Platelet rich plasma (PRP) – What is the craze all about?

From vampire facials to the treatment of sports injuries, soft tissue augmentation as well as bone regeneration – PRP is becoming more and more popular.

KR Snyman (BPharm; MSc Pharmaceutics); I Laurens (BSc Med Sci, MSc Pharmacology)

From vampire facials to the treatment of sports injuries, soft tissue augmentation as well as bone regeneration – PRP is becoming more and more popular. PRP is defined as the cell free plasma which contains an enriched concentration of blood platelets, white blood cells (leucocytes in PRP), cytokines as well as clotting factors and a “soup” of growth factors including epidermal growth factor. These growth factors are all able to enhance the natural healing process.1,2 PRP has the unique ability to mimic and accelerate the natural wound healing process and is growing in popularity for the treatment of various conditions which include sports injuries (e.g. tendon injuries or overuse injuries and inflammation), chronic wounds, genital soft tissue augmentation (e.g. penile erectile dysfunction, and vaginal atrophy), hair growth (male pattern hair loss and post-menopausal hair loss) as well as skin rejuvenation. It is important to note that not all PRPs are alike and equal. All PRP preparation involves centrifugation of whole blood with anticoagulants to prevent fibrin polymerization. Without using an anticoagulant, a platelet-rich fibrin (PRF) will be formed. The best evidence indicates that the best results are observed when PRP is allowed to copy the body’s natural way of activating platelets to release active growth factors using activator solutions. Research has shown that the anticoagulant used most often with PRP preparation, namely acid-citrate dextrose (ACD) or sodium-citrate (SC) exert a harmful and local effect that interferes with the regenerative properties of platelets. ACD and SC act as calcium chelating agents, rendering the platelet incapable of activating. Calcium restitution is required to impair the cellular and tissue alterations induced by citrate-anticoagulants contained in PRP. Furthermore, when PRP systems only contain the platelet rich plasma – without activation – superior results may not be achieved. As the PRP is harvested the growth factors (healing proteins) are protected inside the platelets. These growth factors are only activated once the platelets undergo a shape change and degranulation which is similar to activation of the clotting cascade, a calcium driven pathway. With DIAMOND PRP (a specialised kit unique to dermaV Pharmaceuticals – celluVance™ PRP kit), the L-PRP (leucocyte rich PRP) is placed in special glass vials with calcium ions and organic solvents to activate the platelets and reverse the effect of the citrate-anticoagulant. The coagulation cascade is activated by combining PRP with calcium ions, organic solvents and a negatively charged surface such as glass to mimic the effects of autologous thrombin. A calcium-thrombin combination significantly releases growth factors over 7 days, when compared with nonactivated PRP DIAMOND PRP assures the platelets are active and able to release growth factors when injected back into the skin / tissue or site of injury.4,12,13,14   

PRP thus acts as a delivery system for a variety of different growth factors as well as cytokines contained within the alpha (α)-granules of the platelets. Growth factors are polypeptides that play a vital role in normal wound healing.3 The concentration of growth factors in PRP is proportional to the platelet concentration, PRP can therefore deliver an increased growth factor concentration to the area where PRP is administered thereby accelerating the “natural” healing of both soft and hard tissues.1,3,5,6 Figure 1 summarises the applications for which PRP may be used successfully. 

Figure 1 Applications for which PRP is used.4 

PRP is a revolutionary technology, using the ingredients of the patient’s own blood (autologous growth factors), which aids in the regeneration and rejuvenation of the skin/tissue – providing age-defying results which are suitable for all skin types. PRP is commonly used in soft tissue augmentation which includes: (i) surgery-free repair of “sports injuries” and (ii) cutaneous wound remodelling in e.g. diabetic foot ulcers.1,2,3 PRP is known as the part of the blood rich in growth and repairing factors (active proteins) essential for tissue regeneration and healing. 

Focussing on the skin: These growth factors mimic the body’s natural wound healing process – during this process collagen, elastin and new blood vessels are increased, and damaged skin repaired and regenerated. Collagen and elastin are the agents which gives the skin a youthful appearance – as we age (and due to sun exposure) collagen and elastin production is reduced and declines which causes wrinkles and fine lines. To rejuvenate the skin – with the use of PRP these growth factors may be injected into the skin to create new collagen/elastin for vibrant skin that looks refreshed and glowing. PRP may be used to treat the 3 main signs of ageing – (i) dull, colourless skin due to a decrease in blood flow; (ii) sagging of the skin due to muscle and collagen decrease and (iii) smoothen skin texture. Figure 2 describes how PRP may be applied for skin rejuvenation within the facial and decollete region. 

Figure 2 PRP applications for skin rejuvenation on the facial and decollete are.4

Soft tissue impairment:  PRP is being used more frequently in the promotion of healing in muscle and tendon injuries. As stated previously, PRP contains growth factors which are able to accelerate physiological healing processes and thus the use of these factors is simple and non-invasive. PRP may be used to improve tissue repair in cartilage, tendons, ligaments, muscles as well as bones by the downregulation of inflammatory mediators and the synthesis of regenerative proteins. PRP containing leucocytes also reduces the chance of infection and has a negative feedback and modulatory effect on the inflammatory process. PRP has demonstrated antimicrobial properties which aid in the reduction of pain and prevent further infection. PRP is generally administered by local injection or applied directly in the form of a gel (or the combination) into or onto the site of wound and or injury.7 The applications of PRP for the treatment of tissue repair and sports injuries is depicted in Figure 3. 

