Stem Cells from Liposuction

Is it too good to be true? Can you really make stem cells out of liposuction fat?

Yes, you can is the simple answer. The process takes some complicated steps that may result in tumor formation. So, years will be needed to simplify the concept of turning fat into stem cells. The field of autologous medicine (autologous = your own stuff such as fat or blood) is evolving rapidly. Platelet rich plasma is specific example of this type of medicine.

Read the abstract and article below. This is science not science fiction.

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"Stanford researchers have found that globs of fat removed during liposuction contain cells that can be efficiently reprogrammed to become induced pluripotent stem cells — a type of stem cell that does not require the use of an embryo.

The findings were scheduled to be published online Monday in the Proceedings of the National Academy of Sciences, a Stanford press release said.

Stanford surgery professor and study co-author Dr. Michael Longaker described the leftover fat as "liquid gold." (From the Mercury News: See the full article)

Excellent Evidence for Platelet Rich Plasma (PRP)

Bosch et al in the Journal of Orthopedic Research just reported significant biomechanical evidence supporting the use of a single Platelet Rich Plasma injection for tendon injuries in an equine model. It is important to note this research was conducted using a formulation of platelet rich plasma contained about 4 times platelet concentration and 6 times white blood cell concentration. (Biomet Biologics GPS Device) The PRP was injected under ultrasound guidance.

Some PRP devices concentrate only platelets without any white blood cell concentration. This evidence and published human clinical data support the use of PRP that concentrate both. Make sure when considering a PRP procedure for tendon injuries to have the published literature guide treatment.

"The repair tissue in the PRP group showed a higher strength at failure (p = 0.021) and Elastic Modulus (p = 0.019). Histologically, PRP-treated tendons featured better organization of the collagen network (p = 0.031) and signs of increased metabolic activity (p = 0.031). It was concluded that PRP increases metabolic activity and seems to advance maturation of repair tissue over nontreated experimentally induced tendon lesions, which suggests that PRP might be beneficial in the treatment of clinical tendon injuries." See Full Abstract

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Another NY Times Article about Platelet Rich Plasma

The lay press are clearly interested in Platelet Rich Plasma (PRP) as a treatment. It is intriguing to both athletes and reporters. The worldwide scientific data continues to support the use of PRP for tendon and ligament injuries. Large prospective randomized trials are also on-going. Today this article appeared in the New York Times:

"LAST April, at a meeting of the American Medical Society for Sports Medicine, three experts in tendon injuries sat on a stage and talked about their preferred treatments. One said that the best treatment was to inject small amounts of a patient’s own blood into the injured tendon. Another said that the best method was to concentrate the platelets of the patient’s blood and then inject the concentration, a substance known as platelet rich plasma."

Read the Full Article.....

As the lay press examines PRP as a treatment, it is important to realize PRP still needs continued scientific investigation to prove its efficacy by specific indication.

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NFL Player Platelet Rich Plasma

Another NFL player has documented success using platelet rich plasma for elbow tendonitis.

See story in Philadelphia newspaper.

This is a recurring pattern of elite athletes being treated with PRP. The evidence is, however, unfortunately weak. We need formal studies to prove these results are valid. If the NFL, MLB, NBA or other leagues sponsored formal trials or at least prospective studies we would better be able to determine the true value of PRP. We could also hopefully answer questions about what formulation of PRP is best.

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New York Times Article: Personal Best

A medical reporter from the New York Times just wrote an article about platelet rich plasma for her hamstring injury. Below is her part of her story:

"From what they see in patients with injuries like mine, he said, the doctors are enthusiastic. “The results over all are so promising and so positive,” (her doctor told her) As a skeptical medical reporter, I’d say, that’s not very convincing evidence. As an injured runner, I say, “I’ll take it.”

Full Article Link

As the data surrounding platelet rich plasma matures and is published widely, we will be able to answer her questions better about how and when to use PRP most appropriately. For now, however, it is indeed a reasonable treatment for patients with chronic severe tendiniopathy.

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PRP Cutting Edge Treatment for Athletes

A well written article by Jenny Vrentas was just published about how ailing athletes are using platelet rich plasma. It discusses many of the hot issues surrounding PRP including doping. She notes:

"The NFL and MLB currently regard PRP as a medical treatment, not a performance-enhancement agent, so its use is left to the discretion of team physicians. WADA is still gathering information and will address PRP at upcoming meetings. Its Prohibited List for 2009 doesn't specifically mention PRP, though a spokesperson said blood processing techniques that lead to the release of growth factors generally fall under the "Hormones and Related Substances" section of that list. Athletes, however, can request a Therapeutic Use Exemption for a substance or method, if it is used to treat a serious medical condition."

