Autologous Blood-derived Product Research Articles

Platelet-rich plasma in the management of rotator cuff tendinopathy.

Platelet-rich plasma (PRP) is an autologous blood-derived product that has gained significant attention in the treatment of tendinopathies as one of many treatment modalities in the field of regenerative medicine. Rotator cuff pathologies are the leading cause of shoulder pain. Despite the high success rate with conservative treatment and arthroscopic surgical repair, the search for a nonsurgical treatment has made PRP a trending topic recently. The purpose of this article is to review the recent literature data on the possible role of PRP in different rotator cuff pathologies. The limited data in the literature about isolated tendinopathies without a tear (tendonitis and tendinosis) suggests potential benefit from conservative treatment with PRP. Many studies exist for the treatment of rotator cuff tears solely using PRP or as an augmentation to arthroscopic repair. Despite the large number of randomized clinical trials and meta-analyses about the topic, there is no consensus in favor of routine application of PRP in this patient population. The existing reliable evidence of benefit seems to be restricted to its use in only inflammatory tendinopathies with preserved tendon integrity.

Autologous Blood-Derived Products (ABDPs) for the Treatment of Chronic Wounds.

Autologous blood-derived therapies have emerged as a unique and promising treatment option for chronic wounds. From whole blood clots to spun-down clot constituents, these therapies are highly versatile and tend to have a lower cost profile, allow for point-of-service preparation, and inherently carry minimal to no risk of rejection or allergic reaction when compared to many alternative cellular and matrix-like products. Subsequently, a diversity of processing systems, devices, and kits have surfaced on the market for preparing autologous blood-derived products (ABDPs) and many have demonstrated preclinical and clinical efficacy in facilitating chronic wound healing. However, not all ABDPs are created equal, and the lack of standardization among product formulations and cell concentrations as well as varying complexities in preparation protocols has led to unreliable substrate viabilities and overall inconsistent conclusions on efficacy. Additionally, external factors, such as the ease of drawing blood, the health of a patient's blood, and the reimbursement landscape have dissuaded some practitioners from incorporating ABDPs into an algorithm of care for recalcitrant wounds. Here, we attempt to categorize ABDPs into "classes" and examine their efficacy, advantages, and limitations when used as both a primary therapy and an adjunct for treating chronic wounds as well as comment on some potential considerations that may help gear future product development and application.

Blood Collection for Autologous Blood-Derived Product Preparation: Technique and Application

Background: In periodontics, interest in use of autologous blood-derived products (ABPs) has increased due to demonstrated safety, enhanced initial healing, and for some applications, superior clinical outcomes. Periodontists commonly place peripheral intravenous catheters for moderate sedation, thus encountering opportunities to utilize ABPs routinely. The purpose of this report is to describe a safe blood collection technique for ABP preparation and define typical blood volume requirements for periodontal procedures. Methods: Five cases requiring various amounts of liquid and membrane-formed platelet-rich fibrin are presented. Case 1 involves treatment of an infrabony periodontal defect. Case 2 illustrates alveolar ridge preservation at a maxillary right second premolar site. Case 3 demonstrates repair of a defect related to nasopalatine duct cyst removal. Cases 4 and 5 illustrate the use of PRF in sinus elevation and root coverage, respectively. Results: Use of PRF in the presented cases added minimal procedural time and expense. Blood samples varied from 20 to 60 ml in volume. There were no complications related to blood collection or use of PRF. Each patient reported minimal discomfort limited to the first few postoperative days. Favorable early healing was observed in each case. Conclusions: The blood collection method described in this report, which is consistent with published standards of practice, necessitates few additional steps and supplies for practitioners already placing peripheral intravenous catheters. Blood volumes necessary for typical procedures in periodontics are safe and well below maximum attainable samples.

Autologous Blood-Derived Products for Chronic Nonhealing Wounds: Journey to Successful Reimbursement.

