Posts Tagged ‘growth factors’

Platelet Rich Plasma Therapy seeing widespread use

Thursday, January 15th, 2009

platelet_1
The public, commerical, and medical community are becoming increasingly aware of the potential promise of platelet rich plasma, growth factors, and stem cell therapy. While I use PRP for tendon and cartilage disorders, physicians in South Africa have been using PRP for facial rejuvination and wrinkles by potentially stimulating collagen synthesis.

http://www.internationalshoulderjournal.org/article.asp?issn=0973-6042;year=2007;volume=1;issue=2;spage=64;epage=73;aulast=du
Also research is being conducted to treat alopecia (hair loss) by stimulating follicular growth. Adult Stem cells the precusor for these proteins may hold the most promise.

It is my opinion that there is much more to be learned regarding PRP. However ultimately we may find that isolating individual growth factors with specific responsibilities may be more effective. Researchers are already working on isolating individual growth factors for specific tasks like cartilage regeneration etc.

Dry Needling effective for Plantar Fasciitis

Thursday, January 15th, 2009

NormalplantarfasciaUSGWith musculoskeletal ultrasound to examine the heel (much like looking obstetrician’s use to examine a fetus), physicians are able to accurately target heel pain.

With the advancement of technology we are able to further our understanding of disease as well as offer innovative treatments.

At the December 08 annual Radiological Society of North America, Luca M. Sconfienza, MD, from University of Genoa in Italy demonstrated 95% efficacy with dry needling followed by cortisone.

Plantar Fasciitis is one of the most common foot problems affecting 1 million people. Patients typically complain of inner heel pain with stiffness in the morning and later throughout the day with weight bearing.

44 patients were treated who had previously failed extra corporeal shockwave therapy. Shock wave therapy works by a similar means through creation of micro trauma that increases blood flow and promotes healing in a deficient ligament or tendon.

A similar procedure is done with platelet rich plasma therapy, which involves needling of the thickened and oxygen deficient plantar fascia under ultrasound guidance. But rather than using cortisone, the patients own growth factors (extracted from their arm from a blood draw) are injected into the area of injury to promote natural healing. Unlike cortisone, platelets & growth factors have no reported ill effects of tendon tearing or rupture, but rather regenerate the tissue.

http://www.healthimaging.com/index.php?option=com_articles&view=conference&id=publication:37:article:15307:section:1&division=hiit

New Platelet Rich Plasma (PRP) Study on Tennis Elbow (Lateral Epicondylitis)

Thursday, July 17th, 2008

t_elbowcomm+ext+tend+us+pictureGosens & Sluimer from the Netherlands, just reported on a prospective, double blinded, randomized study comparing PRP to cortisone injections in the treatment of 100 patients with tennis elbow. They used a visual analog pain score (1-10) & a DASH score to measure treatment response by 24 weeks. Both groups demonstrated initial improvement. However, by 24 weeks the cortisone group had a recurrence of pain whereas the PRP group continued to have improved pain scores. 1 and 2 year follow up results will be reported in the future.

This article originated from St. Elisabeth Hospital, Tilburg, the Netherlands.

Prior research has showed that after 4-6weeks tendons are no longer inflammed, but rather become thickened, scarred, & fibrotic with poor blood supply. Therefore at this point the proper nomenclature is “tendinosis” not tendinitis. With this understanding we try to facilitate healing by increasing blood flow and breaking up scar tissue.

New Biologics Textbook Includes Platelet Rich Plasma (PRP)

Wednesday, June 18th, 2008

biologics+bookA new textbook was released by Jennifer E. Woodell-May and William S. Pietrzak which includes a chapter reviewing PRP. The chapter includes a literature review including case reports that suggest the multitude of potential applications.
One of the chapter’s authors, Jennifer Woodell-May has produced insightful research regarding the role of growth factors & their concentrations.

www.springerlink.com/content/h25275w189773071/

January 08′ Platelet Rich Plasma Enhances Tendon Healing

Monday, January 14th, 2008

cellphysiologyA new article from the Journal of Cellular Physiology presented some new insights into the role of PRP in tendon healing. After injecting PRP into mice patellar tendons, accelerated healing was demonstrated. The PRP had an 8.8 times platelet concentration above baseline versus whole blood.

Circulation derived cells play a key role in tendon healing. Blood flow is very important in connective tissue regeneration. Tendons typically have a poor blood supply (only 1/3 of the amount found in muscles). This study showed increased quantity of these healing cells in the early phase of tendon repair. Unfortunately, these helpful cells normally disappear with time. Therefore prolonging their presence is advantageous. Also increased type I & III collagen and macrophages were increased; supporting that PRP promotes tendon healing

http://www3.interscience.wiley.com/cgi-bin/abstract/117880365/ABSTRACT?CRETRY=1&SRETRY=0

A need to Clarify Platelet Rich Plasma use in International athletes

Sunday, January 13th, 2008

worldantidopeA new article from the British Journal of Sports Medicine Nov 07, reviews PRP (Platelet rich Plasma) use in sports medicine. After a good thorough review, they point out that using growth factors is considered a doping violation by the WADA (World Anti-Doping agency). THE WADA created in 1999 to promote, coordinate, and monitor the fight against doping in sports. The WADA prohibits use of a particular growth factor, Insulin like growth factor (IGF-I). However scientific literature has shown that IGF-I is not increased in PRP. This misunderstanding of PRP may create an ironic situation where this cutting edge technology may be available to the weekend warrior, but not the Olympian. Keep in mind that “growth factors” are different from “growth hormones.”
swimmer
As PRP use increases so does the need for the scientific community to comprehend it’s applications & mechanism of action. Hopefully the application of PRP will be recognized as a natural and safe alternative to promote healing in high level athletes and the weekend warrior alike.

