Administration Of Autologous Platelet-rich Plasma Research Articles

Intradiscal administration of autologous platelet-rich plasma in patients with Modic type 1 associated low back pain: A prospective pilot study.

Various treatments for chronic low back pain (LBP) have been reported; among them, platelet-rich plasma (PRP) as a regenerative medicine has attracted much attention. Although Modic type 1 change (MC1) is associated with LBP, no treatment has been established so far. In addition, no studies have administered PRP to intervertebral discs (IVDs) in patients with LBP, targeting MC1 only. Thus, the purpose of this study was to determine the safety and efficacy of PRP administration to the IVDs in patients with MC1 experiencing LBP. PRP was injected intradiscally to 10 patients with MC1 experiencing LBP. Patients were followed prospectively for up to 24 weeks after primary administration. Physical condition, laboratory data, and lumbar x-ray images were evaluated for safety assessment. Furthermore, to evaluate the effectiveness of PRP, patient-reported outcomes were considered. In addition, changes in MC1 were assessed using magnetic resonance imaging (MRI). There were no adverse events in the laboratory data or lumbar X-ray images after administration. The mean visual analog scale, which was 70.0 ± 13.3 before the treatment, significantly decreased 1 week after PRP administration and was 39.0 ± 28.8 at the last observation. Oswestry disability index and Roland Morris disability questionnaire scores promptly improved after treatment, and both improved significantly 24 weeks after PRP administration. Follow-up MRI 24 weeks after treatment showed a significant decrease in the mean high-signal intensity of fat-suppressed T2-weighted imaging from 10.1 to 7.90 mm2 compared with that before PRP administration. The safety and efficacy of PRP administration to the IVDs of patients with MC1 experiencing LBP were identified. Post-treatment MRI suggested improvement in inflammation, speculating that PRP suppressed inflammation and consequently relieved the patient's symptoms. Despite the small number of patients, this treatment is promising for patients with MC1 experiencing LBP. The study protocol has been reviewed and approved by the Certified Committee for Regenerative Medicine and the Japanese Ministry of Health, Labor and Welfare (Japan Registry of Clinical Trials [jRCT] No. jRCTb042210159).

Influence of local administration of autologous platelet-rich plasma on the level of expression of matrix metalloproteinases in experimental tendinopathy

Purpose: To evaluate the expression of matrix metalloproteinases in the calcaneal tendon tissue under conditions of experimental tendinopathy and under the influence of local administration of autologous platelet-rich plasma.
 Material and methods: The study was conducted on 20 mature Wistar rats divided into 5 groups. In all groups, experimental modeling of tendinopathy of the calcaneal tendon was performed by intra- and near-tendon injection of 0.5 ml of a 10 % suspension of sterile talc. Further, autologous platelet-rich plasma (PRP), hyaluronic acid preparation Rusvisk (Russia) or their sequential combination was injected into the area of tendinopathy. The results of the study were evaluated after 10 weeks; autopsy preparations prepared for immunohistochemical analysis were studied using light microscopy and morphometry.
 Results: Histological signs characteristic of tendinopathy were identified: disorganization of collagen structures, mucoid and lipoid degeneration, neovascularization, lymphoid-histiocytic infiltration. Injection of PRP into the area of simulated tendinopathy, hyaluronic acid, or their sequential combination led to changes in the immunohistochemical pattern of the tissue. As a result, there was a decrease in the expression of immunoreactive material in the cytoplasm of tenocytes and cells of the inflammatory infiltrate, compared with the picture observed in micropreparations in animals with tendinopathy, which were not subjected to any manipulations.
 Conclusion: The introduction of PRP into the area of the calcaneal tendon under conditions of experimental tendinopathy reduces the level of expression of matrix metalloproteinases and, thereby, preserves the structure of the tendon tissue, demonstrating tendoprotective properties.