Autologous Blood-Derived Products for Chronic Nonhealing Wounds: Journey to Successful Reimbursement.

Effect of PRF on extraction socket healing

Extraction socket healing is a critical process in dental care that determines the success of subsequent dental treatments, such as implant placement. Platelet-rich fibrin (PRF) has emerged as a promising biomaterial for enhancing wound healing in various medical and dental applications. This abstract aims to provide a comprehensive overview of the effect of PRF on extraction socket healing, with a particular focus on the sample size of studies conducted in this area. PRF is an autologous blood-derived product rich in growth factors, cytokines, and platelets, which play key roles in tissue repair and regeneration. When applied to extraction sockets, PRF promotes accelerated wound healing by stimulating angiogenesis, enhancing cell proliferation, and modulating the inflammatory response. These biological effects contribute to improved soft tissue healing and osseous regeneration. A thorough review of the literature reveals that several studies have investigated the effect of PRF on extraction socket healing, with varying sample sizes. Sample sizes ranged from small-scale studies with fewer than 20 participants to larger-scale investigations involving over 100 subjects. The inclusion of sufficient sample size is crucial for obtaining statistically significant results and ensuring the generalizability of findings.

Comparisons of Cytokines, Growth Factors and Clinical Efficacy between Platelet-Rich Plasma and Autologous Conditioned Serum for Knee Osteoarthritis Management

This study aimed to directly compare the contents and the clinical efficacy of the two autologous blood-derived products, platelet-rich plasma (PRP) and autologous conditioned serum (ACS) for osteoarthritis (OA) treatment. The contents of standard-prepared PRP and ACS prepared at 37 °C for 1 h, 3 h, 6 h, and 24 h from healthy volunteers were compared. The clinical efficacy of pain relief in patients with Stage III knee OA was evaluated by a patient-reported visual analog scale (VAS) pain rating. PDGF-BB levels in ACS 1 h were significantly higher than those in PRP, and the levels in ACS preparations remained stable. IGF-1 level of ACS 24 h showed a significant increase compared to those of other ACS preparations and PRP. ACS 3 h showed a turning of IL-1Ra level and revealed a time-dependent increase up to 24 h. ACS 6 h showed a turning increase in TNF-α levels. ACS 3 h was chosen for clinical comparison with PRP. The reduction in pain VAS in the ACS group was significantly more compared to those of the PRP group (p = 0.028). However, PRP showed significant earlier improvement (p < 0.001). Conclusion: ACS contained higher levels of PDGF-BB and IL-1Ra and provided better improvement in pain relief compared to PRP.

Autologous Platelet-rich Plasma for the Treatment of Nonhealing Perineal Wounds: A Report of Two Cases

Introduction. Patients with perineal wounds often encounter difficulty in local wound healing after hemorrhoidectomies. PRP contains a high concentration of platelets and has been used to improve wound healing. Objective. In this case study, PRP was used in the treatment of nonhealing perineal wounds to expedite wound healing. Case Reports. The 2 patients in these cases suffered from perineal wounds that were nonhealing for more than 2 months. After assessment of their physical condition, autologous PRP was used in the treatment of both patients. A total of 150 mL of peripheral blood was collected from each patient to prepare autologous PRP in a completely enclosed environment. For one patient, the PRP product was injected subcutaneously around the wound. The rest of the PRP product was activated into a gel by thrombin and calcium chloride, and the gel was applied to the surface of the wound with dressing changes every 5 days. The other patient was externally treated with autologous PRP gel, and dressing changes were administered after a week. The 2 patients were treated twice with PRP, and both completely recovered within 2 weeks without any other treatment. Conclusion. As an autologous blood-derived product, PRP was safe and showed promising results in perineal wound healing.

Efficacy of biologics in root coverage and gingival augmentation therapy: An American Academy of Periodontology best evidence systematic review and network meta-analysis.