Click here for the full article.

Hopefully, soon we will have a definitive ruling about PRP. The argument is actually quite simple. Nothing new or more is added to the patient at the time of the treatment. And, although PRP may speed healing from an injury, it has never been shown to enhance performance.

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PRP Published Data Link

Platelet Rich Plasma papers are being published almost daily now.

PRP Datalink will periodically be updated. Check it out and send in your suggestions for additions to the list. Only articles available in PubMed will be considered.

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Dr. Allan Mishra on Sirius-XM Radio

Dr. Allan Mishra will be featured on Sirius XM radio this week discussing Platelet Rich Plasma.

Click here for the link to the full audio interview.

PRP at the Advanced Team Physician Course

Dr. Allan Mishra and Dr. Nicola Maffulli debated how to diagnosis and treat patellar tendinopathy at the Advanced Team Physician Course. It was a spirited discussion of when to use imaging, when to hold an athlete out of competition and then how to treat these patients. It was clear from the meeting that there is no consensus about how to treat this sometimes difficult problem. Dr. Mishra advocated early imaging and a biologically enhanced rehabilitation. The biologic enhancement would come from a platelet rich plasma procedure early on at 6-8 weeks after the onset of symptoms.

Obviously we need better prospective randomized trials of PRP, surgery and other therapies for chronic patellar tendinopathy.

PRP Improves Muscle Function

Platelet Rich Plasma in a study just published in the American Journal of Sports Medicine was found to significantly improve muscle function. This was in a high repetition injury model. This is excellent evidence to enable a human trial of PRP for muscle injuries.

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Use of autologous platelet-rich plasma to treat muscle strain injuries.

Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM.

Am J Sports Med. 2009 Jun;37(6):1135-42.

BACKGROUND: Standard nonoperative therapy for acute muscle strains usually involves short-term rest, ice, and nonsteroidal anti-inflammatory medications, but there is no clear consensus on how to accelerate recovery. HYPOTHESIS: Local delivery of platelet-rich plasma to injured muscles hastens recovery of function. STUDY DESIGN: Controlled laboratory study. METHODS: In vivo, the tibialis anterior muscles of anesthetized Sprague-Dawley rats were injured by a single (large strain) lengthening contraction or multiple (small strain) lengthening contractions, both of which resulted in a significant injury. The tibialis anterior either was injected with platelet-rich plasma, was injected with platelet-poor plasma as a sham treatment, or received no treatment. RESULTS: Both injury protocols yielded a similar loss of force. The platelet-rich plasma only had a beneficial effect at 1 time point after the single contraction injury protocol. However, platelet-rich plasma had a beneficial effect at 2 time points after the multiple contraction injury protocol and resulted in a faster recovery time to full contractile function. The sham injections had no effect compared with no treatment. CONCLUSION: Local delivery of platelet-rich plasma can shorten recovery time after a muscle strain injury in a small-animal model. Recovery of muscle from the high-repetition protocol has already been shown to require myogenesis, whereas recovery from a single strain does not. This difference in mechanism of recovery may explain why platelet-rich plasma was more effective in the high-repetition protocol, because platelet-rich plasma is rich in growth factors that can stimulate myogenesis. CLINICAL RELEVANCE: Because autologous blood products are safe, platelet-rich plasma may be a useful product in clinical treatment of muscle injuries.

Unactivated Platelet Rich Plasma Proves Better

In a recently published study by Han et al published in the Journal of Bone and Joint Surgery (JBJS June 2009, American Volume), unactivated platelet rich plasma "stimulated chondrogenesis on Day 14 and osteogenesis on Days 28 and 56, whereas thrombin-activated platelet-rich plasma acted as an inhibitor of such events. In addition, inflammatory cells were detected in demineralized bone matrix samples that were mixed with thrombin-activated platelet-rich plasma. These cells were not present in matrix mixed with platelet-rich plasma alone." (See Full Abstract)

This data clearly supports the use of PRP that has NOT been activated by thrombin and/or calcium. This unactivated form of PRP has also proved useful for chronic tennis elbow. See References

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