Platelet-Rich Plasma (PRP) As A New Approach And Promising Therapy In Patients With Alopecia Areata

Background: Alopecia areata (AA) is a non-scarring, autoimmune, inflammatory condition that causes well-defined areas of hair loss on the scalp and/or body. A new biotechnology called platelet-rich plasma (PRP) was developed as a result of increased interest in tissue engineering and cell-based therapies. This therapy is defined as an autologous, non-allergic preparation of platelets in concentrated plasma. Study aimed to evaluate the effect of PRP treatment in alopecia areata. Case: This study included 3 patients complaining of multiple patchy alopecia areata. They were treated with combination of PRP therapy, topical fluocinolone acetonide 0.025% cream, minoxidil 2 and 5%, and ketoconazole 2% scalp solution. One patient was also treated with intralesional triamcinolone acetonide injections. PRP was injected intradermally every 4 weeks and final monitoring was conducted after 4-6 sessions. Evaluation and follow up results were determined using photographic monitoring as well as patient’s satisfaction. Results: Administration of autologous PRP had significance hair regrowth in all three patients in this study. PRP treatment sessions varied from 3 to 6 sessions. However, significance outcomes in these patients were established after 3 sessions of PRP treatment, while the best results were obtained after 4-6 sessions of PRP treatment. No major side effects was reported. Conclusion: PRP is effective in promoting hair growth. PRP treatment for alopecia areata is safe, easy to perform, and can achieve patient’s satisfaction, without any major adverse effects. However, further research on standardized protocol of PRP methods are needed.

Clinical Benefit of Autologous Platelet-Rich Plasma Infusion in Ovarian Function Rejuvenation: Evidence from a Before-After Prospective Pilot Study.

Background: The intraovarian administration of autologous platelet-rich plasma (PRP) acts beneficially for the stimulation of follicle production in women presenting different forms of ovarian dysfunction. This pilot study aimed to evaluate and provide significant data regarding the efficacy of PRP to rejuvenate the ovaries. Methods: A total of 253 women aged 22-56 years, were divided into five groups, based on their status. All participants signed for informed consent for the current study. Blood sampling, preparation of PRP and intraovarian infusion of the latter were performed on all participants. The evaluation of PRP efficacy, a two-month follow-up detecting the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and anti-mullerian hormone (AMH), was performed for all participants. For women with advanced ages (>48 years), the restoration and regularity of the menstrual cycle were additionally evaluated. Results: After the two-month follow-up, the majority of the participants presented improvement in their hormonal profiles. Additionally, 17% of the women in this pilot study successfully conceived. The restoration of the menstrual cycle was detected in 15% of the women with advanced ages. Conclusions: Intraovarian infusion of autologous PRP exhibited remarkable evidence and promising results to restore ovarian insufficiency.

Structural changes of the tendon in experimental tendinopathy and administration of autologous platelet-rich plasma

Objectives assessment of structural changes in the calcaneal tendon tissue in experimental tendinopathy under autologous platelet-rich plasma.
 Material and methods. Twenty mature Wistar rats, selected for the study, were divided into 5 groups. Rats of all groups received intra- and peritendinous injections of 0.5 ml of 10% sterile talc suspension to provide the experimental modeling of tendinopathy of the calcaneal tendon. Then the tendinopathy area was treated by injections of autologous platelet-rich plasma (PRP), a hyaluronic acid preparation "Rusvisk" (Rusvisk, Russia) and their sequential combination. The results were evaluated after 10 weeks in the autopsy preparations using a light microscopy method and morphometry.
 Results. The histological signs characteristic of tendinopathy were revealed, such as the disorganization of collagen structures, mucoid and lipoid degeneration, neovascularization, lymphoid and histiocytic infiltration. The injection of PRP, hyaluronic acid, or their sequential combination in the area of simulated tendinopathy led to changes in the histological presentation of the tissue. As a result, the collagen matrix had less signs of disorganization and less pronounced degenerative changes, as well as manifestations of the inflammatory process in the peritenon and the soft tissues surrounding the tendon, in comparison with the histological profile, which was observed in micropreparations in animals with tendinopathy who had no treatment.
 Conclusion. The introduction of PRP into the area of the calcaneal tendon has reduced the manifestations of the inflammatory process, disorganization of the collagen matrix, promoted the enhancement of collagen synthesis by cells and, ultimately, the processes of tissue remodeling.

