Actualización en plasma rico en plaquetas / Platelet rich plasma update

Resumen El plasma rico en plaquetas es un producto derivado de la sangre, rico en péptidos y proteínas de señalización intercelular, así como citoquinas capaces de intervenir en cada una de las etapas de la regeneración de varios tejidos. Principalmente, se le han atribuido efectos antiinflamatorios en diferentes lesiones, así como otros efectos biológicos sobre las células y tejidos. A la fecha, no existe un protocolo estándar de producción o preparación, tampoco se ha descrito una dosis específica; la forma de aplicación es muy variable y depende de la condición por tratar. A pesar de ello, se han visto efectos positivos en campos como: odontología, ortopedia, dermatología, medicina reconstructiva, oftalmología, medicina deportiva, medicina vascular, entre otros. Su regulación es muy diversa a nivel internacional. Aunque hay expectativas con el tratamiento de plasma rico en plaquetas, no hay suficientes ensayos clínicos robustos que brinden un alto nivel de evidencia para validarlo como un tratamiento de rutina frente a determinada condición clínica. Además, no se pueden comparar fácilmente los resultados de diferentes investigaciones, por la variabilidad en el método de preparación y por la falta de homogeneidad en las lesiones tratadas, entre otros factores. Es por lo anterior que resulta necesario desarrollar más investigaciones serias que conlleven al establecimiento de un protocolo estandarizado, así como demostrar la efectividad de este nuevo tratamiento, de forma que se culmine con la implementación de nuevas terapias validadas y autorizadas para garantizar una mejoría real a los pacientes.

Abstract Platelet-rich plasma is a blood-derived product, rich in peptides and intercellular signaling proteins and cytokines capable of intervening in each stage of the regeneration of various tissues. Mainly, it has been attributed anti-inflammatory effects in different lesions, as well as other biological effects on cells and tissues. To date, there is no standard production or preparation protocol, nor has a specific dose been described. The form of application is very variable and depends on the condition to be treated. Despite this, positive effects have been seen in different fields such as: dentistry, orthopedics, dermatology, reconstructive medicine, ophthalmology, sports medicine, vascular medicine among others. Its regulation is very diverse internationally. Although there is a lot of expectation with the treatment of platelet-rich plasma, there are not enough robust clinical trials that provide a high level of evidence to validate it as a routine treatment for a certain clinical condition. In addition, the results of different investigations cannot be easily compared due to the variability in the method of preparation and the lack of homogeneity in the treated lesions, among other factors. It is for this reason that it is necessary to develop more serious investigations that lead to the establishment of a standardized protocol, as well as to demonstrate the effectiveness of this new treatment and culminate with the implementation of new validated and authorized therapies to guarantee a real improvement to the patients.

Utilização de plasma rico em plaquetas no tratamento de ferida cutânea em cão: relato de caso / Use of platelet-rich plasma in the treatment of cutaneous wound in dogs: a case report / Utilización de plasma rico en plaquetas en el tratamiento de herida cutánea en perro: relato de caso

O plasma rico em plaquetas (PRP) consiste em um concentrado suprafisiológico de plaquetas extraído a partir do sangue autógeno do paciente e centrifugado adequadamente. O presente relato descreve a utilização do PRP no tratamento de ferida cutânea, após exérese de massa com evolução de 4 meses em um cão fêmea, da raça Beagle, de 7 anos de idade. Citologia aspirativa por agulha fina (CAAF) foi realizada na massa e diagnóstico sugestivo de neoplasia de anexo cutâneo de baixo grau foi identificado. O tratamento instituído consistiu na excisão da massa e aplicações tópicas e intradérmicas do produto obtido nos bordos da ferida. A lesão apresentou diminuição da resposta inflamatória, cicatrização limpa, bordos uniformes, e ausência de exsudato purulento, tecido de granulação exagerado e complicações sob o caráter neoplásico da etiologia da ferida, cicatrizando completamente após 17 dias.(AU)

Platelet-rich plasma (PRP) consists of a supra-physiologic platelet concentrate extracted from the patient's autogenous blood, after being properly centrifuged. This report describes the use of PRP in the treatment of cutaneous wound, after excision of mass with 4-month evolution in a 7-year-old beagle bitch. Fine needle aspiration cytology (FNAC) was performed in the mass and suggestive diagnosis of cutaneous adnexal neoplasm was identified. The treatment consisted of mass excision, added by topical and intradermal applications of the studied product in the wound edges. The wound presented decreased inflammatory response, clean healing, uniform edges, and absence of purulent exudate, exaggerated granulation tissue or complications under the neoplastic character of the wound, healing completely after 17 days.(AU)

