem Cell Platelet-Rich Plasma
Supplying Both PRP And Stem Cells For Regeneration
In regions with hypoxia (poor blood supply) like joints, meniscus tissue, rotator cuff, spinal discs etc the supply of platelets (and therefore growth factors) as well as the stem cells are limited. So what if we supplied both the stem cells and Platelet-Rich Plasma for triggering the regeneration process?
That’s the question these Japanese scientists answered in their research. Here’s another group of scientists who took on the same challenge.
They used Adipose-derived mesenchymal stem cells (ADSC) which is known for their ease of isolation and extensive differentiation potential. These researchers noted that these stem cells often can’t survive in areas of local hypoxia, oxidative stress and inflammation – thereby making them ineffective. However, when Platelet-Rich Plasma (or thrombin-activated PRP) is added to ADSC, it kept them alive for prolonged periods and the growth factors in the Platelet-Rich Plasma triggered cell differentiation and proliferation more easily.
Why This Exact Combination Is The Future
Done this way, both Adipose-derived mesenchymal stem cells (ADSC) and Platelet-Rich Plasma are raw materials for healing that’s already available in plenty in almost every one (there are exceptions of course). That means, for complete healing to take place this combination treatment, still in it’s very primitive stage of development, may have the potential to replace expensive synthetic drugs that carry complex unexplained side effects. The procedure takes our body’s natural healing agents — stem cells from body fat and PRP from blood — and then inject it inside knee or other joints (or other areas where they are insufficient) for regeneration.
Isn’t that like the most wonderful thing ever?
Whether it’s cartilage cell, or a bone cell, or a collagen cell for ligaments and tendons that needs to be healed, all you need is a same-day procedure by a local, but specialized doctor, using the natural ingredients of the body.
I believe this special combo is a huge win for Platelet-Rich Plasma.
The Challenges For Growing Adoption Of This Treatment
We know Platelet-Rich Plasma has safe, yet high-speed recovery potential with it’s multiple growth factors. And it is effective in regenerative healing of cartilage injuries – the most toughest injuries to heal – as well as Osteoarthritis. However the challenges are Platelet Quality. We need to somehow ensure the Platelet-Rich Plasma quality is uniform. Currently it varies from two to several fold above baseline concentration based on donor’s physical condition.
Next we need to identify the exact PRP growth factors that promote ADSC proliferation. Scientists believe growth factors such as basic fibroblast growth factor (bFGF), epidermal growth factor, and platelet-derived growth factor stimulate stem cell proliferation while some growth factors under certain conditions are known to inhibit the process.
The percentage of PRP matters too. 5 percent, 10 percent, 15 percent and 20 percent Platelet-Rich Plasma in ADSC are tested by scientists.
The Only Treatment In Modern Medicine For Cartilage Regeneration
The bottom line is that Stem Cell Platelet-Rich Plasma or ADSC + PRP procedure is the only treatment in modern medicine that has showed cartilage regeneration. So it’s too important to ignore. And it could one of greatest advances that science has brought to the millions of people suffering from serious pain in their joints, knee and spine as well people suffering from all kinds of tendon diseases and injuries.
Since it is a new science, many people are skeptical about Platelet-Rich Plasma, otherwise known as PRP. There are some studies out there that state that PRP work no better than a similarly administered placebo, but there are many other studies and doctors that claim that PRP works and works well. This also works well at a much lower cost and less side effects, than traditional medicine.
One branch where the skepticism is loud and clear is podiatry, which deals with feet and ankles. Trying to combat this skepticism can help many surgeons to lower complication rates, improve patient satisfaction, and have better outcomes. For instance, here is a list of cases where PRP has been effective for the feet and ankles.
- Plantar Fasciitis
PRP has become rather common as a treatment for Plantar Fasciitis, with many studies to prove the efficacy of this treatment. For instance, Dr. Daanial Kassicieh or Sarasota Neurology claims that PRP is one of the most effective treatments for this condition, and that PRP is actually fully cure it. Many of his patients have avoided surgery just by utilizing PRP therapy.
This is done with no down time, no rehabilitation, and no side effects. This woud explain why plantar fasciitis is the 5th popular medical condition treated by PRP. This can be explained by over 3 million people that are diagnosed with this and no other treatment really works for it, besides, in fact, PRP.
- Archilles Tendonitis
This is another condition that can be fairly hard to treat, and gets worse over time unless healed. Many surgical approaches are often trickey and generally do not end up with good results. Because of this, the main treatment option is simply to give patients corticosteroids to reduce the pain, but really nothing else to treat the symptoms.
However, there have been many studies done that have shown that PRP is a lot more effective, including that from the European Foot and Ankle Society. This means that PRP is safer and more effective alternative than any other treatments available.
- Diabetic Foot Ulcers
Diabetic foot ulcers can be troublesome, especially when they do not heal or heal properly. Over 2.5 million Americans with diabetes who suffer from these ulcers. About 11% of these cases may need amputation of their affected limb. However, some studies have noted that just one injection of PRP and a topical solution bi-weekly started to heal the ulcers in just 8 weeks. Topical PRP also has been shown to work better than anti-septic creams as well.
- Regenerating Bones
Bone regeneration is most commonly needed in food and ankle area. Although mechanical stabilization works best, the utilization of PRP has been surprising. PRP helps with healing bones and soft tissue at the damage site. According to a recent systematic review of 64 articles, the conclusion was to include more PRP therapy into the healing of foot and ankle bones.