PECULIARITIES OF PERFORMING ORGAN-SAVING AMPUTATION OF THE FOOT COMBINED WITH OZONE THERAPY, LOCAL APPLICATION OF AUTOLOGOUS PLATELET-RICH PLASMA AND VACUUM SANATION OF POSTOPERATIVE WOUND IN PATIENTS WITH ISCHEMIC-GANGRENOUS FORM OF DIABETIC FOOT SYNDROM

A positive result of treatment of patients suffering from ischemic-gangrenous form ofdiabetic foot syndrome (DFS) becomes possible with an optimal choice of surgery,effective renewal of blood supply and active stimulation of tissue restoration processon the cellular level.Objective – to study efficiency of the suggested organ-saving variant of surgery combinedwith the use of a complex of auxiliary factors of a reparative process activation in thewound including regional ozone therapy, vacuum sanitation and local application ofautologous platelet-rich plasma (PRP).Material and methods. The treatment of 210 patients with ischemic-gangrenous formof diabetic foot syndrome was carried out from 2017 to 2020. The efficiency of one ofthe variants of organ-saving operative intervention was studied. In the control group -104 (49.52%), the treatment was carried out in accordance with the standard scheme.In the main group (106 patients - 50.47%), in addition to the standard scheme, regionalozone therapy, vacuum sanitation and local application of autologous-rich plasma(PRP) were carried out.Results. These measures reduced the period of treatment of patients in the hospital to24 ± 1.2 days in the main group compared to 37 ± 2, 4 in the control one. 2 years later, patients of the main group confirmed the formation of a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones.Conclusions. The suggested modification of the organ-saving and partial foot amputationin patients with IV degree of ischemia and DFS is indicative of a possibility to performsuch kind of surgery as a variant of choice for patients with ischemic-gangrenousform of diabetic foot syndrome. The complex of auxiliary measures (regional ozonetherapy, vacuum sanitation and local administration of autologous platelet-rich plasma(APRP)), activates a reparative process of healing of a chronic foot wound whichenables to make the period of hospital staying for patients shorter – to 24±1,2 days inthe main group as compared to 37±2,4 days in the control one. Clinical observation ofa remote postoperative period (2 years later) confirms a possibility to form a foot stumpfunctionally adapted for walking with angular dislocation of fragments of the cuboidand scaphoid bones, functionally advantageous for supporting load.

Комплексное лечение увеита с макулярным отеком, ассоциированного с системными заболеваниями, с использованием аутологичной плазмы, обогащенной тромбоцитами

In patients with uveitis associated with systemic diseases, a common cause of low vision is macular edema, which develops at any localization of the inflammatory process in 38–84% of cases. Autologous platelet-rich plasma is widely used in various branches of medicine, however, in the treatment of uveitis accompanied by macular edema, the clinical efficacy of its use has not been sufficiently studied. Purpose. To conduct a clinical and laboratory assessment of the effectiveness of complex treatment of uveitis with macular edema associated with systemic diseases using autologous platelet-rich plasma. Material and methods. The study included 120 people (120 eyes) from 18 to 50 years old with uveitis and macular edema associated with systemic diseases: 51 men, 69 women. Patients were divided into 2 groups: the main group consisted of patients who received anti-inflammatory treatment and administration of autologous plasma platelet-rich; comparison group – patients who received anti-inflammatory treatment. All patients underwent a comprehensive ophthalmological examination. Results. It has been established that the administration of autologous platelet-rich plasma against the background of anti-inflammatory treatment in patients with uveitis associated with systemic diseases accompanied by macular edema improves the maximally corrected visual acuity, a statistically significant decrease in the thickness of the retina in the fovea and an increase in the light sensitivity of the retina, relative to the data obtained in the comparison group. Conclusion. The use of autologous platelet-rich plasma in combination with anti-inflammatory treatment leads to a decrease in the incidence of recurrence of uveitis associated with systemic diseases, helps to reduce macular edema and improve functional parameters. Key words: uveitis, macular edema, anti-inflammatory treatment, autologous platelet-rich plasma.

