Asian Journal of Transfusion Science
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EDITORIAL Table of Contents   
Year : 2015  |  Volume : 9  |  Issue : 2  |  Page : 113-114
Platelet-rich plasma therapy: A novel application in regenerative medicine


1 Department of Transfusion Medicine, PGIMER, Chandigarh, India
2 Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India

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Date of Web Publication12-Aug-2015
 

How to cite this article:
Jain A, Bedi RK, Mittal K. Platelet-rich plasma therapy: A novel application in regenerative medicine. Asian J Transfus Sci 2015;9:113-4

How to cite this URL:
Jain A, Bedi RK, Mittal K. Platelet-rich plasma therapy: A novel application in regenerative medicine. Asian J Transfus Sci [serial online] 2015 [cited 2021 Sep 26];9:113-4. Available from: https://www.ajts.org/text.asp?2015/9/2/113/162679


Plasma samples with platelet concentration above base line values are referred to as platelet-rich plasma (PRP). [1],[2] The clinical efficacy of the PRP was discovered in early 1990s when new "biological glues" were being discovered. They are at present being extensively used in many clinical and surgical fields requiring tissue regeneration such as orthopedics, dentistry, wound healing, and maxillofacial surgeries. [3] The therapeutic effect of PRP is attributed to the abundance of various growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-β, fibroblast growth factor, insulin-like growth factor-1 (IGF-1), IGF-2, vascular endothelial growth factor, epidermal growth factor, and also some cytokines [4] primarily stored in alpha granules.

PRP can be classified into pure - platelet rich plasma (P-PRP), leucocyte and platelet rich plasma (L-PRP), pure platelet rich fibrin (P-PRF), leucocyte and platelet rich fibrin (L-PRF) based upon the technique used to prepare and the final content of the product.[5] Serum eye drops and PRP eye drops are also available these days for ophthalmic use. [6] PRF has been reported to be better than traditional PRP because it simulates the physiological process of platelet degranulation releasing varied growth factors. [5],[7] Studies have also shown that leukocyte poor product is superior compared to leukocyte rich product as residual leukocytes can produce localized inflammation. [8]

PRP can be prepared either from autologous or allogenic source. Majority of studies documented have used autologous platelets preparations as they are more acceptable to the patient and carry lower risk of transmission of viral infections. [6] The PRP is usually prepared by centrifugation of whole blood collected in a sterile container using citrate-based anticoagulant. The centrifugation can be a one-step or two-step protocol. After final centrifugation, a platelet pellet is formed which is resuspended in a small volume of platelet-poor plasma. Further, the platelets in PRP are usually activated by addition of various activators (calcium chloride, thrombin, chitosan, and batroxobin) for release of growth factors. [9] Centrifugation and activation methods are the two important modifiers which have a critical impact on the quality of PRP and release of growth factors. Different studies have used different centrifugation conditions and there is no universally accepted protocol till date. Commercial PRP preparation systems are also available nowadays. These systems consist of desktop centrifuge and single use blood collection tube kits. Availability of such systems has led to the unregulated preparation of the autologous PRP in small laboratories outside the blood bank setup. These laboratories have minimal knowledge as well as training of process control and good manufacturing practices in handling this blood-derived material.

This issue of Asian Journal of Transfusion Science includes two articles on clinical efficacy of the use of PRP. The authors have used different methodologies and source for PRP preparation. Singh et al. [10] have shown the beneficial effect of autologous PRP in treatment of androgenic alopecia. They observed that by the end of 12 weeks all the 10 patients included in the study had good hair growth. They concluded that beneficial effects of PRP may be attributed to PDGFs influencing the function of hair follicles ultimately resulting in improved hair growth. On the other hand, Sonker et al. [11] have evaluated the role of platelet growth factors from allogenic ABO-matched PRP for clinical improvement in split thickness skin graft. They observed that there was 100% uptake of the graft in the wound area where PRP was applied.


