Platelet Rich Plasma Basic Science

This is a video produced by Dr. Allan Mishra discussing the basic science of PRP. Future videos will discuss cell culture, animal and human studies. For more information, please visit either Total Tendon or ApexPRP.

More Evidence that PRP may heal Tendons

In this study the authors found that PRP releasate stimulated cell proliferation and total collagen production. It is an interesting article that adds to the growing body of PRP knowledge.

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Can Platelet-Rich Plasma Enhance Tendon Repair? A Cell Culture Study.

de Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, van Osch GJ.

BACKGROUND: Autologous platelet-rich plasma (PRP) application appears to improve tendon healing in traumatic tendon injuries, but basic knowledge of how PRP promotes tendon repair is needed. HYPOTHESIS: Platelet-rich plasma has a positive effect on cell proliferation and collagen production and induces the production of matrix-degrading enzymes and endogenous growth factors by human tenocytes. STUDY DESIGN: Controlled laboratory study. METHODS: Human tenocytes were cultured 14 days in 2% fetal calf serum medium complemented with 0%, 10%, or 20% vol/vol platelet-rich clot releasate ([PRCR] the active releasate of PRP) or platelet-poor clot releasate (PPCR). At day 4, 7, and 14, cell amount, total collagen, and gene expression of collagen Ialpha1 (COL1) and IIIalpha1 (COL3), matrix metalloproteinases ([MMPs] MMP1, MMP3, and MMP13), vascular endothelial-derived growth factor (VEGF)-A, and transforming growth factor (TGF)-beta1 were analyzed. RESULTS: Platelet numbers in PRP increased to 2.55 times baseline. Growth-factor concentrations of VEGF and platelet-derived growth factor (PDGF)-BB were higher in PRCR than PPCR. Both PRCR and PPCR increased cell number and total collagen, whereas they decreased gene expression of COL1 and COL3 without affecting the COL3/COL1 ratio. PRCR, but not PPCR, showed upregulation of MMP1 and MMP3 expression. Matrix metalloproteinase 13 expression was not altered by either treatment. PRCR increased VEGF-A expression at all time points and TGF-beta1 expression at day 4. CONCLUSION: In human tenocyte cultures, PRCR, but also PPCR, stimulates cell proliferation and total collagen production. PRCR, but not PPCR, slightly increases the expression of matrix-degrading enzymes and endogenous growth factors. CLINICAL RELEVANCE: In vivo use of PRP, but also of PPP to a certain extent, in tendon injuries might accelerate the catabolic demarcation of traumatically injured tendon matrices and promote angiogenesis and formation of a fibrovascular callus. Whether this will also be beneficial for degenerative tendinopathies remains to be elucidated. Am J Sports Med. 2008 Mar 7

Platelet Rich Plasma Wins!

In our informal survey of best names, "Platelet Rich Plasma" won with 61% of the vote with "PRP" taking 22%, "Platelet Gel" 8% and "Platelet Enriched Plasma and Growth Factors" 4% each. With a total of 83% of the votes, Platelet Rich Plasma/PRP wins in a landslide.

I propose we end the argument of what to name it and begin to define it in studies moving forward. The landscape of PRP is scattered at best. In order to figure out how best to use this important tool, we must agree on what we are talking about. Please see the post below for a definition that is published in the literature.

I am repeating the survey of what machine producing the best PRP. I'll post the results in a month.

Total Tendon

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What is platelet rich plasma (PRP)?

Marx one of the pioneers of PRP defined it quite simply: "it is a volume of autologous plasma that has a platelet concentration above baseline". (Marx, Implant Dentistry Dec. 2001, pp. 225-228) There have been other attempts to specific what define PRP but I think this one is the best.

I would add that PRP naturally is unactivated. In his paper, Dr. Marx states that activation of platelet results 70% of the stored growth factors being secreted with in 10 minutes and close to 100% within the first hour. That makes it clear that PRP should NOT be activated until it is ready to be used. As I have consistently suggested, PRP should not be activated at all except in vivo by the collagen that is abundant within most connective tissues.

Any comments on this paper would be appreciated.

Total Tendon

ApexPRP

PRP activates Circulating Cells

The article referenced below discusses how locally injected PRP can mobilize cells to help heal a tendon. This provides solid mechanistic evidence to use PRP for tendon injuries and disorders and helps explain the positive clinical results. It is an excellent study and the authors have contributed significantly to our understanding of how PRP works.

Total Tendon and Apex PRP

Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing.

Kajikawa Y, Morihara T, Sakamoto H, Matsuda KI, Oshima Y, Yoshida A, Nagae M, Arai Y, Kawata M, Kubo T.

J. Cell Physiology Jan. 2008

Circulation-derived cells play a crucial role in the healing processes of tissue. In early phases of tendon healing processes, circulation-derived cells temporarily exist in the wounded area to initiate the healing process and decrease in number with time. We assumed that a delay of time-dependent decrease in circulation-derived cells could improve the healing of tendons. In this study, we injected platelet-rich plasma (PRP) containing various kinds of growth factors into the wounded area of the patellar tendon, and compared the effects on activation of circulation-derived cells and enhancement of tendon healing with a control group (no PRP injection). To follow the circulation-derived cells, we used a green fluorescent protein (GFP) chimeric rat expressing GFP in the circulating cells and bone marrow cells. In the PRP group, the numbers of GFP-positive cells and heat-shock protein (HSP47; collagen-specific molecular chaperone)-positive cells were significantly higher than in the control group at 3 and 7 days after injury. At the same time, the immunoreactivity for types I and III collagen was higher in the PRP group than in the control group at early phase of tendon healing. These findings suggest that locally injected PRP is useful as an activator of circulation-derived cells for enhancement of the initial tendon healing process. J. Cell. Physiol. (c) 2008 Wiley-Liss, Inc.