Эффективность внутриматочного введения аутологичной плазмы, обогащенной тромбоцитами, для подготовки «тонкого» эндометрия к программе переноса размороженных эмбрионов

Эффективность внутриматочного введения аутологичной плазмы, обогащенной тромбоцитами, для подготовки «тонкого» эндометрия к программе переноса размороженных эмбрионов

Platelet-Rich Plasma Promotes Spinal Ligament Healing after Injury.

Spinal ligament injury is often a comorbidity in spine fracture. Although the spinal ligament is important to maintain spinal stability, little is done to improve its healing after injury. Platelet-rich plasma (PRP) has been shown effective in treating many tendon and ligament disorders, but its role in spinal ligament injury remains to be evaluated. Supraspinous ligament and interspinous ligament were cut in rabbits to simulate spinal ligament injury after spine fracture. After the injury, the administration of autologous PRP was performed and compared with saline injection control. Morphology and histological analysis were utilized to assess PRP effect and compare it to the saline control group. To understand potential molecular mechanisms of PRP on ligamentous healing, bioinfor-matics analysis of the microarray dataset (GSE70918) from the Gene Expression Omnibus database was conducted. The PRP group was more likely to have a better appearance both morphologically and histologically than did the saline control group. Pathway analysis determined that IL-17 signaling pathway and TNF signaling pathway were the two significantly induced signaling pathways in tendon fibroblasts treated by PRP. In the protein-protein interaction network analysis, interleukin 6 had the highest degrees of connectivity. PRP improves spinal ligament healing through the activation of pathways related to inflammation. Further studies are required to determine the dosing and timing of PRP administration to achieve better longterm treatment outcome.

Healing of diabetic ulcers in conditions of biological stimulation of reparation

Purpose of study. The repertory effect evaluation of autologous platelet-rich plasma in the treatment of patients with diabetic foot in stage 2.
 Materials and methods. The study included 32 patients with diagnosisof diabetic foot in stage 2. At the time of inclusion in the study, all patients had a defect of the skin and subcutaneous fat on the foot, measuring 3–6 cm2, which was not corrected by traditional methods for 3–4 months. The comparison group consisted of 18 patients (56,25%) who received standard therapy. The study group consisted of 14 patients (43,75%), to whom standard therapy was supplemented by local serial administration of autologous platelet-rich plasma. To assess the effectiveness of the therapy, the area of the ulcerative defect was measured before manipulation, as well as at 1 week intervals until the ulcer was completely healed.
 Results. Our experience with autologous platelet-rich plasma in the treatment of patients with diabetic foot in stage 2 demonstrated the effectiveness of this technique. A progressive, significant (p < 0,01) decrease in the area of the ulcerative defect starting from the 14th day was noted. When using platelet-rich plasma, we managed to achieve complete healing of diabetic ulcers in 64,2% of patients on day 35 and in 100% of patients on day 42.
 Conclusion. Local administration of an autologous platelet-rich plasma allows the complete healing of diabetic ulcers in stage 2 with an area of 3–6 cm2 for 6 weeks.

Experience of local using of platelet-rich plasma in 25 patients with diabetic foot

The aim of the study was to evaluate the effectiveness of local using of autologous platelet-rich plasma in the treatment of patients with diabetic foot in stage 2. The study included 25 patients with a diagnosis of diabetic foot in stage 2. At the time of inclusion in the study, all patients had a defect of 3–7 cm2 of the skin and subcutaneous adipose tissue in the plantar part of the foot. In addition to the standard treatment, it was decided to perform the local administration of autologous platelet-rich plasma in all patients. The entire platelet-rich plasma volume obtained was injected in the edge of skin around the wound using 30-gauge needles. Repeated injections were performed every 5–7 days until complete healing of the soft tissue defect. To evaluate the effectiveness of the treatment, the area of the ulcerative defect was measured before the manipulation, as well as at an interval of 14 days until the ulcer was completely healed. The following results are obtained: prior to the manipulation, the area of ulcerative defects in the examined population was 511.9±120.3 mm2. On the 14th day, this indicator was already 353.6±112.5 mm2 and was significantly different from the area of the ulcerative defects before manipulation (p<0.01). On the 28th day, complete healing of diabetic ulcers was observed in 11 (44%) patients, and the area of the skin defect in the study population was 22.4±24.3 mm2 and was significantly different from those in all previous study dates (p<0.01). On day 42, we noted the complete healing of ulcers in absolutely all patients. Thus, local injection of an autologous platelet-rich plasma improves the local regenerative process and leads to complete healing of stage 2 diabetic ulcers with an area of 3–7 cm2 for 6 weeks.