El plasma rico en plaquetas (PRP) consiste en un concentrado supra fisiológico de plaquetas extraído a partir de la sangre autógena del paciente y centrifugado adecuadamente. El presente relato describe la utilización del PRP en el tratamiento de herida cutánea, tras exéresis de masa con evolución de 4 meses en una perra, de la raza Beagle, de 7 años de edad. Citología aspirativa por aguja fina (CAAF), se realizó en la masa y el diagnóstico sugestivo de neoplasia de anexo cutáneo de bajo grado fue identificado. El tratamiento instituido consistió en la escisión de la masa y aplicaciones tópicas e intradérmicas en los bordes de la herida con el producto obtenido. La lesión presentó reducción de la respuesta inflamatoria, cicatrización limpia, bordes uniformes, ausencia de exudado purulento, tejido de granulación exagerado y complicaciones bajo el carácter neoplásico de la etiología de la herida, cicatrizando completamente después de 17 días.(AU)

Three-dimensional structure and cytokine distribution of platelet-rich fibrin

OBJECTIVES: Previous reports have revealed that several cytokines (including platelet-derived growth factor-BB, transforming growth factors-β1 and insulin-like growth factor-1) can enhance the rate of bone formation and synthesis of extracellular matrix in orthopaedics or periodontology. This study aimed to determine the concentration of cytokines within platelet-rich fibrin microstructures and investigate whether there are differences in the different portions of platelet-rich fibrin, which has implications for proper clinical use of platelet-rich fibrin gel. METHODS: Whole blood was obtained from six New Zealand rabbits (male, 7 to 39 weeks old, weight 2.7-4 kg); it was then centrifuged for preparation of platelet-rich fibrin gels and harvest of plasma. The resultant platelet-rich fibrin gels were used for cytokine determination, histological analyses and scanning electron microscopy. All plasmas obtained were subject to the same cytokine determination assays for the purpose of comparison. RESULTS: Cytokines platelet-derived growth factor-BB and transforming growth factor-β1 formed concentration gradients from high at the red blood cell end of the platelet-rich fibrin gel (p=1.88×10-5) to low at the plasma end (p=0.19). Insulin-like growth factor-1 concentrations were similar at the red blood cell and plasma ends. The porosities of the platelet-rich fibrin samples taken in sequence from the red blood cell end to the plasma end were 6.5% ± 4.9%, 24.8% ± 7.5%, 30.3% ± 8.5%, 41.4% ± 12.3%, and 40.3% ± 11.7%, respectively, showing a gradual decrease in the compactness of the platelet-rich fibrin network. CONCLUSION: Cytokine concentrations are positively associated with platelet-rich fibrin microstructure and portion in a rabbit model. As platelet-rich fibrin is the main entity currently used in regenerative medicine, assessing cytokine concentration and the most valuable portion of PRF gels is essential and recommended to all physicians.

Histological response to platelet-rich plasma added to polypropylene mesh implemented in rabbits

ABSTRACT Introduction: The platelet-rich plasma (PRP) is part of a set of biotechnologies, providing some growth factors that promote repair of different tissues. The polypropylene meshes (PPM) are applied in the correction of abdominal defects, pelvic floor and urinary incontinence, however, they induce many significant complications, as a result of an inappropriate inflammatory response. Purpose: To investigate the changes caused by PRP associated with the implantation of PPM in the abdomen of female rabbits, in the production of collagen I and III and the inflammatory infiltrate (ININ). Materials and Methods: We performed implant meshes with and without PRP in adult rabbits (n=30) and euthanasia at 7, 30 and 90 days. Two plates were prepared from each animal and analyzed in five different fields. The ININ was evaluated by quantification of inflammatory cells using hematoxylin-eosin and the collagen by Sirius red method. The results were analyzed applying the Wilcoxon, Kruskal-Wallis, Junckheere and Friedmann tests. Results: There was a significant difference in the number of inflammatory cells between the groups with and without PRP (p=0.01) at 90 days. There was increased production of collagen I, III and total with the use of PRP, at seven days. Conclusion: The PPM coating with PRP was associated with increased ININ at the implant area, and an increasing trend during the process of tissue repair. The PPM coated with PRP was related to increased concentration of collagen I, collagen III and the concentration of total collagen increased after seven days of implantation.