The aim of this systematic review was to assess the efficacy of three biologics, namely autologous blood-derived products (ABPs), enamel matrix derivatives (EMD) and recombinant human platelet-derived growth factor BB (rhPDGF-BB), in root coverage and gingival augmentation therapy. The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021285917). After study selection, data of interest were extracted. A network meta-analysis (NMA) was conducted to assess the effect of different surgical interventions on the main clinical outcomes of interest (i.e., mean root coverage [MRC%], complete root coverage [CRC%], keratinized tissue width [KTW], gingival thickness [GT] change, and recession depth [RD] reduction). A total of 48 trials reported in 55 articles were selected. All studies reported on the treatment of gingival recession defects for root coverage purposes. Forty-six treatment arms from 24 trials were included in the NMA. These arms consisted of treatment with coronally advanced flap (CAF) alone, EMD+ CAF, platelet-rich fibrin (PRF)+ CAF, and subepithelial connective tissue graft (SCTG)+ CAF. Regarding MRC%, SCTG+CAF was associated with a significant higher estimate (13.41%, 95% CI [8.06-18.75], P< 0.01), while EMD+CAF (6.68%, 95% CI [-0.03 to 13.4], P=0.061) and PRF+CAF (1.03%, 95% CI [-5.65 to 7.72], P=0.71) failed to show statistically significant differences compared with CAF alone (control group) or with each other. Similarly, only SCTG+CAF led to a significantly higher CRC% (14.41%, 95% CI [4.21 to 24.61], P<0.01), while treatment arms EMD+ CAF (13.48%, 95% CI [-3.34 to 30.32], P=0.11) and PRF+CAF (-0.91%, 95% CI [-15.38, 13.57], p=0.81) did not show significant differences compared with CAF alone or with each other. Differences in the CI of PRF+CAF (symmetrical around a zero adjunctive effect) and EMD+CAF (non-symmetrical) suggest that EMD could have some additional value compared with PRF. Treatment with SCTG+CAF led to a statistically significant higher RD reduction (-0.39mm, 95% CI [-0.55 to 0.22], P<0.01), however EMD+CAF (-0.13mm, 95% CI [-0.29 to 0.01], P=0.08) and PRF+CAF (-0.06mm, 95% CI [-0.23 to 0.09], P=0.39) failed to show significant differences compared with CAF or with each other. While SCTG+CAF was associated with a statistically significant higher gain of KTW (0.71mm, 95% CI [0.48 to 0.93], P<0.01), EMD+CAF (0.24mm, 95% CI [-0.02 to 0.51], P=0.08) and PRF+CAF (0.08mm, 95% CI [-0.23 to 0.41], P=0.58) did not result into significant changes compared with CAF alone or with each other. Regarding the use of rhPDGF-BB+CAF, although available studies have reported equivalent results compared with SCTG+CAF, evidence is very limited. The use of ABPs, EMD, or rhPDGF-BB in conjunction with a CAF for root coverage purposes is safe and generally promotes significant improvements respective to baseline clinical parameters. However, the adjunctive use of ABPs and EMD does not provide substantial additional improvements in terms of clinical outcomes and patient-reported outcome measures to those achieved using CAF alone, when baseline KTW is >2mm. Both PRF+CAF and EMD+CAF rendered inferior MRC%, CRC%, RD reduction, and KTW gain compared with SCTG+CAF, which should still be considered the gold-standard in root coverage therapy. Although some studies have reported equivalent results for rhPDGF-BB+CAF compared with the gold-standard intervention, limited evidence precludes formal comparisons with CAF or SCTG+CAF that could be extrapolated to guide clinical practice.

American Academy of Periodontology best evidence consensus statement on the use of biologics in clinical practice.