Growth Factor Delivery Methods in the Management of Sports Injuries:The State of Play http://bjsm.bmj.com/cgi/content/abstract/bjsm.2007.040071v1

Knee Arthritis Helped with Platelet Rich Plasma, Warsaw, Poland Oct 07′

Thursday, October 11th, 2007

- Utilization of Platelet-derived growth factors for the treatment of cartilage degenerative pathology Clinical research / Knee (Chondral and Osteochondral defects)

KneeOsteoarthritis125

E. Kon, G. Filardo, M. Lo Presti, M. Delcogliano, F. Iacono, C. Montaperto, M. Marcacci; Bologna/IT
Purpose
The influence of the growth factors on cartilage repair is not yet widely studied and its application in clinics is still experimental. PRP (Platelet Rich Plasma) is a natural concentrate of autologous growth factors and actually is widely experimented in different fields of medicine. The method is simple, low cost and minimally invasive. The aim of our study is to determine the short-term effect of PRP in cartilage degenerative pathology.
Methods and Materials
30 symptomatic patients (40 knees) were treated with autologous PRP intra-articular injections for degenerative cartilage pathology. Mean age of the patients was 51 years (range:35y to 80y). 3 injections were performed every 3 weeks. All patients were clinically evaluated at the end of the treatment and at 6 months follow up. IKDC, SF36, EQ-VAS, scores were used for clinical evaluation and patient stisfaction and functional status were also recorded.
Results
Statistically significant improvement of all scores was detected after treatment and was maintained at 6 months. Subjective IKDC evaluation showed a significant score enhancement from 37,9 before the treatment to 59,0 after the treatment. Significant correlation of clinical outcome with patients age was found. While the group of patients less then 60 years old have shown 85% of improvement, the group of patients over 60 showed only 30% of improvement of clinical outcome.

Conclusions
Our study have demonstrated a positive effect of treatment of degenerative cartilage pathology with Platelet-derived growth factors in middle-age patients (<60y) at short term. Medium-long term studies are needed to confirm the durability of this treatment.

ICRS – International Cartilage Repair Society.

Knee Cartilage Cell Stimulation with Platelet Rich Plasma, Warsaw Poland, Oct 07′

Thursday, October 11th, 2007

Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes
K. Nakagawa1, T. Sasho1, M. Arai1, S. Kitahara1, S. Ogino1, Y. Wada2, H. Moriya1; 1Chiba/JP, 2Ichihara/JP

chondrocytes

Purpose

Platelet-rich plasma (PRP) is a fraction of plasma in which platelets are concentrated and is reported to be utilized as a source of multiple growth factors. Recent basic studies have shown that allogenic PRP has a promotive effect on chondrocyte metabolism. For the clinical application of PRP to cartilage defects, it is essential to use autologuous prepared PRP in each case. The purpose of this study was to examnie the effect of autologous PRP on adult human chondrocytes.
Methods and Materials
Fresh blood (54ml) and cartilage tissue were obtained from three patients (mean age: 70y.o.) underwent total knee arthroplasty with their consent. Platelet poor plasma (PPP) and PRP were prepared using a platelet concentration system. Chondrocytes were isolated with enzymatic digestion and cultured in monolayer. WST-8 was used for cell proliferation assay. Gene expression of types I, II collagen and aggrecan were examined with a relative quantitative real time RT-PCR assay.
Results
The concentrations of PDGF and TGF-beta1 in the PRP were much higher than those in the PPP. The WST-8 assay showed a higher absorbency in the PRP group, which reflects an enhancement of cell proliferation. PRP significantly enhanced type II collagen synthesis by human chondrocytes, while their aggrecan synthesis was inhibited.
Conclusions
We demonstrated for the first time that autologous PRP stimulated proliferation and collagen synthesis of adult human chondrocytes. PRP is easy to prepare and utilize as both soluble platelet releasate and fibrin gel. The results of this study suggested the usefulness of autologous PRP for the treatment of cartilage defects.

ICRS – International Cartilage Repair Society. http://www.cartilage.org/

Platelet Rich Plasma Introduction

Sunday, August 19th, 2007

This blog site was created to establish a non-competitive forum for physicians performing PRP treatments & for patients interested in learning more about this emerging treatment. I was introduced to this treatment by my colleagues, Dr Bert Mandelbaum & Dr Michael Gerhardt; who are premiere orthopaedists responsible for treating numerous soccer athletes from all over the world. PRP is being used by many European professional soccer clubs, and is now making it’s way to the U.S.

Initially we injected a few professional soccer athletes for MCL tears/sprains and noted accelerated recovery & earlier than expected return to play. Click link to see article:
http://www.mlsnet.com/news/team_news.jsp?ymd=20070417&content_id=89302&vkey=news_cdc&fext=.jsp&team=t120

Shortly afterwards we began treating weekend warriors with chronic non-healing tendon injuries including tennis/golfers elbow, achilles tendonosis, patellar tendonosis (jumpers knee). After a favorable response from patients and following discussions with other leaders in the community on PRP, we are now injecting PRP for other non-healing injuries including knee arthritis & hip bursitis.

PRP provides a safe and natural alternative to surgery using the body’s natural ability to heal itself.