Use of Platelet-Rich Plasma Immediately After an Injury Did Not Improve Ligament Healing, and Increasing Platelet Concentrations Was Detrimental in an In Vivo Animal Model

Background: Limited information in basic science and clinical trials exists to determine if ligament healing may be accelerated with the use of biological adjuvants, such as platelet-rich plasma (PRP). However, there has been widespread acceptance of PRP for use in clinical practice, despite an inadequate understanding of its biological mechanism of action. Purpose: To determine whether a single dose of PRP could accelerate ligament healing and correspondingly improve histological characteristics and biomechanical properties when injected immediately postoperatively into the injured medial collateral ligament (MCL) of New Zealand White rabbits. Study Design: Controlled laboratory study. Methods: Eighty skeletally mature New Zealand White rabbits (160 knees) were used. The MCL was torn midbody to simulate a grade 3 tear. After an acute injury of the MCL, the administration of autologous PRP at 3 different platelet concentrations (0 million/uL, platelet-poor plasma [PPP]; 0.6 million/uL, 2 times the baseline [2× PRP]; and 1.2 million/uL, 4 times the baseline [4× PRP]) was performed and compared with a saline injection control in the contralateral knee. Histological analysis and a biomechanical endpoint characterization were utilized to assess ligamentous healing and compare it to a sham surgery group. Results: The PPP (P = .001) and 4× PRP (P = .002) groups had a significantly lower collagen subscore than the sham surgery group. No other differences were observed among the treatment groups, including the vascularity subscore and overall ligament tissue maturity index score. Compared with saline-injected contralateral knees, the maximum load for PPP and 2× PRP was not significantly different (P = .788 and .325, respectively). The maximum load and stiffness for knees treated with 4× PRP were significantly less than for the saline-treated contralateral knees (P = .006 and .001, respectively). Conclusion: One single dose of PPP or 2× PRP at the time of injury did not improve ligament healing. In addition, 4× PRP negatively affected ligament strength and histological characteristics at 6 weeks after the injury. Clinical Relevance: The current practice of treating knee ligament injuries with PRP may not improve healing at low doses of PRP. The decreased mechanical properties and histological appearance of the torn MCL suggest that high doses of PRP decrease the quality of repair tissue. Further in vivo studies are necessary to determine the dosing and timing of PRP administration after a ligament injury before the widespread use of PRP to treat ligament injuries is recommended.

Successful pregnancy and live birth after intrauterine administration of autologous platelet-rich plasma in a woman with recurrent implantation failure: A case report

Platelets contain a significant amount of growth factors that have positive effects on local tissue repair and endometrial receptivity. Here we present a 45-yr-old woman with primary infertility and two failed in vitro fertilization (IVF) cycles who was candidate to receive donor eggs. Five consecutive frozen-thawed embryo transfer cycles with good quality embryos were performed within 2 yr. With the diagnosis of recurrent implantation failure (RIF), the patient was treated for improving endometrial receptivity with intrauterine administration of autologous platelet-rich plasma (PRP), 24 hr before embryo transfer. The patient gave birth to a healthy baby boy weighing 2350 gr in the cesarean section. Extensive literature search suggests that this is the first successful pregnancy after administration of PRP in a woman with RIF. Local administration of PRP before embryo transfer may play a vital role in successful implantation .

Gait Changes Vary among Horses with Naturally Occurring Osteoarthritis Following Intra-articular Administration of Autologous Platelet-Rich Plasma.

