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Platelet - Rich Plasma

Autologous Platelet-Rich Plasma (PRP) is a treatment method that involves using a small amount of a patient's own blood, separating the platelet-rich plasma through centrifugation. Platelets are rich in various growth factors, which have the function of stimulating cell proliferation and tissue repair. During PRP therapy, PRP is injected into the damaged area, where these growth factors attract cells from within the tissue, facilitate the supply of nutrients, and promote cell proliferation, differentiation, and synthesis to achieve tissue repair. Autologous Platelet-Rich Plasma (PRP) is primarily composed of the following components: Platelets, Plasma, and White Blood Cells (WBC).

PRP's Vital Component - Platelets

Platelets, derived from megakaryocytes in the bone marrow, are the most crucial component of PRP. This is because platelets contain a wealth of growth factors that can promote wound healing, tissue repair, and reduce inflammation. Their main mechanisms involve initiating and regulating cell growth and differentiation, promoting angiogenesis (the formation of new blood vessels), accelerating fibroblast proliferation (cells involved in wound healing), and alleviating the inflammatory response. These functions are essential for wound healing, tissue repair, and the natural healing process. Consequently, PRP finds wide application in various medical fields, including plastic surgery, sports medicine, dentistry, and dermatology, to facilitate self-healing and treatment.

Platelets are small, flat blood cells with a plate-like structure, and they contain three types of granules: dense granules, α-granules, and lysosomes. Dense granules primarily store phosphates such as ADP, ATP, calcium ions, and serotonin. α-granules, on the other hand, contain a vast array of growth factors, including IGF-1, PDGF, TGF-β, among others. Lysosomes facilitate blood clot remodeling through their enzymatic functions.

Therefore, when tissues are damaged, platelets become activated. They release intracellular calcium ions to initiate the clotting process, and they also release growth factors to attract other cells into the damaged tissue and provide the necessary nutrients for repair. Lysosomes play a role in shaping the clots formed in the tissues. Through these substances and mechanisms, they assist in rapid tissue repair.

Platelet count is a blood test indicator, and a normal platelet count typically ranges from about 150,000 to 450,000 per cubic millimeter of blood. Having too many or too few platelets can pose health issues. For example, an excessive number of platelets can lead to blood clot formation, increasing the risk of heart disease and stroke. Conversely, a low platelet count can result in a propensity for bruising and bleeding. Even with a normal platelet count, platelet function may still be impaired, preventing them from participating adequately in the blood clotting process. This condition can lead to bleeding disorders, such as hemophilia.

Therefore, when patients require PRP therapy, it's essential to assess these potential situations to ensure the quality of treatment is not compromised.

Activated Platelets and Their Functions:

IGF (I/II) - Insulin-Like Growth Factors:
Stimulate cell proliferation and differentiation.

TGF (α/β) - Transforming Growth Factors:
Promote cell replication and secretion of collagen.

VEGF - Vascular Endothelial Growth Factor:
Stimulate the growth of endothelial cells in blood vessels.

EGF - Epidermal Growth Factor:
Stimulate the proliferation and differentiation of epidermal cells.
Promote blood vessel formation.

PDGF (AA/AB/BB) - Platelet-Derived Growth Factors:
Regulate cell replication and soft tissue repair.

PRP can be further categorized based on its leukocyte content. Leukocytes are white blood cells, and their presence in PRP can have different therapeutic effects:

Leukocyte-Poor PRP (LP-PRP): In this type of PRP, the concentration of white blood cells is intentionally reduced. LP-PRP primarily consists of highly concentrated platelets and plasma. Platelets contain a wealth of growth factors such as Insulin-like Growth Factor (IGF), Transforming Growth Factor (TGF), Vascular Endothelial Growth Factor (VEGF), Epidermal Growth Factor (EGF), and Platelet-Derived Growth Factor (PDGF). These growth factors play a crucial role in stimulating cell growth, extracellular matrix regeneration, vascularization, and tissue remodeling. LP-PRP is often used for its regenerative properties.

Leukocyte-Rich PRP (LR-PRP): LR-PRP contains a higher concentration of white blood cells, including monocytes and lymphocytes, in addition to platelets. Monocytes can differentiate into macrophages within tissues. Platelets release Transforming Growth Factor-beta (TGF-β), which promotes the transformation of macrophages into an anti-inflammatory phenotype. This type of macrophage helps reduce inflammation in tissues and aids in tissue restructuring. Additionally, the presence of lymphocytes can modulate the healing process. Studies have shown that wounds treated with LR-PRP tend to exhibit delayed closure, reduced inflammation, and less scar tissue formation.

PRP has gained popularity across various medical fields, including orthopedics, dermatology, dentistry, and sports medicine, due to its regenerative and healing properties. It can be used to treat a wide range of conditions, including osteoarthritis, tendon injuries, skin rejuvenation, and more.