Figure 3 PRP applications in soft tissue repair and sports injuries.4

Sexual Health: PRP has many other applications which includes the V-Shot for women and the P-Shot for men – for the healing of aged and damaged tissue of the sex organs for sexual rejuvenation. 

Hair growth: PRP has demonstrated success in the stimulation of hair growth when injected into the scalp area. Activated PRP releases active growth factors to naturally stimulate hair growth. PRP Hair Restoration is suitable for both men and women. It is a state of the art, non-surgical, totally natural, medical procedure that may be combined with hair treatment medication (e.g. minoxidil) used for the treatment of hair loss or hair thinning. 

Topical: Topical PRP is clinically designed to enhance topical wound healing, as seen in figure 4, for burns, skin abrasions as well as post aesthetic treatments such as microneedling, microdermabrasion, laser therapy as well as chemical peels. Topical PRP is able to deliver a cooling gel, which when applied topically to the desired area soothes and heals irritated or damaged skin.4

Figure 4 Topical PRP applied for the treatment of a burn wound (effect within 24h).4

Osteoarthritis and joint pain: PRP has demonstrated to be a safe and effective treatment option for the improvement of pain and symptom management of chronic injuries and osteoarthritis of joints. It stimulates cartilage healing as well as surrounding soft tissue of the joint.

As PRP is produced from the patient’s own blood there are virtually no side effects and is easy to apply to the desired site, with some studies reporting a reduction in pain and infection at the treatment site.8-11 Although DIAMOND PRP does not provide the immediate plumping or reduction of wrinkles e.g. short-term effect of neurotoxins and fillers –  PRP should be included as part of your yearly skin rejuvenation regime as it is the only procedure that can provide the patient with a more youthful overall glowing and vibrant complexion with a long-term benefit in improving overall skin health and age defying results, correcting sun damage and age related skin deterioration.

References

  1. Chung, H.Y., Cesari, M., Anton, S., Marzetti, E., Giovanni, S., Seo, A. Y., Carter, C., Yu, B. P. & Leeuwenburgh, C. 2009. Molecular inflammation: Underpinnings of aging and age-related diseases. Ageing Research Reviews; 8:18-30.
  2. Knighton, D.R., Fiegel, V.D., Austin, L.L., Butler, E.L. & Ciresi, K.F. 1986. Classification and treatment of chronic nonhealing wounds. Annals of Surgery; 204:322-330.
  3. Wroblewski, A.P., Mejia, H.A. & Wright, V.J. 2010. Application of Platelet-Rich Plasma to Enhance Tissue Repair. Operative Techniques in Orthopaedics; 20:98-105.
  4. Data on File.  dermaV Pharmaceuticals. Available at: https://www.dermav.co.za/prpindications
  5. Mazzucco, L., Balbo, V., Cattana, E. & Borzini, P. 2008. Platelet-rich plasma and platelet gel preparation using Plateltex®. Vox Sanguinis; 94:202-208.
  6. Dohan Ehrenfest, D. M., Rasmusson, L. & Albrektsson, T. 2009. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends in Biotechnology; 27:158-167.
  7. Bernuzzi, G., Petraglia, F., Pedrini, M.F., De Filippo, M., Pogliacomi, F., Verdano, M.A. & Costantino, C. 2014. Use of platelet-rich plasma in the care of sports injuries: our experience with ultrasound-guided injection. Blood Transfus; 12(1):s229-s234.
  8. Anitua, E., Andia, I., Ardanza, B., Nurden, P. & Nurden, A.T. 2004. Autologous platelets as a source of proteins for healing and tissue regeneration. Thrombosis and Haemostasis, 91:4-15.
  9. Everts, P. A. M., Knape, J. T. A., Weibrich, G., Schonberger, J. P. A. M., Hoffmann, J. J. H. L., Overdevest, E. P., Box, H. A. M. & Van zundert, A. 2006. Platelet rich plasma and platelet gel: a review. The Journal of extra-corporeal technology, 38:174-187.
  10. Randelli, P. S., Arrigoni, P., Cabitza, P., Volpi, P. & Maffulli, N. 2008. Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study. Disability and Rehabilitation, 30:1584-1589.
  11. Zenker, S. 2010. Platelet-rich plasma (PRP) for skin rejuvenation. J Med Esth et Chir Derm; XXXVII:179-183. 
  12. Arora, A. & Arora, S. 2021. Platelet-rich plasma—Where do we stand today? A critical narrative review and analysis. Dermatologic Therapy; 34: e14343.
  13. Etulain, J. 2018. Platelets in wound healing and regenerative medicine. Platelets; 1369-1635. 
  14. Oneto, P., Zubiry, P.R., Schattner, M. & Etulain, J. 2020. Anticoagulants Interfere With the Angiogenic and Regenerative Responses Mediated by Platelets. Front Bioeng Biotechno; 8:223.