Analysis of cytokine profile and growth factors in platelet-rich plasma obtained by open systems and commercial columns / Análise do perfil de citocinas e fatores de crescimento em plasma rico em plaquetas obtido por meio das metodologias do sistema aberto e colunas

ABSTRACT Objective: To evaluate growth factors and cytokines in samples of platelet-rich plasma obtained by three different centrifugation methods. Methods: Peripheral blood of six individuals with no hematological diseases, aged 18 to 68 years, was drawn to obtain platelet-rich plasma, using the open method and commercial columns by Medtronic and Biomet. The products obtained with the different types of centrifugation were submitted to laboratory analysis, including pro-inflammatory cytokines and chemokines by flow cytometry assays, the concentration of fibroblast growth factors-2 (FGF-2) and transforming growth factor-beta1 (TGF-β1). Results: The diverse separation methods generated systematically different profiles regarding number of platelets and leukocytes. The Medtronic system yielded a product with the highest concentration of platelets, and the open method, with the lowest concentration of platelets. The results of cytokine analysis showed that the different types of centrifugation yielded products with high concentrations of interleukin 8, interleukin 1β. The open system resulted in a product with high levels of interleukin 6. Other cytokines and chemokines measured were similar between systems. The product obtained with the open method showed higher levels of TGF-β1 in relation to other systems and low FGF-2 levels. Conclusion: The formed elements, growth factors and cytokines in samples of platelet-rich plasma varied according to the centrifugation technique used.

RESUMO Objetivo: Avaliar fatores de crescimento e citocinas em amostras de plasma rico em plaquetas obtidas por três diferentes métodos de centrifugação. Métodos: Foi coletado sangue periférico de seis indivíduos, sem doença hematológica, com idades entre 18 e 68 anos, para obtenção de plasma rico em plaquetas, utilizando o método aberto e sistemas comerciais das empresas Medtronic e Biomet. Os produtos obtidos com os diferentes tipos de centrifugação foram submetidos às análises laboratoriais, incluindo citocinas próinflamatórias e quimiocinas, por meio de ensaios de citometria de fluxo, concentração do fator de crescimento fibroblástico-2 (FGF-2) e fator de crescimento transformador-beta1 (TGF-β1). Resultados: As diferentes centrifugações geraram perfis sistematicamente diferentes referentes ao número de plaquetas e de leucócitos. O sistema da Medtronic originou produto com a maior concentração de plaquetas, e o método aberto com a menor concentração de plaquetas. Os resultados da análise de citocinas demonstraram que os diferentes tipos de centrifugação originaram produtos com elevadas concentrações de interleucina 8 e interleucina 1β. O sistema aberto resultou em produto com elevados níveis de interleucina 6. As demais citocinas e quimiocinas mensuradas foram similares entre os sistemas. O produto obtido com o método aberto apresentou níveis superiores de TGF-β1 em relação aos demais sistemas e reduzidos níveis de FGF-2. Conclusão: Os elementos figurados, fatores de crescimento e citocinas, em amostras de plasma rico em plaquetas, variaram conforme a técnica de centrifugação utilizada.

Plasma rich in growth factors and bone formation: a radiological and histomorphometric study in New Zealand rabbits

A radiographic and histomorphometric study was conducted on the influence of autologous plasma rich in growth factors (PRGF) upon bone healing in surgically created defects in rabbits. Radiographically, bone regeneration was significantly greater with the use of PRGF after one month (p = 0.005), though no differences were recorded after the second month. In the histomorphometric analysis one month after surgery, the defects filled with autologous bone plus PRGF showed a greater percentage of neoformed bone (35.01 ± 5.31) than the control defects (22.90 ± 12.23), though the differences were not significant. Two months after surgery, the defects filled with autologous bone showed greater regeneration (46.04 ± 10.36 percent) than the control defects (30.59 ± 5.69 percent), though the differences were not significant. The application of PRGF in the bone defects produced in New Zealand rabbits exerted a limited effect on local bone formation.