ABC broadcasts story about how platelet rich plasma is being used to treat tennis elbow tonight on the evening news. Randomized, controlled trials now support the use of platelet rich plasma for chronic tennis elbow when compared to the standard care of a cortisone shot. Someday PRP may completely replace cortisone. For more PRP information, visit: ApexPRP.com
Medicare to allow use of its database to rate Doctors, Hospitals and other Health Care Providers. This will lead to mobile apps to figure out what doctors and hospitals perform the most operations and what their success and failure rates are by procedure. It will also have unintended consequences.
Genome data interpretation will emerge as its own medical specialty much like radiology for evaluation of xrays, CTs & MRIs. It will take some time but the complexity of the information will eventually lead to a board certified specialist that helps primary care doctors understand genetic tests.
Transformative solutions more often arise via iconoclastic horizons not via the cognoscenti. Translation: Truly significant advances do not arise from established ideas and people. They destroy established ideas and patterns of behavior.
"Citizen Scientists" and "Health Hackers" Conducting trials, analyzing data and presenting papers. How can we all help in the advancement of science: http://online.wsj.com/article/SB10001424052970204621904577014330551132036.html
Tumor Treating Fields (electrical current) used to treat brain cancer. 1st prescription patient. Novel GBM treatment
Platelet Rich Plasma (PRP) and Stem Cell Therapies are becoming more commonly used especially by elite athletes. In order to better understand the scope of the situation, I have put up an interactive site with links to any and all articles about either PRP or Stem Cell Treatments in Athletes. Reasons why elite athletes are seeking out stem cell and platelet rich plasma therapies:
They want to get better and get back to their sport at the highest level as fast as possible.
They are dissatisfied with present treatments or those treatments are not working.
They understand that using the regenerative components of your own blood, bone marrow or fat to treat injured or degenerative tissue makes intrinsic sense.
They are further willing to be treated with these autologous biologic products despite the immaturity of the supporting data.
Please visit the site and add to the list of athletes and articles. This is part of a project to better understand how and why athletes are seeking out these types of treatments and how effective they are. Please use a short one line description with links. Part of the list is outlined below:
Novel transformative solutions require risk. We need to increase the incentives to take such risk. Using platelet rich plasmafor sports related injuries a decade ago was crazy. Now it is commonplace and backed up with level one data for chronic problems such as tennis elbow.
How can we encourage providers and payers to take more risks to help patients?
The entire September 2011 issue of Operative Techniques in Sports Medicine is dedicated to Platelet Rich Plasma. (PRP) Articles included in this issue discuss what is platelet rich plasma, how it is presently being used in the elbow, shoulder, and foot/ankle. Discussions about the basic science of PRP, its effects on cartilage and even the coding and reimbursement of PRP are outlined. Finally, a paper on the future of PRP and its impact on sports medicine is presented.
Elite PRP researchers including but not limited to: Lisa Fortier, Brian Cole (Editors), Scott Rodeo, Steven Arnoczky, James Bradley, Augustus D. Mazzocca, Anthony A. Romeo, Allan Mishra, Taco Gosens, Lew Schon, Tomasz Bielecki, and David M. Dohan Ehrenfest are among the authors.
This represents the latest information about PRP from the people who have been actively engaged in evaluating it scientifically.
Bloodcure has long stated that platelet rich plasma composition matters. A new study just published by Dr. Lisa Fortier's group at Cornell compares two of the most popular PRP systems: Biomet and Arthrex. It is clear these two PRP systems have significantly different bioactivity.
"PRP-1 (Arthrex) system consisted of concentrated platelets (1.99×) and diminished leukocytes (0.13×) compared with blood, while PRP-2 (Biomet GPS) contained concentrated platelets (4.69×) and leukocytes (4.26×) compared with blood. Growth factors were significantly increased in PRP-2 (Biomet) compared with PRP-1 (Arthrex) (TGF-β1: PRP-2 = 89 ng/mL, PRP-1 = 20 ng/mL, P < .05; PDGF-AB: PRP-2 = 22 ng/mL, PRP-1 = 6.4 ng/mL, P < .05). The PRP-1 (Arthrex) system did not have a higher concentration of PDGF-AB compared with whole blood. Catabolic cytokines were significantly increased in PRP-2 (Biomet) compared with PRP-1 (MMP-9: PRP-2 = 222 ng/mL, PRP-1 = 40 ng/mL, P < .05; IL-1β: PRP-2 = 3.67 pg/mL, PRP-1 = 0.31 pg/mL, P < .05)." See Full Abstract
This important work helps to highlight that different types of PRP exist and should be recognized by patients, clinicians and researchers. A PRP classification system also has been published based cellular composition. See Classification System
Today, one of the most common tests ordered in the United States is a Magnetic Resonance Image or MRI. These images are typically ordered of a specific body part or region. The cost of this type of test is variable ranging from $800 to over $3000 and produces exquisite information anatomic images.
