Fact: According to research, PRP treatments are one of the most in-demand treatments available in healthcare.
This is impressive considering the following.
PRP is not supported by the medical industry. No big pharma funding on extensive research or marketing. No medical associations lobbying to increase its awareness.
PRP is shunned by the insurance companies. No reimbursements from them. So getting patients to pay is difficult. Especially for a treatment that’s relatively “unproven” like this.
The cost of PRP treatments are actually rising. In 2006, you can get a PRP treatment for $450. Today it costs $800. The cheapest we’ve seen is $650. The prices are still robust as demand keeps up.
However, we believe the best of PRP is not even here yet. We’re just one breakthrough study away from exploding into mainstream hospitals and clinics. We see the biggest growth in Platelet-Rich Plasma happening in Asia.
Strongly based on fundamental healing theory
The growth can be attributed to PRP’s fundamental healing property. More platelets. More growth factors and cytokines. And therefore more healing. It’s as simple as that. And no one can argue this fact.
Our body’s natural healing mechanism operates with 150,000/ul-350,000/ul platelets in blood. Using Platelet-Rich Plasma means this number is amplified by 3X to 5X. How can this be not translated into better healing?
Believe it or not, the best orthopedic doctors use Platelet-Rich Plasma. And do so regularly.
PLATELET-RICH PLASMA TRENDS
PRP can be used to promote healing of injured tendons, ligaments, muscles, and joints, can be applied to various musculoskeletal problems. And they conduct regular studies to test it’s effectiveness.
One landmark study involved double-blind randomized controlled trials to see the effect of PRP on patients with chronic low back pain caused by torn discs. The study outcome says 60% of the patients felt significant improvements.
Some were cured. CURED!
Platelet-Rich Plasma Variants
So far, there are the following type of PRP variants.
Plasma Rich in Growth Factors (PRGF)
Plasma Rich in Platelets and Growth Factors (PRPGF)
Platelet-Rich Plasma (PRP); Platelet Poor Plasma (PPP)
Plasma Rich in Platelets and Rich in Leukocytes (LR-PRP)
Plasma Rich in Platelets and Poor in Leukocytes (LP-PRP)
Platelet-Rich Fibrin Matrix (PRFM)
All of them involve Plasmapherisis — the two stage centrifugation process to separate platelets from blood. However, what happen what happens after that can be different. And the industry hasn’t found it’s middle ground as to which variant to be standardized. We believe the confusion will clear up in 3-5 years.
PLATELET-RICH PLASMA TRENDS
No matter which variant you end up using, the bio-factors at play are the following:
Growth factors: TGF-B, PDGF, IGF-I,II, FGF, EGF, VEGF, ECGF
Adhesive proteins: Fibrinogen, Fibronectin, Vitronectin, Thrombospondin-1
Clotting & Anti-Clotting factors: Proteins, Antithrombin, Plasminogen, Proteases, Antiproteases
How Platelet-Rich Plasma Actually Work
Why is the treatment commonly used for wound healing and pain management? The answer is because the platelets’ main job is to aid coagulation, act as a biological glue and support stem or primary cell migration. In addition, it also helps in restoring hyaluronic acid and accelerates the synthesis of collagen and glycosaminoglycans and increases cartilage matrix.
Not only that, the platelets are delivered in a clot which means it can immediately act as a scaffold to enable the healing process. 95% of the bio-active proteins are released within 1 hour of injecting Platelet-Rich Plasma. The platelets continue to release growth factors for 7-10 days. Thus it’s recommended to re-inject PRP every 7 days.
PLATELET-RICH PLASMA TRENDS
Why are patients coughing up their hard earned money for this?
This reminds me of hundreds of thousands of PRP treatments paid from patient’s own pocket even though they’ve been paying for years to get covered by their respective insurance provider. In 2015, PRP costs were anywhere between $600 and $800 per site per treatment. And most patients go for repeated treatments. So why were they forking up their hard earned money if the treatment was not working? Weren’t there any better alternatives under the “coverage” of their insurance provider? The answer is 1) the treatment works. 2) there’s nothing else out there that’s as natural and side-effect-free as PRP.
Consider the case of osteoarthritis. 27 millions Americans are impacted by it. 33.6% of people older than 65 are victims. All of them experience gradual degeneration of cartilage and bones — they lose roughly 5% cartilage per year. Yet, our medical industry doesn’t have a fix to stop it.
However, when doctors started doing PRP treatments for their osteoarthritis patients, they found a large majority of them had no further cartilage loss.
To me, it means we should make PRP treatments the default first-line treatment for osteoarthritis across the country.
Another huge market is hair loss and cosmetic facial applications. I know there are many people who believe PRP doesn’t work for hair. Here’s what one of the Platelet-Rich Plasma studies found were the effect of the treatment on hair loss.
