Customized PRP Concentrations Critical for Many Patients
POSTED ON 10/30/2018 IN Regenerative Medicine Education BY Chris Centeno
Our platelets change as we age or lose optimum health. In general, the growth factor levels inside them decline. However, since there's usually a huge supply, that just means adjusting the concentration up for older or infirmed patients. That idea has been well supported in the peer-reviewed literature, so this morning let's review one of those newer studies.
In addition, if you read this blog, you know that I love writing about what I experience on a day-to-day basis. Yesterday, I was speaking with another spine regenerative medicine expert who has also published research. He was lamenting that we likely need a custom mix of PRP to get the best outcomes when injecting into a damaged intervertebral disc. I immediately said that for Regenexx physicians, that was easy, but for other doctors, what he wanted was impossible. Why? Let's explore that as well.
Understanding PRP and Growth Factors
Platelets circulate in abundance in our blood and are small and specialized cell fragments containing growth factors as well as other molecules that aid with healing. The primary function of platelets is to help blood clot. This is critical because when we experience a wound, for example, a paper cut, platelets not only clot to seal the wound and stop the bleeding but also release their growth factors, which stimulate local stem cells and many other cells to start repairing the wound.
Platelet-rich plasma (PRP) is made by concentrating the platelets. First, whole blood is drawn, for example from an arm vein. Then the blood is centrifuged, or spun down, concentrating the platelets in the serum that is separated in the process. PRP works by amping up the healing process in areas that, for whatever reason, haven’t been able to heal on their own.
The Bedside Centrifuge vs. Flexible Lab Platform Approaches to PRP Prep
Most physicians use a simple bedside centrifuge that’s one size fits all to concentrate PRP. This means that they can usually only get one concentration of PRP by using the kit as it's regulated to be used. The problem is that as the patient ages, the concentration of growth factors in each individual patient goes down. Hence, we commonly adjust the PRP concentration up as the patent gets older, which is something we can do with our flexible lab platform that often can’t be done with a simple bedside centrifuge machine. Having a flexible lab platform accomplishes many things that a bedside centrifuge simply isn’t capable of, including customizing types and concentrations of PRP to individual patient needs, obtaining much higher platelet concentrations, and adjusting the processing to the unique properties of a sample.
Now it seems aging patients aren’t the only ones who can benefit from these adjustments to PRP concentrations. Being able to customize PRP concentrations may also be critical for patients with diabetes and those taking drugs to thin their blood and reduce blood clots. Let’s review.
Aging, Diabetes, Blood-Thinning Drugs Reduce Concentrations of Growth Factors in PRP
The new study focused on how growth factors and other PRP proteins are affected by aging, diabetes, and antiplatelet drugs (those medicines that reduce blood clots). Each subject was put into one of four groups: healthy and ≤45 years old, healthy and >45 years old, diabetes and >45, or heart disease and on antiplatelet drugs and >45. Researchers then studied a variety of growth factors concentrations in PRP samples. The results? Concentrations of certain types of growth factors were reduced in aging PRP, but not just with the older group but also in the diabetes and antiplatelet groups. Researchers concluded these growth factor reductions weaken the regenerative potential and lower the quality of PRP in these patient groups.
What does this mean? For starters, a one-size-fits-all concentration of PRP created in a simple bedside machine just isn’t going to cut it for patients who are older, who have diabetes, or who are on antiplatelet medications. Given that for many practices, this is most of the patients needing help, that's a problem. Therefore, it's imperative that PRP concentrations are customized to these individual patients’ unique needs, and this can only be accomplished by using a flexible lab platform.
The upshot? Can your doctor concentrate PRP and customize it to your unique problem or does he or she use a one-size-fits-all kit? As you can see, based on the research, if your physician is injecting the same stuff into young and old and healthy and infirmed patients, then he or she isn't doing all that can be done to maximize your chances of a successful outcome.
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