A biologic is a therapeutic agent with biological activity that is administered to achieve an enhanced regenerative or reparative effect. The use of biologics has progressively become a core component of contemporary periodontal practice. However, some questions remain about their safety, indications, and effectiveness in specific clinical scenarios. Given their availability for routine clinical use and the existing amount of related evidence, the goal of this American Academy of Periodontology (AAP) best evidence consensus (BEC) was to provide a state-of-the-art, evidence-based perspective on the therapeutic application of autologous blood-derived products (ABPs), enamel matrix derivative (EMD), recombinant human platelet-derived growth factor BB (rhPDGF-BB), and recombinant human bone morphogenetic protein 2 (rhBMP-2). A panel of experts with extensive knowledge on the science and clinical application of biologics was convened. Three systematic reviews covering the areas of periodontal plastic surgery, treatment of infrabony defects, and alveolar ridge preservation/reconstruction and implant site development were conducted a priori and provided the foundation for the deliberations. The expert panel debated the merits of published data and exchanged experiential information to formulate evidence-based consensus statements and recommendations for clinical practice and future research. Based on an analysis of the current evidence and expert opinion, the panel concluded that the appropriate use of biologics in periodontal practice is generally safe and provides added benefits to conventional treatment approaches. However, therapeutic benefits and risks range based on the specific biologics used as well as patient-related local and systemic factors. Given the limited evidence available for some indications (e.g., gingival augmentation therapy, alveolar ridge preservation/reconstruction, and implant site development), future clinical studies that can expand the knowledge base on the clinical use of biologics in periodontal practice are warranted.

Activated Platelet Rich Plasma versus Non-Activated Platelet Rich Plasma in the Treatment of Alopecia Areata

Introduction: Alopecia areata is a common recurrent T cell-mediated autoimmune-induced non-scarring hair loss with not fully understood pathogenesis. It affects nearly 2% of the general population during lifetime. The course of the disease is unpredictable, and currently no treatment is available for complete cure or prevention. Platelet rich plasma (PRP) is an autologous blood-derived product, which has widely spread in the last decades for treatment of different dermatological conditions including hair disorders. Methods: The aim of this work was to evaluate the efficacy and safety of activated PRP in comparison to non-activated PRP in the treatment of alopecia areata. This study was conducted on two groups of 20 subjects each who received 4 treatments of intradermal injection of activated and non-activated PRP. Results and Conclusion: Data obtained in our research confirm that PRP is safe, effective, and well tolerated by patients as a treatment modality for alopecia areata. Besides, such a method is cost-effective as there is no need for any expensive tools for preparation and it can be done in outpatient clinics. Also, activation of PRP prior to injection is not mandatory as there was no statistically significant difference between both groups.

A Novel Method for the Production of an Autologous Anti-Inflammatory and Anti-Catabolic Product (Cytorich) from Human Blood: A Prospective Treatment for the COVID-19-Induced Cytokine Storm.

BackgroundAutologous blood-derived products can target specific inflammatory molecular pathways and have potentially beneficial therapeutic effects on inflammatory pathologies. The purpose of this study was to assess in vitro the anti-inflammatory and anti-catabolic potential of an autologous blood product as a possible treatment for COVID-19-induced cytokine storm.Material/MethodsBlood samples from healthy donors and donors who had recovered from COVID-19 were incubated using different techniques and analyzed for the presence of anti-inflammatory, anti-catabolic, regenerative, pro-inflammatory, and procatabolic molecules.ResultsThe highest concentrations of therapeutic molecules for targeting inflammatory pathways were found in the blood that had been incubated for 24 h at 37°C, whereas a significant increase was observed after 6 h of incubation in blood from COVID-19-recovered donors. Beneficially, the 6-h incubation process did not downregulate anti-COVID-19 immunoglobulin G concentrations. Unfortunately, increases in matrix metalloproteinase 9, tumor necrosis factor α, and interleukin-1 were detected in the product after incubation; however, these increases could be blocked by adding citric acid, with no effect on the concentration of the target therapeutic molecules. Our data allow for safer and more effective future treatments.ConclusionsAn autologous blood-derived product containing anti-inflammatory and anti-catabolic molecules, which we term Cytorich, has a promising therapeutic role in the treatment of a virus-induced cytokine storm, including that associated with COVID-19.