“Hair loss reduced and at 3 months it reached normal levels. Hair density reached a peak at 3 months (170.70 ± 37.81, P < 0.001). At 6 months and at 1 year, it was significantly increased, 156.25 ± 37.75 (P < 0.001) and 153.70 ± 39.92 (P < 0.001) respectively, comparing to baseline. Patients were satisfied with a mean result rating of 7.1 on a scale of 1-10. No remarkable adverse effects were noted.”
I’ll take that.
That’s me getting PRP for hair. ??
PLATELET-RICH PLASMA TRENDS
PRP market is expected to hit $126 million in 2016
That number looks paltry. But that’s an 180% increase over the 2009 figure of $45 million.
Consider this. Just for osteoarthritis alone, if all the 27 million Americans receive 1 PRP shot a year at a conservative $400 per treatment, it would be a market of $10 billion. And that’s one condition out of the many that Platelet-Rich Plasma injections are proven to work.
Another condition that PRP is known to work very well is Tennis Elbow. It affects on average 1% to 3% of the overall population. That number is as high as 50% among tennis players.
Do the math.
Just getting Platelet-Rich Plasma covered by insurance will unleash the market big time and will help heal millions of patients naturally, more effectively.
Oh ya, that means the insurance companies will have to pay more. Why would they?
HOWEVER, if this treatment could reduce further expensive intervention like surgery then it may actually be a blessing for the insurance guys in terms of savings. One surgery avoided by a patient through right intervention through PRP treatments will save the insurance companies at least $25,000. Now, that’s a win-win for both patients and insurance.
I believe it’s a matter of time before insurance companies start realizing their folly of not supporting this treatment.
PLATELET-RICH PLASMA TRENDS
After all is said and done, it’s still “unproven”
The problem with PRP is that it can be used for just about everything, which is a good problem to have until health care officials (and insurance companies) start realizing that people are going to misuse it.
So it’s classified as unproven. The VAST scope of the treatment calls for urgent structure and guidelines. There are some 20+ conditions where researchers have found it “helps” in one way or another. It’s a daunting task to prove its efficiency in all the areas. Nevertheless, we’ll get there.
Though we’ll need a lot of funding for that.
And yes, we need to standardize the procedure. As well as come up with optimized protocols for each conditions. Someone need to take initiative on that. We’re counting on independent doctors and medical institutions. The big pharma won’t jump in because what’s in it for them, right?
It’s so simple, you’d be an idiot to not try it.
You only need a vacuum blood harvesting tube like what we offer here, a centrifuge with adapter for the tube, pipettes and 10ml ampules of 10% calcium chloride.
The only complexity comes from not following a standard PRP system. Because the final platelet count can depend on a variety of factors. Like initial volume of blood, the technique used and relative concentration of WBC and/or RBC. As well as on the patient’s side, there are factors such as age, growth factor and WBC content.
However, concentration-wise, there’s little confusion as once a sufficiently high range is reached, more doesn’t have any adverse or enhancing effect — it saturates at a certain point. So that’s the minimum. Once you reach that, you’re good. Although the outcome is not always guaranteed to be same, with the right number of platelets, platelet activation and cytokine release, you can get a consistency in your PRP offerings.
There’s still some uncertainty over the number of injections, the timing and delivery method of Platelet-Rich Plasma. But with wide-spread adoption, some kind of structure will emerge.
Let’s hope the first glimpses of it will arrive this year.
Do you know in 2015, the world saw approximately 1 million knee arthroplasties for osteoarthritis? At $25,000 apiece, $25 billion.
How many of these patients had the good fortune of their doctor recommending PRP early on?
Yep, it’s Platelet-Rich Plasma. There has been numerous speculations about which one among the latest Platelet-Rich family was the greatest—is it the plasma or the fibrin or even latest the A-fibrin? That confusion is somewhat over now.
Platelet-products are known to facilitate angiogenesis, hemostasis, osteogenesis, and bone growth. But see, the only reason plasma can do that is because of the growth factors it carries. Let’s review the specific roles of these growth factors in the healing process.
Growth Factors In Platelet-Rich Plasma
These are growth factors that are traditionally known to have played a vital healing role in PRP. If you’re seeing your patients get better as a result of that injection you gave, these are guys you need to thank for.
Platelet-Derived Growth Factor (PDGF): Regulates cell growth and division. Especially in blood vessels. In other words, this guy is the reason the blood vessels in our body reproduces.
Transforming Growth Factor Beta(TGF-b): Responsible for overall cell proliferation, differentiation, and other functions.
Fibroblast Growth Factor (FGF): Plays a vital role in the wound healing process and embryonic development. Also behind the proliferation and differentiation of certain specialized cells and tissues.