Total Tendon Network

A new network of both Patients and Providers has been created to improve the diagnosis and treatment of tendon related injuries and disorders. Discussion groups, pictures and video can be posted on this FREE network. Patients and Providers (Surgeons, Phyisicans, Physical Therapist etc) have joined from North America, Europe, South American, Australia and Asia.

Joining is simple and FREE.

Click here to sign up for the Total Tendon Network.

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American Academy of Orthopedic Surgery Article

Dr. Mishra's recent trip to Europe was featured in the American Academy of Orthopedic Surgery's Magazine: AAOS Now. The article titled "AAOS fellow takes European PRP Tour" was feature in the Jan. 2008 issue. The picture above is Dr. Mishra assisting on a platelet rich plasma enchanced achilles tendon repair in Sweden.


Click here to view AAOS Platelet Rich Plasma view article

Another sports medicine meeting in Chamonix France focusing on PRP will take place at the end of Jan 2008. Details of both meetings will be posted here soon.

Total Tendon

PRP Stimulates the greatest number of genes

According to recent reports from BEVA 2007, Cornell researchers examined the use of platelet-rich plasma (PRP) in horses with tendon injury, according to Schramme (Schnabel et al., Journal of Orthopedic Research, 2007). "The rationale is that if platelets release considerable growth factors, you could help with the healing of cartilage, tendons, ligaments)," he said.

"This study looked at gene expression patterns, DNA, and collagen content of equine tendon explants cultured (in vitro) with whole blood, plasma, and platelet-rich plasma," he continued. Concentrations of TGF-â1 and PDGF were higher in PRP-treated tendons, compared to other blood products and bone marrow."

Schramme commented that all blood products stimulate gene expression, PRP seemed to stimulate the greatest number of genes (collagen types II and III, and COMP), with no c with no concomitant (accompanying) increase in molecules of harmful enzymes. "These findings support in vivo (in the live animal) investigation of 100% PRP as an autogenous (generated in the body), patient-side treatment for tendonitis," he noted. "It's another treatment that we need to carefully evaluate in vivo as it continues to come along.

Total Tendon.com

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Platelet Rich Plasma for Colonic Anastomosis

Below is yet another recent study outlining the benefits of PRP in surgery. The data supports the use of platelet rich plasma for further study in colonic anastomosis. Similar data has already been published supporting the use of PRP for achilles tendon repairs. For more PRP information, visit: Apex PRP.com

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J Surg Res. 2007 Oct 26

Effects of Platelet Rich Plasma on Colonic Anastomosis.Tekin A, Yol S, Yilmaz H, Küçükkartallar T, Esen H, Caglayan O.

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PURPOSE: To investigate the effect of platelet-rich plasma (PRP) on tissue maturation and wound healing in experimental colonic anastomosis. MATERIALS AND METHODS: Thirty Sprague Dawley rats were divided into three groups of 10 rats each. Group I (control group) was subjected to colon anastomosis only. Group II (PRP group) was subjected to colon anastomosis and topical PRP was applied. Group III (Bioglue group) was subjected to colon anastomosis and topical tissue sealant was applied (Bioglue; Cryolife, Kennesaw, GA). The rats were sacrificed on postoperative day 7, and the bursting pressure of the anastomosis and tissue hydroxyproline levels were measured; histopathological changes on the anastomosis line were also examined. RESULTS: The bursting pressure was statistically higher in the PRP group than in the control and Bioglue groups (P <>

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The Future of Platelet Rich Plasma

Platelet rich plasma in the last year has taken off as a potential stand alone treatment or a way to augment other treatments. Prospective randomized trials for PRP are on-going in several countries including the US, Sweden, Italy, Spain and the Netherlands. As we continue to gather both basic science and clinical data we will be better able to determine specific applications.

A group of patients and providers has been formed to help work on not just PRP but other potential treatments for tendon injuries and disorders. If you would like to contribute this discussion, please join the Total Tendon Network. To join this group or to learn more, visit: Total Tendon.com

AM

Platelet Rich Plasma and Growth Hormone

Today the San Francisco Chronicle on the front page of its sports section published an article written by Gwen Knapp on growth hormone use in sports. Dr. Mishra in the article is quoted about the use of platelet rich plasma (PRP). Below is a portion of that article:

Article by Gwen Knapp: "Who’s to say that someday, not far in the future, growth hormone won’t be as common as cortisone? Or that right now, brilliant doctors aren’t chafing under FDA rules and sports world priggishness that prevent them from treating patients at what they believe to be optimal, and safe, levels?"

"I thought Allan Mishra, a surgeon at the Menlo Medical Clinic and an adjunct professor at Stanford, might be one of them. He is researching something called platelet-enriched plasma and its effect on damaged tendons. Platelets are the clotting element in blood, and Mishra said a high concentration of them near a wound appears to trick the body into sending growth factors, a healing agent, to the site."

To read the full article, Click Here

For more PRP information visit: Total Tendon.com