Utility of platelet-rich plasma in aesthetics

Platelet-rich plasma (PRP) has expanded its therapeutic applications into the field of aesthetic medicine. PRP is an autologous blood-derived product with an increased concentration of platelets to plasma relative to that of whole blood, which supports its therapeutic effects. Frequently promoted and marketed directly to consumers and patients, clinicians are often questioned on the efficacy and safety of PRP as a therapeutic modality. Given the rise in popularity of PRP, multiple clinical trials have been conducted to assess its application within the field of aesthetic medicine, particularly for hair loss conditions, skin rejuvenation, scarring, and conditions of dyspigmentation. We have reviewed the relevant research about the utility of PRP and associated evidence-based practices and discuss the direction for future research.

In vitro responses to platelet-rich-plasma are associated with variable clinical outcomes in patients with knee osteoarthritis

Autologous blood-derived products such as platelet-rich plasma (PRP) are widely used to treat musculoskeletal conditions, including knee osteoarthritis (OA). However, the clinical outcomes after PRP administration are often variable, and there is limited information about the specific characteristics of PRP that impact bioactivity and clinical responses. In this study, we aimed to develop an integrative workflow to evaluate responses to PRP in vitro, and to assess if the in vitro responses to PRP are associated with the PRP composition and clinical outcomes in patients with knee OA. To do this, we used a coculture system of macrophages and fibroblasts paired with transcriptomic analyses to comprehensively characterize the modulation of inflammatory responses by PRP in vitro. Relying on patient-reported outcomes and achievement of minimal clinically important differences in OA patients receiving PRP injections, we identified responders and non-responders to the treatment. Comparisons of PRP from these patient groups allowed us to identify differences in the composition and in vitro activity of PRP. We believe that our integrative workflow may enable the development of targeted approaches that rely on PRP and other orthobiologics to treat musculoskeletal pathologies.

Wnt5a/Platelet-rich plasma synergistically inhibits IL-1β-induced inflammatory activity through NF-κB signaling pathway and prevents cartilage damage and promotes meniscus regeneration.

Noncanonical Wnt5a is a particularly attractive growth factor to maintain chondrogenesis. Platelet-rich plasma (PRP) is an autologous blood-derived product and a source of bioactive growth factors involved in tissue regeneration. The present study aimed to investigate the effect and inflammation reaction of Wnt5a/PRP on meniscus cells, and evaluate meniscus regeneration and osteoarthritis (OA) prevention by the application of Wnt5a/PRP gel in a rabbit model of massive meniscal defect. In vitro, the proliferation, migration, differentiation, and interleukin-1 beta (IL-1β) IL-1β-induced inflammation reaction of meniscus cells treated by Wnt5a and PRP was assessed. In vivo, the anterior half of the medial meniscus of 18 New Zealand rabbits was excised and implanted with PRP gel, Wnt5a/PRP gel or untreated. After 6 and 12weeks, the regenerated meniscus were evaluated. Wnt5a can promote the migration of meniscus cells. PRP and Wnt5a had synergistic effect in promoting the proliferation and chondrogenic differentiation of meniscus cells. The IL-1β-induced meniscus cells study showed that PRP and Wnt5a had the anti-inflammatory actions through nuclear factor kB (NF-κB) signaling pathway. PRP and Wnt5a/PRP significantly inhibited the increase of the p-p65/p65 and p-IκB-α/IκB-α ratios. In vivo transplantation of Wnt5a/PRP gel was demonstrated to promote meniscus regeneration, while reducing OA of knee joint. Wnt5a with PRP had the anti-inflammatory activity in an IL-1β-induced inflammatory model. They can synergistically improve the chondorgenic differentiation of meniscus cells. Wnt5a/PRP gel treatment could potentially be developed into a new method for meniscus regeneration and the prevention of OA.

