PRP INJURIES 2008
AUTOLOGOUS PLATELET-RICH PLASMA ( A-PRP) CAN AMELIORATE ACUTE SPORTS INJURIES SUCH AS HAMSTRING INJURIES, AND OTHER MUSCULO-TENDINOUS TEARS.
Autologous platelet-rich plasma ( A-PRP) refers to clinical applicable cell therapy with the patient’s own plasma enriched with platelets and release of growth factors such as PDGF, TGF, EGF AND VEGF once the PRP is activated with calcium chloride.
Will injected A-PRP be able to stimulate skeletal muscle myoblasts/ satellite cell regeneration to facilitate the healing process? The answer is yes, because ex vivo tissue culture studies show that PRP is a potent stimulator for the proliferation of myoblasts and satellite cells that play key roles in the regeneration and healing of skeletal muscle. It has been suggested that A-PRP is more effective than steroid injection in inducing pain relief. The reason is that the A-PRP has anti-inflammatory effects as well as growth factor enhancement. Skeletal muscle myoblasts or satellite cells ( progenitor cells) can be generated in monolayer culture when skeletal muscle is co-cultured ex vivo in PRP-enriched media using advanced tissue culture (TC) technologies. See illustration. This is of considerable interest and relevant to sports science physicians and biokineticians that deal with muscle and tendon injuries that pose significant challenges in athletes ( in terms of healing time and recurrence of the injured tendon/muscle). A-PRP, if correctly generated, can release TGF,PDGF, EGF and VEGF, which together with myriads of other factors, is important in the wound healing cascade ( Marx, Eppley, Du Toit et al 2006, 2006, 2008). Theoretically then, A-PRP injected carefully and under controlled conditions, taking into account all the relevant local anatomical structures, into injured muscles and musculo-tendinous junctions , can stimulate proliferation of satellite cells ( myoblasts: progenitor cells that regenerate adult skeletal muscle) in situ at the injection point or point of care. This cell-based treatment option, based on platelet-derived growth factors, has been sporadically applied with success in conjunction with conventional strategies such as RICE, biokinetics and physiotherapy. Relevant scientific publications regarding PRP, tissue culture, translational research regarding musculo-tendinous injuries are listed below:
- Anecdotal clinical studies indicate that autologous PRP can enhance operative tissue repair during Achilles tendon surgery in humans ( Sanchez et al 2007).
- In experimental models, PRP can enhance Type I and III collagen immunoreactivity in early phase tendon healing ( Kajikawa et al 2008). This suggests that locally injected PRP may well enhance the initial tendon healing process ( by increased cellular proliferation and collagen production).
- Human tenocytes in PRP driven tissue culture can stimulate cell proliferation and total collagen production ( de Mos et al 2008).
- Autologous biological production of plasma rich in GF promote proliferation and induce VEGF and HGF production by human tendon cells in culture ( J ORTH RES 2005).
- Activated platelets release various GF, some of which are recognized to improve nerve regeneration ( Sariguney et al 2008): see results of sciatic nerve re-myelinization in animal models.
- PRP can enhance anabolic gene expression patterns in flexor digitorum superficialis tendons. Tendons cultured in 100% PRP show enhanced gene expression of matrix molecules such as COL 1A1, COL3A1, and Comp ( Schnabel at al 2007).
- Collagen-platelet rich plasma hydrogel enhances primary repair of porcine anterior cruciate ligament ( Murray et al 2007).
- Anitua et al 2005, from Spain, reported that autologous PRP may be beneficial to the treatment of tendon injuries by inducing cell proliferation and promoting the synthesis of angiogenic factors during the healing process ( J ORTOP RES 2005).
- Injection of PRP, can improve repair in various rat Achilles tendon transsection models ( Virchenko et al 2006).
- Tendon repair can be stimulated by thrombin and platelets (Acta Orthop 2006). Currently, in the RSA, a new device enables the rapid side-room preparation ( REGEN-PRP-THT), with unsurpassed high platelet yield and growth factors.New reports indicate that autologous–PRP ( A-PRP) may suppress harmful cytokine release, limit inflammation and thereby promote tissue, muscle and tendon regeneration.
A-PRP kits and individual tubes , available for aesthetic and regenerative medicine are available in South Africa and distributed by Omnimed, (Pty).,(Ltd)., Sandton, Johannesburg, South Africa. Early clinical results show that A-PRP is effective for acute tendonitis non-responsive to conventional treatment, but not effective for chronic disorders, accept tennis elbow.