The science behind this is solid, for bone or tissue to form, three things are needed in the area:
- A scaffold for the growth to take place
- Biological stimulants to signal proteins
- Stem cells that provide bone building potential
All three of these are crucial for bone formation.. PRP can provide at least two of these, so there is no reason to ignore it when it comes to bone regeneration.
- Ankle Sprains
This is an incredibly common condition, and can be effectively treated by using PRP therapy. In one randomized controlled trial, researchers studied the effects of PRP injections on athletes with ankle sprains. This study showed that not only did PRP reduce the healing time by 20 days, but that they also experienced much less pain. This can reduce the recovery period from 6 weeks, for just about 2 or 3 weeks.
Immobilization is Vital
When it comes to foot and ankle related injuries, one thing that really cannot be avoided in rest and rehabilitation. This is true regardless of whether PRP is administered. Because of this, many of the studies that shows PRP to be ineffective often don’t use rest and rehabilitation, and that alone can be an issue.
PRP is in no way a magic pill. All foot injuries need rest and rehabilitation in order to properly heal. With these two combined, it can drastically reduce healing times.
How can Foot and Ankle Surgeons Benefit?
Using PRP in foot and ankle injuries is not going anywhere, so utilizing it would be the best way to go. Test it out with your patients, and try using platelet-rich plasma therapy instead of simply prescribing pills or doing costly surgeries. Your patients will thank you in the end.
Many clients are highly skeptical that their ailments can get better just by utilizing a few injections. Many clients may quit after a few sessions, but then return when they feel their ailments easing up. This is especially true when it comes to the practice of Rheumatology.
Rheumatology has benefited immensely from the use of PRP, otherwise known as Platelet-Rich Plasma. This is because not only is it simple to administer, but it works wonders for musculoskeletal conditions, such as joint issues, swelling, and bone issues.
If you are a Rheumatologist, you have probably used, or at least heard, of PRP therapy. This has helped many patients from having to go through surgery. However, over 27 million Americans in the osteoarthritis segment alone would have benefited more if their rheumatologist used PRP therapy.
Not All Treatments Are Successful, Here Is Why
Sometimes PRP can work, sometimes it may not, and this can differ even among the same person. However, there are some things you can do to prevent treatments from failing.
For PRP to work, the platelets present in the blood extracted has to be more concentrated than the baseline in the body. This can work by utilizing a PRP kit, which you can purchase at Adimarket. Using these kits, you can get a 5-8x the baseline, which works best for the treatments.
- White Blood Cells
PRP with white blood cells behave differently than those that do not have it. Most popular forms of PRP have these blood cells. There are three subgroups within this: Red Blood Cells, that don’t have platelets, Platelet Serum that has suspended platelets, and the Buffy Coat, which has both platelets as well as white blood cells. Adding in white blood cells can help speed up the healing process by removing bacteria and dead or dying cells.
- Using Anti-Coagulants
When making PRP, it is standard to use an anti-coagulant. This prevents the blood from clotting, but it does make the blood a little more acidic than usual. This can be detrimental on the growth factors, so adding a buffer before injection can be beneficial.
The Growth Factors Used
PRP heals wounds rather well due mostly to the growth factors that re found in blood platelets. By activating these platelets, the growth factors are able to be used by tissues and ligaments. Although the specifics are not well known, there is plenty of evidence that growth factors help with inflammation, remodeling, and even regenerating cells.
What is the clinical Evidence supporting PRP?
- PRP and Subacromial Tendonitis.
PRP has been shown to be effective in treating Subacromial Tendonitis in many studies. One study, headed by Dr. Turlough O’Donnell of the UPMC Beacon Hispital in Dublin Ireland, studied 102 patients treated with PRP while another 102 were treated with a 20mL solution of bupivacaine and 80 mgs of methylprednisolone.
After 12 months of follow-up, the PRP group were 16 times less likely to have to have invasive surgery as opposed to the other group.
This is often a chronic form of tendinopathy, and treatments are rarely effective. However, studies involving PRO have been promising. In one study, 19 patients who would otherwise have gotten surgery were given PRP treatment instead, and after 8 weeks, they saw a 60% improvement, and within two years, that number rose to 93%.
Another randomized double-blind study compared PRP with corticosteroids in 100 patients with chronic epicondylitis. The beneficial effects of PRP far outweighed the effects of the corticosteroids.
- Plantar Fasciitis
Otherwise known as Policeman’s Heel, plantar fasciitis is fairly common in the field of rheumatology. The main treatment to date would be to simply mask the symptoms by using corticosteroids. However, one study showed that PRP was much better than corticosteroids after a 3 month followup.
- Knee Osteoarthritis
PRP therapies for osteoarthritis of the knee have been studies intensively in the past few years. These studies have shown a lot of promise for this therapy. One systematic review showing a total of 1543 participants showed that PRP therapy fares better than hyaluronic acid when it comes to improving knee joint cartilage.
How PRP can Benefit Rheumatology
PRP is not just a passing trend, and is here to stay, and may be the most useful tool for rheumatologists. With no other treatments coming close to its safety, efficacy, or simplicity, It is a shame that it is not more common than it currently is. Since this therapy carries no risk, there is no reason to at to not at least give it a try.
Trying it is relatively inexpensive, and will pay for itself over time. Adimarket will be happy to supply you with kits, and even a standard lab centrifuge.
We need more rhumatologists to utilize PRP and help patients forgo intrusive surgeries. This will be beneficial for over 27 million Americans. Besides, since it is a new treatment option, getting into the field early will make you a pioneer in the field, which will benefit your practice immensely.