Platelet-rich plasma vs bone marrow aspirate concentrate: An overview of mechanisms of action and orthobiologic synergistic effects.

The use of orthobiologics as a novel therapy for the treatment of numerous musculoskeletal disorders has increased considerably over the past decade. Currently, there are multiple alternatives available as suitable treatments; however, the use of autologous blood-derived products such as platelet-rich plasma (PRP), bone marrow aspirate (BMA) and BMA concentrate (BMAC), specifically, is expanding. Although many investigations attempted to demonstrate the effectiveness of these therapies, even with positive results, the literature lacks standardized protocols and overall accuracy in study designs, which leads to variance and difficulty in reproducibility of protocols. The efficacy of PRP for the treatment of cartilage, bone and muscle tissues is well known. Although BMAC has generated optimistic results for the same purposes, its applicability in clinical trials is still relatively recent when compared to PRP. Both products demonstrate the potential to set forth reparative processes, each in their own distinct mechanism. The combination of these biological products has been previously proposed, yet little is known about their synergism. Evidence indicates that growth factor, cytokine, and chemokine profiles seen in both PRP and BMAC vary but are likely to work synergistically to enhance musculoskeletal healing. BMAC products seem to work well without PRP; however, the addition of PRP to BMAC has been shown to act as a rich and natural source of culture medium for stem cells located either peripherally or in the bone marrow itself. Nevertheless, additional variables associated with the use of BMAC and PRP in orthopedics must be further evaluated in order to consolidate the efficacy of this therapeutic strategy.

Vénás lábszárfekély sikeres kezelése vérlemezkében gazdag fibrin segítségével

The autologous platelet-rich blood derivatives have been used in bioregenerative medicine for decades in various indications including the facilitation of wound healing. Leukocyte- and platelet-rich fibrin (PRF) is a second-generation autologous blood-derived product, which can be obtained relatively easily and at low cost. PRF is rich in growth factors and antimicrobial proteins that are released by activated platelets and leukocytes. The authors present a successful treatment of a venous leg ulcer providing a detailed presentation of the PRF method.

Characterization and Chondroprotective Effects of Extracellular Vesicles From Plasma- and Serum-Based Autologous Blood-Derived Products for Osteoarthritis Therapy.

Autologous blood products gain increasing interest in the field of regenerative medicine as well as in orthopedics, aesthetic surgery, and cosmetics. Currently, citrate-anticoagulated platelet-rich plasma (CPRP) preparations are often applied in osteoarthritis (OA), but more physiological and cell-free alternatives such as hyperacute serum (hypACT) are under development. Besides growth factors, blood products also bring along extracellular vesicles (EVs) packed with signal molecules, which open up a new level of complexity at evaluating the functional spectrum of blood products. Large proportions of EVs originated from platelets in CPRP and hypACT, whereas very low erythrocyte and monocyte-derived EVs were detected via flow cytometry. EV treatment of chondrocytes enhanced the expression of anabolic markers type II collagen, SRY-box transcription factor 9 (SOX9), and aggrecan compared to full blood products, but also the catabolic marker and tissue remodeling factor matrix metalloproteinase 3, whereas hypACT EVs prevented type I collagen expression. CPRP blood product increased SOX9 protein expression, in contrast to hypACT blood product. However, hypACT EVs induced SOX9 protein expression while preventing interleukin-6 secretion. The results indicate that blood EVs are sufficient to induce chondrogenic gene expression changes in OA chondrocytes, while preventing proinflammatory cytokine release compared to full blood product. This highlights the potential of autologous blood-derived EVs as regulators of cartilage extracellular matrix metabolism and inflammation, as well as candidates for new cell-free therapeutic approaches for OA.