Mechanisms to reduce lameness associated with osteoarthritis (OA) are vital to equine health and performance. This study was designed to quantify response to autologous, intra-articular platelet-rich plasma (PRP) in horses with OA. Kinetic gait analysis was performed on 12 horses with unilateral forelimb lameness and OA in the same limb before and after intra-articular anesthesia (IAA). Radiographs and kinetic data were obtained before and 6 and 16 weeks after PRP administration to same joint, 4 weeks after IAA. Statistical evaluations included filtration effect on platelet concentration, relationship between kinetic variable changes after IAA versus PRP in the affected limb, and associations between response to PRP and response to IAA, platelet concentration, and radiographic OA. A positive response to IAA or PRP was defined as ≥5% improvement in peak vertical force, vertical impulse, or breaking impulse of the affected limb. Out of 10 horses that responded to IAA, 3 responded to PRP at both time points and 4 responded at one. Of the two horses that did not respond to IAA, one responded to PRP at both time points. Filtration increased platelet concentration significantly. The relationship between kinetic variable alterations of the affected limb after IAA and PRP was not significant, and response to PRP was not associated with response to IAA, platelet concentration, or radiographic OA. Changes in kinetic variables following IAA in joints with naturally occurring OA provide a custom standard to assess intra-articular therapy. Kinetic gait changes after intra-articular PRP are variable in horses with moderate to severe forelimb OA.

Experimental Morphologic and Clinical Substantiation of Autothrombocytic Growth Factors in Complex Treatment of Achilles Tendon Rupture

Study of the influence of autothrombocytic growth factors upon the injured tendinous tissue was performed. Experimental results (60 Chinchilla rabbits, 3—5 kg) showed that administration of autologous platelet-rich plasma (PRP) into Achilles tendon (AT) injury zone promoted activiza- tion of reparative processes with diminution of inflammatory manifestations; increase in angio- genesis, proliferative and synthetic fibroblasts activity, fibrillogenesis processes; earlier tendon healing. Clinical study included 57 patients (33—68years) with acute (8—48 hours) and old (1—12 months) AT ruptures. After AT surgical reconstruction(Cuneo tendon sutures in acute AC ruptures and Chernavsiautoplasty in the old ones) PRP was additionally administrated to 30 patients from the main group. Treatment results were evaluated by J. Leppilahti and AOFAS scales in 4 months after surgical intervention. In no one patient from the main group AT reruptures were recorded while in control groupreruptures were recorded in 26% of patients.

Local administration of autologous platelet-rich plasma in a female patient with skin ulcer defect

The paper describes a clinical observation of the efficiency of local therapy with autologous platelet-rich plasma for .skin ulcer defect in a female with chronic lymphocytic leukemia

New therapeutic approaches for management of sport-induced muscle strains

Muscle strains are one of the most common sports-induced injuries. Depending on the severity and location of the muscle strain, different treatment approaches can be taken. This review highlights recent trends in conservative, pharmacologic, and surgical approaches to the management of sports-induced muscle injuries as presented at a symposium held during the 93rd Annual Congress of the Italian Society of Orthopedics and Traumatology (SIOT) in Rome, Italy in November 2008. Conservative approaches now include growth factor therapy and administration of autologous platelet-rich plasma during the early postinjury period; however, its use is currently considered a doping violation under the World Anti-Doping Agency code, therefore restricting its use to nonelite sports people only. Topical anti-inflammatory therapy is a promising therapeutic strategy, since it allows local analgesic and anti-inflammatory effects while minimizing systemic adverse events. As the drug delivery system is critical to clinical effectiveness, the advent of a new delivery system for ketoprofen via a new-generation plaster with a marked increase in tissue penetration and a clinical efficacy comparable with that of oral administration, provides a viable option in the treatment of single sport lesions. Surgical treatment of muscle lesions is less common than conservative and topical therapies and indications are limited to more serious injuries. Presentations from SIOT 2008 show that advances in our understanding of the healing process and in conservative, pharmacologic, and surgical treatment approaches to the management of sports-induced muscle strains contribute to better clinical outcomes, faster healing, and a swifter return to normal training and activity levels.