Why platelet functionality is key to superior PRP results
By definition, platelet rich plasma (PRP) is blood plasma with a higher concentration of platelets than the baseline (< 1X to >10X). These concentrated platelets contain special proteins including growth factors, chemokines and cytokines that are not only pivotal in the repair and regeneration of tissues but also in initiating new blood vessel formation and connective tissue repair.
However, to only use the definition of an increase in platelets and their concentration above the baseline, is a very gross description of PRP and does not accurately describe the many variables of successful PRP therapy.
Although PRP has been used for several decades spanning a variety of medical applications, there is also a wide variation in the reported protocols for standardisation and preparation of PRP.
Platelet quality and functionality are integral to successful PRP results, and a higher concentration of platelets does not necessarily mean higher quality plasma and better results. With so many systems offering PRP preparation, it becomes more crucial than ever to invest in a best-in-class PRP system backed by clinical studies of all the variables of PRP and not just platelet concentration.
Does a higher concentration of platelets lead to better results?
Platelet count is the first variable to consider. It has been touted that a higher platelet count would yield more growth factors and better clinical results, however this is not the case and may actually have an inhibitory e ect. In vitro findings1-4 have shown too high a platelet concentration (> 5X) can have a deleterious effect on cells and even induce cell death (apoptosis), while optimal results were obtained with PRP with platelet concentration close to the physiological value (1 to 3X).
In animal studies5-7 increasing platelet concentration either did not further improve the results or induced unwanted inhibitory and cytotoxic effects.
In clinical studies8-9 PRP with 1 to 3 X concentrations of platelets showed more robust healing rates than those with higher concentrations (3 to 8X) in a study on wounds. Regen PRP (1.6X) has been shown to be therapeutically efficient in more than 70 publications, on more than 2000 patients, for different clinical indications such as wound care, skin care, sexual medicine, ophthalmology, dentistry, maxillo-facial surgery, otorhinolaryngology, neural and spine surgery, sports medicine and orthopedic surgery.
In addition, by increasing platelet concentration, much of the platelet-poor plasma (PPP) is discarded, meaning precious plasma molecules, including IGF, which is an important growth factor for all tissues, is absent.
Interestingly, absolute platelet count also varies depending on the individual patient. Two patients given the same concentration methods may end up with a radically different concentration of platelets and growth factors.
What’s left out is important, too
The presence or absence of PRP cellular contaminants is a crucial determinant of the success of PRP. Minimising red blood cells and white blood cells is arguably more important than maximising platelet numbers with respect to decreasing inflammation and enhancing matrix gene synthesis.
Regen Lab has an extremely low red blood cell contamination and white blood cell content, with <97% neutrophil depletion. Platelet recovery is more than 80% with the Regen Lab PRP system.
All PRP is not created equal
As the use of PRP has grown, so has the demand for, and availability of, PRP–concentrating machines and methods. There are also doctors who ‘homemade-harvest’ PRP rather than use one of the systems developed for this purpose. The basic differences among these various methods are: the amount of concentration of platelets and the presence and number of red or white blood cells.
Platelet quality and functionality is imperative. The preparation process of some systems may not recover the larger platelets (that have been shown to be more active and release more chemokines than smaller platelets10-11), damage the platelet, alter their functionality and induce unspecific release of growth factors. Performance tests have demonstrated that platelets isolated with Regen Lab devices are fully functional.
Regen PRP platelets are able to respond to specific ADP activation by an increased expression of P-selectin, aggregate in presence of collagen and resist hypotonic stress. Platelets recovered with some competitor PRP devices are more fragile and thus have lower resistance in time to hypotonic stress than Regen PRP platelets.
Comparative studies have shown that Regen PRP obtains quality large dense platelets. The content in growth factor per platelet is higher in Regen PRP than in competitor systems. Regen PRP yields quality platelets with full functionality in physiological conditions (pH 7) with virtually no undesired cellular contaminants in the highly therapeutic domain in which Regen PRP has been tested.
Regen Lab was the first to market PRP in the Australian aesthetic arena in 2007. Now, with well over 162 clinical studies backing it, Regen PRP is a proven PRP system using optimal concentrations and offering consistent results you can rely on. AMP
- Graziani, F. et al. The in vitro effect of different PRP concentrations on osteoblasts and broblasts. Clin. Oral. Impl. Res. 2006; 17:212–219.
- Mazzocca, A. D., M. B. McCarthy, et al. The positive e ects of di erent platelet-rich plasma methods on human muscle, bone, and tendon cells. Am J Sports Med 2012; 40(8): 1742-1749.
- Yoshida, R., M. Cheng, and M.M. Murray, Increasing platelet concentration in platelet- rich plasma inhibits anterior cruciate ligament cell function in three-dimensional culture. J Orthop Res, 2014. 32(2): p. 291- 5.
- Atashi, F, Jaconi ME, Pittet-Cuenod B, Modarressi A. Autologous platelet-rich plasma: a biological supplement to enhance adipose-derived mesenchymal stem cell expansion. Tissue Eng Part C Methods 2015;21:253-62.
- Fleming, B.C., et al., Increased platelet concentration does not improve functional graft healing in bio-enhanced ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2014.
- Weibrich, G. et al., E ect of platelet concentration in platelet-rich plasma on peri-implant bone regeneration. Bone 2004; 34:665-671.
- Yamaguchi, R. al., E ects of Platelet-Rich Plasma on Intestinal Anastomotic Healing in Rats: PRP Concentration is a Key Factor. J Surg Res. 2012 Apr;173(2):258-66.
- Rappl, L.M. et al. E ect of platelet-rich plasma gel in a physiologically relevant platelet concentration on wounds in persons with spinal cord injury. Int Wound J 2011; 8:18.7–195.
- Papalia, R., et al., Intra-Articular injections for degenerative cartilage lesions of the knee: platelet rich plasma vs hyaluronic acid. Muscles Ligaments Tendons J, 2012. 2(3 – Suppl): p. 67.
- Corash L, Tan H, Gralnick HR. Heterogeneity of human whole blood platelet subpopulations. I. Relationship between buoyant density, cell volume, and ultrastructure. Blood 1977;49:71-87.
- Mangalpally, K.K., et al., Platelet activation patterns in platelet size sub-populations: di erential responses to aspirin in vitro. J Thromb Thrombolysis, 2010. 30(3): p. 251- 62.
Regenlab PRP: Best in Class