Platelet-Rich Plasma à la Carte: Commentary on an article by Satoshi Terada, MD, et al.: “Use of an Antifibrotic Agent Improves the Effect of Platelet-Rich Plasma on Muscle Healing After Injury”

第一作者：Christopher H. Evans

2013-07-09 点击量：453 　　我要说

Commentary

Platelet-rich plasma (PRP) is the latest orthopaedic panacea, administered promiscuously for whatever ails the musculoskeletal system. At the last count this included torn tendons and ligaments, unhealed bones, damaged cartilage, injured muscle, and osteoarthritis. Beyond orthopaedics, use of PRP is associated with treatments for hair loss, wrinkles, and erectile dysfunction. There is only one snag—it may not work, at least not for all of the indications, when using PRP version 1.0.

A detailed meta-analysis, published recently in this journal, reported that “use of PRP provided no significant benefit” for treating bone and soft-tissue injuries. Another recent meta-analysis of the use of PRP in wound-healing yielded similar conclusions. Part of the problem in assessing the merits of PRP is the poor quality of the clinical studies. However, there are additional issues.

Several different devices are approved by the FDA (U.S. Food and Drug Administration) in the United States for generating PRP, and these deliver products of diverse composition with regard to the platelet concentration, presence of leukocytes, contamination by erythrocytes, and concentration of certain growth factors. Moreover, repeated PRP preparations from the same individual vary in composition, rendering standardization all the more difficult. Finally, there is the complexity of the product.

Use of PRP is usually justified by the physician because it contains a “rich cocktail of growth factors.” This may be true, but it contains a lot of other things as well. The platelet secretome has over 300 proteins, including interleukins (ILs), chemokines, proteinases, inhibitors of proteinases, and adhesion molecules. Attention has focused on the proteins present in PRP, but platelets are also a rich source of sphingolipids, thromboxanes, purine nucleotides, serotonin, calcium, and many other mediators. Although PRP is widely thought to have anti-inflammatory properties, several components (such as IL-1, IL-6, and IL-8) are pyrogens, whereas others (such as transforming growth factor-beta [TGF-β]) are pleiotropic. Moreover, ingredients that are an advantage in one setting may be a disadvantage in another. For example, vascular endothelial growth factor (VEGF), a prominent angiogenic component of PRP, might be helpful for bone healing, which has an absolute need for angiogenesis, but a hindrance for repairing cartilage, which is avascular.

Terada et al. address the point that PRP cannot be all things to all tissues. Their solution is to customize PRP for specific indications, an innovative and potentially rewarding concept. They demonstrate the utility of this approach with a murine model of skeletal muscle injury and repair. PRP has the potential to improve healing by enhancing angiogenesis and myoblast proliferation, but the presence of TGF-β impairs healing by promoting fibrosis and inhibiting satellite cell differentiation.

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