Clinical Application

Clinical applications of Platelet-Rich Plasma (PRP) in various medical fields include:

Orthopedics / Rehabilitation

Treatment of cervical/lumbar disc protrusion or degeneration [2].

Repair of torn muscles and tendons in the shoulder, elbow, and knee [3] [4] [5].

Management of degenerative joint diseases like osteoarthritis [6].

Relief from plantar fasciitis [7].

Dermatology / Plastic Surgery

Smoothing of scar tissue and reduction of skin wrinkles [8] [9].

Maintenance of the viability of fat and cartilage cells used in transplants [10].

Gynecology

Management of stress urinary incontinence [11].

Promotion of endometrial thickening [12].

Urology

Treatment of interstitial cystitis [13].

Management of erectile dysfunction [14].

Otorhinolaryngology (ENT)

Repair of vocal cords [15].

These are some of the clinical applications of PRP in different medical specialties. It's worth noting that while PRP holds promise in these areas, its effectiveness can vary, and it may be used as part of a comprehensive treatment plan in conjunction with other therapies. Always consult with healthcare professionals for the most appropriate treatment options for specific conditions.

Reference List

  • [1] Xinyi Wang, Swathi Balaji, Emily H. Steen, Hui Li, Meredith M. Rae, Alexander J. Blum, Qi Miao, Manish J. Butte, Paul L. Bollyky, and Sundeep G. Keswani. T Lymphocytes Attenuate Dermal Scarring by Regulating Inflammation, Neovascularization, and Extracellular Matrix Remodeling. Advances in Wound Care. 2019;527-537.

  • [2] Cameron JA, Thielen KM. Autologous Platelet Rich Plasma for Neck and Lower Back Pain Secondary to Spinal Disc Herniation: Midterm Results. Spine Res. 2017; Vol. 3 No. 2:10 

  • [3] Sengodan VC, Kurian S, Ramasamy R. Treatment of Partial Rotator Cuff Tear with Ultrasound-guided Platelet-rich Plasma. J Clin Imaging Sci. 2017;7:32.

  • [4] Halpern BC, Chaudhury S, Rodeo SA. The role of platelet-rich plasma in inducing musculoskeletal tissue healing. HSS J. 2012;8(2):137-45. 

  • [5] Filardo, G., Kon, E., Della Villa, S., Vincentelli, F., Fornasari, P. M., & Marcacci, M. Use of platelet-rich plasma for the treatment of refractory jumper's knee. International orthopaedics, 2021;34(6), 909–915.

  • [6] Laudy A, B, M., Bakker E, W, P., Rekers M., Meon M, H. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. British Journal of Sports Medicine. 2015;49:657-672.

  • [7] Monto R. R. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot & ankle international, 2014;35(4), 313–318.

  • [8] Shah, S. D., Mehta, B. D., Borkar, M. A., & Aswani, R. C. Study of safety and efficacy of autologous platelet rich plasma combined with fractional CO2 laser in the treatment of post acne scars: a comparative simultaneous split-face study. International Journal of Research in Medical Sciences, 2017; 5(4), 1344–1351.

  • [9] Elnehrawy, N. Y., Ibrahim, Z. A., Eltoukhy, A. M., & Nagy, H. M. Assessment of the efficacy and safety of single platelet-rich plasma injection on different types and grades of facial wrinkles. Journal of cosmetic dermatology, 2017; 16(1), 103–111.

  • [10] Gentile, P., Di Pasquali, C., Bocchini, I., Floris, M., Eleonora, T., Fiaschetti, V., Floris, R., & Cervelli, V. Breast reconstruction with autologous fat graft mixed with platelet-rich plasma. Surgical innovation, 2013; 20(4), 370–376.

  • [11] Chiang C- and Kuo H- (2022) The Efficacy and Mid-term Durability of Urethral Sphincter Injections of Platelet-Rich Plasma in Treatment of Female Stress Urinary Incontinence. Front. Pharmacol . 2022; 13:847520.

  • [12] Chang, Y., Li, J., Chen, Y., Wei, L., Yang, X., Shi, Y., & Liang, X. Autologous platelet-rich plasma promotes endometrial growth and improves pregnancy outcome during in vitro fertilization. International journal of clinical and experimental medicine, 2015; 8(1), 1286–1290.

  • [13] Jiang, YH., Kuo, YC., Jhang, JF. et al. Repeated intravesical injections of platelet-rich plasma improve symptoms and alter urinary functional proteins in patients with refractory interstitial cystitis. Sci Rep. 2020; 10, 15218. 

  • [14] Liu MC, Chang ML, Wang YC, Chen WH, Wu CC, Yeh SD. Revisiting the Regenerative Therapeutic Advances Towards Erectile Dysfunction. Cells. 2020; 9(5):1250. 

  • [15] Woo SH, Kim JP, Park JJ, Chung PS, Lee SH, Jeong HS. Autologous platelet-poor plasma gel for injection laryngoplasty. Yonsei Med J. 2013; 54(6):1516-23.

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