PRP and Major League Baseball

A major league baseball pitcher begins throwing again after Platelet Rich Plasma.

Read the full story. AM (Total Tendon)

Future Trends in Sports Medicine

Below is the abstract from a soon to be published article discussing the use of PRP for tendon and muscle. It will be published in a volume of Clinics in Sports Medicine entitled: "Future Trends in Sports Medicine"

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Treatment of Tendon and Muscle Using Platelet-Rich Plasma.Mishra A, Woodall J Jr, Vieira A.Clin Sports Med. 2009 Jan;28(1):113-125.Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA.

Tendon and muscle injuries are common in elite and weekend athletes. Treatment of these injuries in both groups is rapidly evolving. Sports medicine patients are demanding better and less invasive solutions for all types of musculoskeletal disorders. In this context, platelet-rich plasma (PRP) has emerged as a potential solution. PRP is a fraction of whole blood containing concentrated growth factors and proteins. These cytokines direct tissue healing through autocrine and paracrine effects. The number of basic science, animal, and human investigations of PRP for tendon and muscle injuries worldwide has risen sharply in recent years. These studies are helping clinicians better understand the mechanisms of PRP and are guiding novel treatment protocols. In this paper, the value of PRP as a treatment for acute or chronic tendon and muscle disorders is explored.

Platelet Rich Plasma helps Treat Achilles Tendons

The published and presented data supporting the use of buffered platelet rich plasma continues to grow. PRP has now been shown in a small study to help treat chronic achilles tendonitis (tendinosis).

AM (Total Tendon, ApexPRP)

Guelfi et al recently presented a series of 16 cases of non-insertional achilles tendonitis at a recent meeting in Brazil. They used unactivated, buffered platelet rich plasma prepared using the Biomet Recover System, also known as the GPS. Significant improvement was found in all 16 of their patients via imaging. They also reported the patients returning to sports at six months with a high degree of satisfaction.

MRI Prior to PRP

4 months after PRP

"International Federation of Foot and Ankle Societies", , Third Triennial Scientific Meeting, Costa do Sauipe, Bahia, Brazil September 18-20, 2008. (The case shown is from AM)

Growth Factors in Shoulder Surgery

In the article outlined below, Dr. Randelli and his colleagues have confirmed that valuable growth factors are released when performing an arthroscopic acromioplasty. This is a landmark paper that will be cited many times as we try to understand how to use platelet rich plasma and other biologic treatments. His work for the first time has confirmed that the mechanical removal of an acromial spur has biologic consequences. Excellent information.

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Knee Surg Sports Traumatol Arthrosc. 2008 Oct 31.

Release of growth factors after arthroscopic acromioplasty.

Randelli P, Margheritini F, Cabitza P, Dogliotti G, Corsi MM.

It has recently been postulated that a variety of growth factors may be released from cancellous bone after an acromioplasty. The aim of this study was to demonstrate the presence of growth factors in the subacromial space after acromioplasty. Between October 2006 and March 2007, 23 patients underwent arthroscopic acromioplasty. A sample of at least 3 ml of fluid from the shoulder was obtained 15 min after the end of the procedure. At the same time another sample of 3 ml of the patient's venous blood was obtained as a control. The concentrations of growth factors in the fluids collected were determined using enzyme-linked immunosorbent assay (ELISA). The growth factors assayed were platelet-derived growth factor-AB (PDGF-AB), basic fibroblast growth factor basic (bFGF) and transforming growth factor beta 1 (TGF-beta1). The concentrations of TGF-beta1 (p = 0.0001), PDGF-AB (p = 0.02), and bFGF (p <>

PRP promotes Cell Proliferation

Below is still more basic science evidence to suggest platelet rich plasma is helpful for wound healing and tissue engineering.

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Plast Reconstr Surg. 2008 Nov;122(5):1352-60.

Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts.

Kakudo N, Minakata T, Mitsui T, Kushida S, Notodihardjo FZ, Kusumoto K.

Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan. kakudon@takii.kmu.ac.jp

BACKGROUND: This study evaluated changes in platelet-derived growth factor (PDGF)-AB and transforming growth factor (TGF)-beta1 release from platelets by platelet-rich plasma activation, and the proliferation potential of activated platelet-rich plasma and platelet-poor plasma on human adipose-derived stem cells and human dermal fibroblasts. METHODS: Platelet-rich plasma was prepared using a double-spin method, with the number of platelets counted in each preparation stage. Platelet-rich and platelet-poor plasma were activated with autologous thrombin and calcium chloride, and levels of platelet-released PDGF-AB and TGF-beta1 were determined by enzyme-linked immunosorbent assay. Cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 5% whole blood plasma, nonactivated platelet-rich plasma, nonactivated platelet-poor plasma, activated platelet-rich plasma, or activated platelet-poor plasma. In parallel, these cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 1%, 5%, 10%, or 20% activated platelet-rich plasma. The cultured human adipose-derived stem cells and human dermal fibroblasts were assayed for proliferation. RESULTS: Platelet-rich plasma contained approximately 7.9 times as many platelets as whole blood, and its activation was associated with the release of large amounts of PDGF-AB and TGF-beta1. Adding activated platelet-rich or platelet-poor plasma significantly promoted the proliferation of human adipose-derived stem cells and human dermal fibroblasts. Adding 5% activated platelet-rich plasma to the medium maximally promoted cell proliferation, but activated platelet-rich plasma at 20% did not promote it. CONCLUSIONS: Platelet-rich plasma can enhance the proliferation of human adipose-derived stem cells and human dermal fibroblasts. These results support clinical platelet-rich plasma application for cell-based, soft-tissue engineering and wound healing.

Best Treatment for Tennis Elbow?

We are polling people to figure out the best treatment for a patient with 3 months of tennis elbow pain (lateral epicondylitis). The patient is a healthy 42 year old female who plays 2-3 hours per week and can no longer participate. Her pain now occurs even with activities of daily living such as driving. Please vote in the poll on this blog.

Comment as you wish as well.

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Cartilage Formation better with Platelet Rich Plasma

Here is more evidence that PRP may be helpful for cartilage regeneration.

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Platelet lysate favours in vitro expansion of human bone marrow stromal cells for bone and cartilage engineering.

Zaky SH, Ottonello A, Strada P, Cancedda R, Mastrogiacomo M.

Istituto Nazionale per la Ricerca sul Cancro, and Dipartimento di Oncologia, Biologia e Genetica dell'Universita' di Genova, Genova, Italy.

The heterogeneous population of non-haematopoietic cells residing in the bone marrow (bone marrow stromal cells, BMSCs) and the different fractions and components obtained from platelet-rich plasma provide an invaluable source of autologous cells and growth factors for bone and other connective tissue reconstruction. In this study, we investigated the effect of an allogenic platelet lysate on human BMSCs proliferation and differentiation. Cell proliferation and number of performed cell doublings were enhanced in cultures supplemented with the platelet-derived growth factors (platelet lysate, PL), either with or without the concomitant addition of fetal bovine serum (FBS), compared to cultures performed in the presence of FBS and FGF2. Both in vitro and in vivo osteogenic differentiation were unaltered in cells maintained in medium supplemented with PL and not FBS (Only PL) and in cells maintained in medium containing FBS and FGF2. Interestingly, the in vitro cartilage formation was more effective in the pellet of BMSCs expanded in the Only PL medium. In particular, a chondrogenic differentiation was observed in pellets of some in vitro-expanded BMSCs in the Only PL medium, whereas pellets from parallel cell cultures in medium containing FBS did not respond to the chondrogenic induction. We conclude that the platelet lysate from human source is an effective and even more beneficial substitute for fetal bovine serum to support the in vitro expansion of human BMSCs for subsequent tissue-engineering applications.

Stanford Football Player returns after PRP

A Stanford football player who had chronic severe patellar tendonitis has returned to play this year after being treated with platelet rich plasma by Dr. Mishra.
Click here to read the full story.

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United Nations and Platelet Rich Plasma

AM at the United Nations

This week Dr. Allan Mishra presented his platelet rich plasma research at the United Nations in Geneva, Switzerland. The lecture was part of a worldwide conference on stem cells and regenerative medicine. Researchers, clinicians and government ministers from the United States, Dubai, Japan, Sinapore, Australia, Italy, France, Switzerland, the Netherlands, Spain, England, Turkey, Brazil and even Kazakhstan were in attendance.

The BioBridge meeting included the researchers from Kyoto Japan who are pioneering the use of induced pluripotential stem cells (an alternative to embryonic stem cells) and several physicians using platelet rich plasma (PRP) for dermatologic, traumatic and degenerative conditions. Data from the meeting suggests PRP is ahead of stem cells as a therapeutic biologic agent in terms of applications and safety.

The meeting was a collaborative and inspiring international event. The relationships established and the sharing of data will hopefully lead to future multi-disciplinary discoveries.

AM

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Forbes Magazine Article Platelet Rich Plasma Tennis

Forbes just published an article on the use of platelet rich plasma (PRP) in elite athletes. It discusses the value of PRP in the context of cortisone and surgery. Forbes Story

To join in a group of patients and providers discussing the use of PRP and other treatments for tendon related injuries join the FREE Total Tendon Network.

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Wired Magazine Stem Cells and PRP

Wired magazine just ran an article about stems and platelet rich plasma. Dr. Mishra's work is mentioned toward the end of the article.

Wired Stem Cell and PRP Article

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