Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020

Abstract

Emerging autologous cellular therapies that utilize platelet-rich plasma (PRP) applications have the potential to play adjunctive roles in a variety of regenerative medicine treatment plans. There is a global unmet need for tissue repair strategies to treat musculoskeletal (MSK) and spinal disorders, osteoarthritis (OA), and patients with chronic complex and recalcitrant wounds. PRP therapy is based on the fact that platelet growth factors (PGFs) support the three phases of wound healing and repair cascade (inflammation, proliferation, remodeling). Many different PRP formulations have been evaluated, originating from human, in vitro, and animal studies. However, recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, progress has been made in understanding PRP technology and the concepts for bioformulation, and new research directives and new indications have been suggested. In this review, we will discuss recent developments regarding PRP preparation and composition regarding platelet dosing, leukocyte activities concerning innate and adaptive immunomodulation, serotonin (5-HT) effects and pain killing. Furthermore, we discuss PRP mechanisms related to inflammation and angiogenesis in tissue repair and regenerative processes. Lastly, we will review the effect of certain drugs on PRP activity, and the combination of PRP and rehabilitation protocols.

Angiogenesis Is Differentially Modulated by Platelet-Derived Products

“…We used freshly prepared PRP and PRP-HA and commercial PL. Currently, there is no in vivo evidence to indicate which type of preparation has the best angiogenic activity [ 4 ].…”

“…Autologous blood derived-products like platelet-rich plasma (PRP) are alternative therapies for the promotion of tissue repair and angiogenesis. For more than ten years, the regenerative potential of PRP has been demonstrated in a range of tissue types including skin, bone, cartilage, tendon and muscle and to improve tissue healing after surgery [ 4 ].…”

Platelet Lysate Nebulization Protocol for the Treatment of COVID-19 and Its Sequels: Proof of Concept and Scientific Rationale

“…It is also being applied in different pathologies in other branches of medicine such as ophthalmology, dermatology, nervous system lesions, and recently in gynecology as a treatment for ovarian and uterine pathology, for example. In all these pathologies, its efficacy and the ideal composition and dose of PRP are still being studied in multiple clinical studies [ 11 ].…”

“…Platelet-rich plasma, a biological therapy approved by regulatory agencies, is based on the concentration of the platelets present in blood [ 11 ]. Platelets are small anucleate cells derived from megakaryocytes whose biosynthesis takes place in both bone marrow and lungs [ 12 , 13 ].…”

New design to remove leukocytes from platelet-rich plasma (PRP) based on cell dimension rather than density

“…Nevertheless, in some cases the leucocytes containing in PRP as found in buffy coat layer might induce deleterious effect to bone regeneration by increasing pro-inflammatory cytokines, or platelet might also induce fibrosis by stimulating extracellular matrix production [ 21 , 22 ]. Further, a dose-dependent manner of PRP occurs to the cell respond in which the limitation of the cell membrane receptors may be counterproductive of cell function when the growth factors released by platelet too high [ 23 ]. The work of the commercial buffy coat kits available today are commonly based on blood-component density [ 24 , 25 ].…”