   Regulatory Issues Top


PRP is a biological product. [12] The biological product and the device used for its preparation should fall under the purview of regulatory authorities. In India, for preparation of both "plasma" and "platelets," blood banks need to obtain licence from Central Licence Approving Authority. However, the Drug and Cosmetics Act, 1940, is silent about the preparation, quality control, and use of PRP in regenerative medicine. In USA also, there is a lot of confusion with regard to regulatory issues of autologous PRP preparation device and its final product. All the PRP preparation systems in USA are brought to the market via 510 (k) clearance which certifies that the safety and performance of the device is substantially equivalent to a predicate PRP device. Nevertheless, here the device is controlled but not the final PRP product. [13] It is of concern as the final content of the product depends upon the device used.


   Challenges and Future Directions Top


PRP preparations are being extensively used in wound healing and tissue repair despite of insufficient evidence support. [14],[15] Blinded, multicentric, randomized controlled studies with large sample sizes to establish their therapeutic efficacy is the need of hour. There are no universally established standards for collection, quality control, and administration of the product. [15] In addition, the threshold dose required for therapeutic benefit is also undefined for different clinical indications. Hence, guidelines for the same need to be laid down by regulatory authorities to ensure its rational use. Although no adverse effects have been reported till date, patient safety still remains a major concern. All this emphasizes the role of transfusion medicine specialty in assuring quality, consistency, and safety of the product.

 
   References Top

1.
Russell RP, Apostolakos J, Hirose T, Cote MP, Mazzocca AD. Variability of platelet-rich plasma preparations. Sports Med Arthrosc 2013;21:186-90.  Back to cited text no. 1
    
2.
Marques LF, Stessuk T, Camargo IC, Sabeh Junior N, dos Santos L, Ribeiro-Paes JT. Platelet-rich plasma (PRP): Methodological aspects and clinical applications. Platelets 2015;26:101-13.  Back to cited text no. 2
    
3.
Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: A review. Curr Rev Musculoskelet Med 2008;1:165-74.  Back to cited text no. 3
    
4.
Moshiri A, Oryan A. Role of platelet rich plasma in soft and hard connective tissue healing: An evidence based review from basic to clinical application. Hard Tissue 2013;2:6.  Back to cited text no. 4
    
5.
Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: From pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 2009;27:158-67.  Back to cited text no. 5
    
6.
De Pascale MR, Sommese L, Casamassimi A, Napoli C. Platelet derivatives in regenerative medicine: An update. Transfus Med Rev 2015;29:52-61.  Back to cited text no. 6
    
7.
Passaretti F, Tia M, D′Esposito V, De Pascale M, Del Corso M, Sepulveres R, et al. Growth-promoting action and growth factor release by different platelet derivatives. Platelets 2014;25:252-6.  Back to cited text no. 7
    
8.
Dhillon MS, Behera P, Patel S, Shetty V. Orthobiologics and platelet rich plasma. Indian J Orthop 2014;48:1-9.  Back to cited text no. 8
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9.
Zhu Y, Yuan M, Meng HY, Wang AY, Guo QY, Wang Y, et al. Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: A review. Osteoarthritis Cartilage 2013;21:1627-37.  Back to cited text no. 9
    
10.
Singhal P, Agarwal S, Dhot PS, Sayal SK. Efficacy of platelet-rich plasma in treatment of androgenic alopecia. Asian J Transfus Sci 2015;9:159-62.  Back to cited text no. 10
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11.
Sonker A, Dubey A, Bhatnagar A, Chaudhary R. Platelet growth factors from allogeneic platelet-rich plasma for clinical improvement in split-thickness skin graft. Asian J Transfus Sci 2015;9:155-8.  Back to cited text no. 11
  Medknow Journal  
12.
Beitzel K, Allen D, Apostolakos J, Russell RP, McCarthy MB, Gallo JG, et al. US definitions, current use, and FDA stance on use of platelet-rich plasma in sports medicine. J Knee Surg 2015;28:29-34.  Back to cited text no. 12
    
13.
Harm SK, Fung MK. Platelet-rich plasma injections: Out of control and on the loose? Transfusion 2015;55:1596-8.  Back to cited text no. 13
    
14.
Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, et al. Autologous platelet-rich plasma for treating chronic wounds. Cochrane Database Syst Rev 2012;10:CD006899.  Back to cited text no. 14
    
15.
Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev 2013;12:CD010071.  Back to cited text no. 15
    

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Correspondence Address:
Prof. Ravneet Kaur Bedi
Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6247.162679

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2006 - Asian Journal of Transfusion Science | Published by Wolters Kluwer - Medknow
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