OMNIMED A-PRP SERVICES AVAILABLE IN THE RSA
- Cosmetic, aesthetic and regenerative medicine
- Hair transplantation
- Chronic wound healing and care
- Surgery, neurosurgery, plastic surgery, facial oro-maxillary surgery
ADVANTAGES OF THE REGEN PROCESS OVER SYNTHETIC FACIAL FILLERS IF USED FOR AESTHETIC PURPOSES
- A-PRP rejuvenates the face by use of the patient’s own plasma and is therefore a big plus point over RF,IPL and lasers. Rejuvenation of the aging face with the patient’s own plasma. A unique form of cell therapy, superior to the use of autologous fibroblasts harvested and cultured from the client’s skin.
- A-PRP is 100% safer than synthetic fillers or hyaluronic acid, because the natural route is used. No allergies, because the patient’s own plasma is used and therefore no skin testing is needed. But, A-PRP is not a magic bullet for facial rejuvenation and maintenance follow-up injections will be needed after 6- 8 months. In some patient’s undergoing facial rejuvenation, excellent results are observed, regarding tone and texture and is quantifiable by advanced skin digital analysis.
- A-PRP has a safer profile than synthetic fillers and does not cause dermal granulomas.
- A-PRP provides other distinct biological advantages that synthetic fillers do not.
- A-PRP is far more cost effective than synthetic fillers as the whole face and neck can be done at a fraction of the cost of lasers and IPL, without causing thermal induced facial scarring in the long-term.
- A-PRP can stimulate fibroblasts and deposition of collagen and elastin, that is impossible with synthetic fillers.
Leading South African international publication by an academic on the application of A-PRP in the clinical setting. Google, by typing in Soft and Hard-tissue augmentation with platelet-rich plasma. This will take the browser to the International Journal of Shoulder Surgery and the whole article can be down-loaded free.
Histology of human skeletal muscle (H&E X20). Note large adjacent vein. Satellite cells can be cultured from skeletal muscle after enzymatic digestion.
Skeletal-muscle, myoblast-derived progenitor ( satellite) cells, proliferation ex vivo in PRP enriched TC medium.
Biotechnology laboratory and aseptic laminar flow facility for ex vivo generation of monolayer tissue culture of skeletal muscle myoblasts, also referred to as satellite cells.
Partially torn hamstring in a provincial track athlete, proven on ultrasound. Injury was injected with A-PRP into and around the torn musculo-tendinous insertion with excellent relief of symptoms at 7 days when conventional sports directed rehabilitation was commenced. The illustration shows the relevant superficial anatomy of the right popliteal fossa, the structures of which must be taken into account when the damaged tendon is infiltrated with the A-PRP. Knowledge of the relationships of the arteries, veins and nerves that pass
through the popliteal fossa is important, prior to injection.
The second international multi-disciplinary wound healing conference ( 7-9 May 2008) of WHASA was held at The INDABA HOTEL, Fourways in Gauteng. Professor Don du Toit FRCS made a scientific presentation regarding the biological role of autologous PRP in wound healing. REGEN PRP was added to the Classification of Wound Healing Dressings and Biologicals.
Cape Town, South Africa. Home of BOLANDCELL Technologies. Mother City and City of learning: Universities of Stellenbosch, Cape Town and UWC. Table Mountain and Grootte Schuur Hospital, where the first heart transplantation was performed by Christiaan Barnard, unquestionably, the best known heart surgeon in the world.
BOLANDCELL REFERENCES ON A-PRP:
1. Sanchez M et al. Comparison of surgically repaired Achilles tendon tears using platelet –rich fibrin matrices ( Am J Sports Med 2007, 245-51).
2. Du Toit DF et al. Soft and hard-tissue augmentation and platelet-rich plasma. Tissue culture dynamics, regeneration and molecular biology perspective. International Jnl of Shoulder Surgery 2007; 1:64-73
3. Du Toit DF et al: Biotechnological and anti-aging cell therapy treatment of facial wrinkles with cultured human fibroblasts. The Specialist Forum 2005, 5:38-46
4. Du Toit DF et al. Shoulder surgeon and autologous cellular regeneration (ACR). From bed to bench. Int J Shoulder Surgery,1: 87-95
DISCLAIMER: All persons needing advice must visit their own health care practitioner so that an informed decision can be made.
Posted 12 MAY, 2008
ILLUSTRATIONS RELEVANT TO THE USE OF A-PRP IN THE TREATMENT OF TORN TENDONS BY THE USE OF CELL THERAPY AND PLATELET –DERIVED GROWTH FACTORS (GF).