THE SCIENCE OF PLATELET RICH PLASMA

Cheri A. Ong , MD FACS

ONG INSTITUTE FOR PLASTIC SURGERY & HEALTH

WHAT IS PRP

• BLOOD PLASMA

• 55% of the body’s today body volume

• 45% blood cells:- Red blood cells, White blood cells and platelets.

• PLATELET RICH PLASMA = PLASMA “RICH” WITH PLATELETS

WHAT IS A PLATELET

• Formed in bone marrow and circulate in the blood

• Contain tiny encapsulated structures called Alpha-granules

• Alpha granules contain:- growth factors and protein that play a role in blood clotting and tissue healing

• Working definition of PRP = 1,000,000 platelets/μl in 5ml plasma

• Concentrated plasma which contains 4-6 times the number of platelets normally found in the blood

• Marx RE. Platelet-rich plasma (PRP): What Is PRP and What Is Not PRP? Implant Dent.2001;10:225–8. [PubMed: 11813662]

• *Many commercial systems commonly in use do not have adequate platelet concentration/ml volume to meet the scientific definition of Platelet Rich Plasma.

DOES PLATELET COUNT MATTER?

• The proliferation of endothelial cells and its migration and the invasion of endothelial cells occurred in a bell-shaped manner. The authors found that the stimulation for proliferation of endothelial cells peak at 1.25 x 106 platelets /μl and angiogenesis at 1.5 x 106 platelets /μl , respectively.

• This signifies the fact that a PRP platelet count 1 million/mL has become the working definition for therapeutic PRP and also reasons out the criticism on not getting the expected best results of PRP, which might be due to lower concentrations of platelets.

• Rughetti A, Giusti I, D’Ascenzo S, Leocata P, Carta G, Pavan A, et al. Platelet gel-released supernatant modulates the angiogenic capability of human endothelial cells. Blood Transfus. 2008;6:12–7.[PMCID: PMC2626859] [PubMed: 18661919]

•Platelet-rich plasma is employed as a matrix graft, often referred to as an autologous tissue graft. This platelet-rich plasma (PRP) matrix is defined as a "Tissue graft incorporating autologous growth factors and/ or autologous undifferentiated cells in a cellular matrix where design depends on the receptor site and tissue of regeneration." (Crane D, Everts PAM. Practical Pain Management. 2008; January/ February: 12- 26) 2008)Wei, Nathan (2012-08-23). The Book On PRP (p. 60). Nathan Wei,MD FACP FACR.

•*Activated PRP ( matrix) provides growth factors and bio-active proteins that stimulate regeneration of whatever tissue it is introduced to

Optimal level of platelet concentration for angiogenesis is 1.5 x 106 platelets /μl for a 4-5 times baseline concentration

PRP can induce migration and provide a scaffolding of mesenchymal stem cells

• Activated platelets : degranulation of alpha granules and release contents of growth factors eg PDGF, TGF, VEGF, etc

• Act as chemical messengers that exert a bioregulatory action where you place them

• Repair and regenerate tissue

• Resolve inflammation

• Attract stem cell to area

• Anti-bacterial and antifungal properties

• Create new neural and vascular tissue growth

ACTIVATED PLATELETS REGENERATE TISSUE

ACTIVATED PLATELETS REGENERATE TISSUE

• Degranulation > secretion of active proteins> bind to receptors of target cells > activate intracellular signal protein> expression of gene sequence that directs tissue repair and regeneration

• The active secretion of these growth factors by platelets begins within 10 min after activation, with more than 95% of the pre-synthesized growth factors secreted within 1 h.

NOT ALL PRP IS THE SAME

Pure PRP Magellan Regen/Eclipse

Platelet Concentration 6.6x 5.7x 0.7/0.5 ( less

than baseline)

Platelet yield 80% 62% <35%

Deliverable platelets 1084 983 98/79

Granulocytes 0.7 8.4 0/0

Monocytes 12.6 12.6 0.4/0

Average PRP volume 7.3 7.1 5/7

COMPARISON DATA

•Professional Systems – high concentration platelets

• Emcyte Pure PRP II – low granulocytes and RBC, high monocytes.

• Harvest – RBC and Inflammatory WBC

• Magellan – RBC and Inflammatory WBC

• Common Systems – poor quality and not validated

• DrPRP and YesPRP – neither are validated, inconsistent platelet yield (YesPRP NOT FDA Cleared)

•Single Spin – low platelet concentration (< 1x)

• RegenLab – single spin tube – low platelets

• Eclipse – single spin tube – low platelets (not validated)

Single spin systems: Not possible to create 6cc of 2.5c concentrated PRP from 11cc of whole blood

PURE PRP II60 ml of anticoagulated blood = high yield of platelet rich

plasma with true growth factors for repair and regeneration

DOUBLE SPIN SYSTEMS

NSAID’S AND PRP

• PRP and all its cellular components facilitate cell proliferation, neuroangiogenesis, stimulation of unipotent stem cells and recruitment of mesenchymal stem cell - vital to tissue repair and regeneration only when concentration of platelets is adequate and degranulation of alpha granules is accomplished

• NSAID use is found to inhibit degranulation and therefore likely affecting the therapeutic effect.

CLINICAL USES

• Dentistry

• Orthopedics and sport injuries

• Pain medicine

• Plastic and reconstructive surgery

• Sexual medicine

• Aesthetic applications

MY PRACTICE

• Surgical

• Sexual wellness ( O-Shot, urinary incontinence)

• Aesthetics : Vampire Facial, Fillers ( Vampire facelift) and Breast

• Hair regeneration

QUESTIONS?