MRI of Torn Rotator Cuff
An MRI, however, gives the clinician no information about the patients systemic physiology or potential underlying risk factors. If DNA sequencing can follow Moore's Law from computer science, then the cost should drop to $1000 within five years or perhaps less. Databases are already being created with numbers reaching over 100,000 patients. As the cost drops, physicians will begin ordering these tests almost as often as MRIs and we will then see dramatic shifts in the practice of medicine. The natural history (what happens if no intervention occurs) is different for different patients. We may be able to predict with DNA sequencing who will recover WITHOUT any specific or expensive treatment. We also may be able to predict which patients will require aggressive treatment. The era of personalized genomic medicine will have arrived. This has broad implications for reducing the cost of care if implemented appropriately.
According to published reports, Kobe Bryant has had three arthroscopic (scopes) surgeries on his right knee. (2003, 2006 and 2010) This is similar to the three surgeries that Tiger Woods has had on his left knee. Both of these athletes are in their 30s and the question for both of them is: What is going on inside these elite knee joints and why did they both turn to platelet rich plasmato potentially help them?
BLOODCURE thinks it is safe to assume that both of them have some arthritic changes in their knees. This means that they have lost some of both the smooth cartilage covering the bone (articular cartilage) and some of the cushioning cartilage between the thigh and shin bones (meniscus cartilage). In Tiger's case, he may have been treated for patellar tendonitis after an ACL reconstruction but there is no presented or published information about the specifics of his treatment. In Kobe's case, he may have been treated for knee arthritis but despite BLOODCURE contacting its many sources in the USA and Europe, no one has come forward with specific information about his treatment. What did he have done and why did he travel to Germany to get it done? Plenty of physicians within the USA and specifically California have experience with PRP. So, did he get some form of PRP that is not available in the USA?
Answers to these questions will help us all better understand the value of PRP for iconic professional athletes and for sports medicine in general. Importantly, we also need to learn what type of PRP (many exist) they received. Here is a video of a PRP Classification System.
If anyone has information about these cases, please post a comment below.
AAOS NOW just published a discussion about what's behind the hype of platelet rich plasma Read an excerpt below: --------------------------------------------------------------------------------------------------------------------------------
"Dr. Mishra also presented a concise classification system for PRP formulations (See Video of PRP Classification) to help compare data from various studies. The system takes into account the inclusion of white blood cells, the addition of a thrombin activator, and the final concentration of platelets.
He noted that PRP is “autologous engineering” a way to help maximize how the body helps heal itself. Stem cells and bone marrow are other examples.
“Patients are seeing elite athletes, like Tiger Woods and Raphael Nadal, being treated with some form of PRP and are asking their orthopaedic surgeons to give them ‘what Tiger got.’ The problem is that we don’t know ‘what Tiger got,’ what happened to him before or afterwards, or what was used, and no one is publishing that data,” noted Dr. Mishra.
“But all three major sports organizations—the National Football League (NFL), Major League Baseball, and the National Basketball Association—as well as the World Anti-Doping Agency, have declared that PRP is a reasonable treatment, despite the fact that we may all agree that there’s limited research to support the efficacy of its use,” he continued.
Read the full article. ------------------------------------------------------------------------------------------------------------------------------------ Clearly, PRP needs more evidence to be fully validated. This will require investigation of specific PRP formulations and specific indications with important but expensive large randomized trials. Athletes in general, however, do not wait until there is definitive proof. They are constantly searching for the best ways to recover from injuries and PRP has increasing evidence that it may help.