The Comparative Effectiveness of Autologous Blood-derived Products Versus Steroid Injections in Plantar Fasciitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Plantar fasciitis is one of the most common musculoskeletal diseases, and nearly 90% of patients can be successfully treated by nonsurgical options. However, it is yet to be determined which nonsurgical treatment has the best efficacy. The present study investigated differences between autologous blood-derived products and corticosteroid injections in the treatment of plantar fasciitis. TYPE: Systematic Review and Meta-analysis. PubMed, EMBASE, CINAHL, and Web of Science were searched for relevant articles up to November 2019. There was no language restriction, and unpublished trials were excluded. This systematic review included only randomized controlled trials. The primary outcomes were Visual Analog Scale and American Orthopedic Foot and Ankle Score (AOFAS). The follow-up times were divided into short term (3-6 weeks), intermediate term (3 months or 12 weeks), and long term (6 months or 24 weeks). The random-effects model was utilized, and weighted mean difference was calculated as the pool estimates. Thirteen randomized controlled trials and 640 patients were included. No significant difference in Visual Analog Scale reduction was observed between autologous blood-derived product and corticosteroid injections in the short term (weighted mean difference [WMD] = -0.84; 95% confidence interval [CI], -1.71 to 0.03; P = .057), intermediate term (WMD = -0.24; 95% CI, -0.90 to 0.42; P = .475), and long term (WMD = 0.47; 95% CI, -0.72 to 1.65; P = .44). No significant difference in AOFAS was observed between autologous blood-derived products and corticosteroids in the short term (WMD = -0.65; 95% CI, -5.40 to 4.10; P = .79), intermediate term (WMD = 0.17; 95% CI, -8.07 to 8.41; P = .97), and long term (WMD = 1.16; 95% CI, -4.54 to 6.86; P = .69). This systematic review and meta-analysis of autologous blood-derived products versus corticosteroids for plantar fasciitis is the first that includes only randomized controlled trials. The meta-analysis found no significant difference between autologous blood-derived products and corticosteroids, as measured by Visual Analog Scale or AOFAS. These findings applied whether followed up in short, intermediate, or long term. These results differ from previous studies that showed superior efficacy of autologous blood-derived products compared with corticosteroids in the long term.

Functional capacities of extracellular vesicle micro-RNA in autologous blood-derived products

Purpose: Autologous blood-derived products have been applied in osteoarthritis therapy for over a decade, however, the mechanisms of action still remain unclear. Traditionally, research has focused on growth factors present in blood products to explain clinical outcomes, but in recent years, there is growing evidence that extracellular vesicles (EVs) are genuinely responsible for the regenerative potential of blood-derived products. EVs are nano-sized membrane particles of around 50-800nm that are generated by a plethora of cells and are found in all body fluids.

Combined intralesional triamcinolone acetonide and platelet rich plasma versus intralesional triamcinolone acetonide alone in treatment of keloids

Background Keloids are benign fibro-proliferative growths occurring after skin injury or spontaneously. Intralesional triamcinolone acetonide (TA) is their first-line therapy, but commonly associated with side effects or recurrence. Platelet rich plasma (PRP) is an autologous blood-derived product with promising results in improving wound healing with lower keloid occurrence. Objective To compare the efficacy of combined intralesional TA and PRP versus TA alone in keloids treatment. Methods Forty patients with keloids were divided randomly into two equal groups (A and B). Both groups received intralesional TA (20 mg/ml) for four sessions, 3 weeks apart. Group A patients received additional intralesional PRP 1 week after TA injections. Evaluation was done after 3 months of follow up by Vancouver scar scale (VSS) and verbal rating scale (VRS) for pain and itching. Results Both groups showed significant improvement in all parameters of VSS and VRS in comparison with baseline. Significantly better improvement in height, pigmentation, and pliability and overall VSS was detected in patients of group A. A significantly higher incidence of post-TA atrophy and hypopigmentation was observed in group B. Conclusion Combining intralesional PRP with TA could yield cosmetically better outcomes in keloid treatment with lower incidence of TA-induced side effects especially atrophy and hypopigmentation.