Dr. Pietro Randelli and his colleagues just published a prospective randomized trial on the use ofplatelet rich plasma for rotator cuff repair surgery. He showed a specific type of PRP (Increased platelets in combination with white blood cells) improved outcomes especially within the first 30 days.
Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up.
Department of Scienze Medico Chirurgiche, University of Milano, IRCCS Policlinico San Donato, Milano, Italy.
Pub Date: 06/2011
Source/Vol: Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]/20
Hypothesis Local application of autologous platelet rich plasma (PRP) improves tendon healing in patients undergoing arthroscopic rotator cuff repair.
Study Design Prospective, randomized, controlled, double blind study; considering an alpha level of 5%, a power of 80%, 22 patients for group are needed.
Materials And Methods Fifty-three patients who underwent shoulder arthroscopy for the repair of a complete rotator cuff tear were randomly divided into 2 groups, using a block randomization procedure. A treatment group (N = 26) consisted of those who received an intraoperative application of PRP in combination with an autologous thrombin component. A control group (N = 27) consisted of those who did not receive that treatment. Patients were evaluated with validated outcome scores. A magnetic resonance image (MRI) was performed in all cases at more than 1 year post-op. All patients had the same accelerated rehabilitation protocol.
Results The 2 groups were homogeneous. The pain score in the treatment group was lower than the control group at 3, 7, 14, and 30 days after surgery (P < .05). On the Simple Shoulder Test (SST), University of California (UCLA), and Constant scores, strength in external rotation, as measured by a dynamometer, were significantly higher in the treatment group than the control group at 3 months after surgery (strength in external rotation [SER]: 3 ± 1.6 vs 2.1 ± 1.3 kg; SST: 8.9 ± 2.2 vs 7.1 ± 2.7; UCLA: 26.9 ± 3 vs 24.2 ± 4.9; Constant: 65 ± 9 vs 57.8 ± 11; P < .05). There was no difference between the 2 groups after 6, 12, and 24 months. The follow-up MRI showed no significant difference in the healing rate of the rotator cuff tear. In the subgroup of grade 1 and 2 tears, with less retraction, SER in the PRP group was significant higher at 3, 6, 12, and 24 months postoperative (P < .05).
Conclusion The results of our study showed autologous PRP reduced pain in the first postoperative months. The long-term results of subgroups of grade 1 and 2 tears suggest that PRP positively affected cuff rotator healing.
Regenerative Medicine is exploding worldwide. There is a healthy debate emerging about who is in the lead. Is it North America (USA, Canada), Europe, South America, Australia or Asia? Could Africa be the place of a monumental discovery discovery much like when Christiaan Barnard did the first heart transplant in Cape Town in 1967?
Countries and continents are taking vastly different approaches to stem cell treatments, genetic engineering and other forms of regenerative medicine. Regulatory issues are especially different by country and changing rapidly. It is also difficult to keep track of all the trials that are popping up everyday.
Send in your comments or follow bloodcure on twitter to be part of the conversation.
Regenerative medicine is a buzz phrase right now. Patients, providers and politicians are all in favor of "Regenerative Medicine". There are three major components to evaluate when assessing treatment value (TV). Treatment value is directly related to overall efficacy (E) of the drug or procedure and inversely related to cost (C) and risk (R). A simple equation can define it:
TV = E / C x R2
That is Treatment Value = Efficacy divided by Cost times Risk squared.
We need treatments of high value with maximal efficacy that have reasonable costs and minimal risks. When evaluating new potential "Regenerative Medicine Treatments", consider this equation.
Dr. Taco Gosens and his team from the Netherlands have just published in the American Journal of Sports Medicine the best paper to date on the use of platelet rich plasma for tennis elbow. Using the Biomet GPS device to create platelet rich plasma (Type 1A PRP in Mishra's classification system of PRP), they found PRP patients were successfully treated more often than patients treated with corticosteroid injections at two year follow up. This was highly statistically significant at a p value of < 0.0001. Read the entire abstract here.
This paper confirms that a specific type of PRP is better than the often used cortisone injection for chronic lateral epicondylar tendinopathy. This team of researchers also needs to be congratulated on finishing this important work.
"The participants of the 2011 PRP Forum also endorsed the development of standards in the manufacture of PRP, noted that PRP may be contraindicated in some conditions, and called for the establishment of a study group to follow up on the other recommendations resulting from the session." "At the end of the day, an informal survey of participants found most in agreement that PRP would be an option, particularly if conservative treatments have failed and the next step would be surgery."
The group agreed that PRP needs a classification system. Dr. Allan Mishra proposed one that is under consideration.
The American Academy of Orthopaedic Surgery and AAOS Now will be conducting a Platelet Rich Plasma Forum on February 14, 2011 just prior to the Annual Meeting in San Diego. Participating in this meeting are an elite group of clinicians and researchers including but not limited to Dr. James Andrews, Dr. Steven Arnoczky, Dr. Terry Canale, Dr. William Clancy, Dr. Freddie Fu, Dr. Taco Gosens, Dr. Elizaveta Kon, Dr. Nicola Maffulli, Dr. Robert Marx, Dr. Allan Mishra, Dr. Pietro Randelli, Dr. Scott Rodeo, and Dr. JR Woodall.
This group along with several others has been tasked with evaluating the state of platelet rich plasma. It will be the most comprehensive discussion of the topic with regard to orthopedics and sports medicine. The goal is to hopefully make some sense of how to best evaluate and potentially use PRP.
Researchers at the Stanford University School of Medicine, in collaboration with BioParadox, Inc., have published data supporting the use of RevaTen platelet-rich plasma as a promising biologic treatment for myocardial infarction (heart attack).
The findings were published online in Cardiovascular Revascularization Medicine and will be presented at The Sixth International Conference on Cell Therapy for Cardiovascular Disease at Columbia University Medical Center, New York City, on January 20, 2011.
Platelet-rich plasma (PRP) has been identified as a novel biologic treatment for wound healing and sports-related injuries. Studies indicate PRP stimulates cell repair via growth factor release and by attracting reparative cells. Only recently, however, have scientists begun to study PRP's potential in repairing damaged cardiovascular tissue.
Working with colleagues at Stanford University Medical Center, lead author Allan Mishra, MD, a leading PRP researcher, studied the effects of RevaTen PRP (a proprietary formulation of concentrated platelets and white blood cells) on cardiac function after inducing cardiac ischemia (damage to myocardial tissue caused by blood restriction) in mice. The research was conducted under the direction of Robert Robbins, MD, chairman of the department of cardiothoracic surgery at Stanford University.
In this study of 28 mice, researchers induced ischemia by either permanently occluding the left anterior descending artery (Group A) or temporarily ligating it for 45 minutes (Group B). The hearts were then injected with RevaTen PRP or saline control. In order to assess cardiac function after treatment, magnetic resonance images were taken at seven days post-procedure (Group A) and 21 days (Group B). Tissue from all hearts was collected for histopathologic evaluation.
In both groups, mice that received PRP after ischemia had significantly better cardiac function as measured by left ventricular ejection fraction on MRI than those that had been injected with saline only. In group A, the RevaTen-treated animals had 38% better ejection fraction compared to saline controls. In group B, the RevaTen-treated animals had 28% improvement in ejection fraction compared to controls. Additionally, less scar tissue was found in RevaTen-treated hearts than in controls.
"Although this is an observational study using an animal model, PRP might someday be employed at the point of care to treat patients who have had a heart attack. This could preserve cardiac function and limit the progression to congestive heart failure," Dr. Mishra says. "Since myocardial infarction remains the leading cause of death in industrial nations, RevaTen PRP may become a powerful biologic tool in fighting heart disease and provide cost savings." The authors caution that this is a preclinical study and that further translational research is needed to understand how RevaTen PRP might work to repair and/or protect cardiovascular tissue.
2011 will be the year we begin to figure out how to best use platelet rich plasma. For almost a decade now, it has been employed as a treatment for a variety of problems. Last year, level one data was published showing how PRP is better than cortisone for tennis elbow. Other data revealed that achilles tendionpathy that is mild to moderate and that had NOT been treated did not get significantly better with PRP and exercise compared to a saline injection and exercise.
This year, large specialty organizations have dedicated time to debate the value of PRP. Via this forums, we will learn from experts. New formulations and indications will emerge as some will fade. These changes will be based on presentation and publication of elite data.