Vascular Endothelial Growth Factor: Responsible for vasculogenesis and angiogenesis. Restores oxygen supply in cells when inadequate. It also helps create new blood vessels after injury.
Keratinocyte Growth Factor (KGF): Found in the epithelialization-phase of wound healing. In other words, it causes the formation of epithelium immediately after a wound or injury occurs.
Connective Tissue Growth Factor: Major functions in cell adhesion, migration, proliferation, angiogenesis, skeletal development, and tissue wound repair.
These growth factors are what enables a Platelet-Rich product in tissue regeneration.
Platelet-Rich Plasma Rules
However, this new study suggests Platelet-Rich Plasma and it’s gelled cousin Platelet-Rich Fibrin both differ in the release of these growth factors which can significantly affect the healing outcome.
Here’s the takeaway:
“The advantage of PRP is the release of significantly higher proteins at earlier time points whereas PRF displayed a continual and steady release of growth factors over a 10-day period.”
Some argue that PRP enriched with large number of growth factors (a portion of it may even be excess) produce short-term effect and so is less desirable than a PRF whose release is slower and thus more beneficial in the long run.
That being said, PRF do have some advantage over PRP. Mainly:
It doesn’t need thrombin and anticoagulants.
It results in better healing due to its slow polymerization process.
And it helps in hemostasis.
How Platelet-Rich Plasma Differs From Platelet-Rich Fibrin
Platelet-Rich Plasma is a result of double spin method — a hard spin to separate red blood cells from everything everything else in the autologous (or whole) blood and a soft spin to separate the platelets and white blood cells. The result is Platelet-Rich Plasma (PRP), Platelet-Poor Plasma (PPP) and Red Blood Cells.
PRF is a newer method. Here after the first centrifugation, the middle layer is taken—which contains less platelets but more clotting factors. This gradually forms into a fibrin network and traps in the cytokines. It is then centrifuged in a PRF centrifuge resulting in PRF, a fibrin layer containing platelets and plasma.
What Matters In Healing
Obviously, when it comes to accelerating healing, immediate availability of growth factors and cytokines matter. So I believe PRP does a better job in this than PRF. Also the immediate release of growth factors for PRP means we can repeat the PRP injections for more healing factors just days after initial injection.
Platelet-derived products are in it’s infancy now. However, considering the huge potential benefits, there’s still a lot more research to be done. How about you? Which of these do you find beneficial?
If you’re a physician using any or both of these, do write to us and let us know of your experiences. Use the contact form here.
“You start out happy that you have no hips or boobs. All of a sudden you get them, and it feels sloppy. Then just when you start liking them, they start drooping.”
Just like men associate (some of) their masculinity with the shape and size of their muscles, women associate (some of) their femininity with the shape and size of their breasts. However, unlike the muscles, exercise won’t be of much help for augmenting the size of breasts.
Fortunately, we have an array of procedures to the rescue. And today, we’re going to take a look at everything that Platelet-Rich Plasma can do for breast augmentation.
Platelet-Rich Plasma For Breast Augmentation
PRP & Breasts: The Incorrect Perception
Currently the traditional breast augmentation procedures like breast implant surgery and fat grafting are still the most effective methods. However, the general public do talk about Platelet-Rich Plasma for breast augmentation. And often times, they have a wrong perception of it. Here’s their typical conversation with a dermatologist goes.
Patient:”Hey, I heard about this thing called PRP, and I was told it’s just a couple of injections with stuff drawn from our own blood.”
Doctor: “Yeah, they are really good.”
Patient: “Really? You think so? I also heard they’re good for breast augmentation. Can you do it for me?”
This follows by the doctor slapping on their forehead. Then the doctor patiently explains how PRP is a healing tool and not an implant tool.
Platelet-Rich Plasma For Breast Augmentation
How Platelet-Rich Plasma For Breast Augmentation Works
Here are two ways PRP is used for breast procedures.
- Fat Transfer & Platelet Rich Plasma For Breast Lift
Fat transfer is the process of taking unwanted body fat (liposuction procedure) from other parts of the body and processing it before injecting it to upper part of the breast and in the cleavage area. This is immediate enhancement. And since it’s immediate, the sudden expansion of the breast can cause blood vessels to be blocked causing some parts of the breasts or the nipples to lose sensitivity. Sometimes it can even cause the skin at those areas to go haywire.
So the best way to avoid that is to make sure enough collagen and growth factors are supplied, well in excess of the area’s needs. That’s why it makes sense to combine the Fat Transfer procedure with Platelet-Rich Plasma. In this combination, the doctor adds PRP (Platelet Rich Plasma) derived from the patient’s own blood, to the fat when processing the fat, which includes many blood-derived growth factors and tissues containing collagen for skin rejuvenation. The end-product is then injected like a typical PRP Injection. The result is firmer breasts with not just a change in size, but also changes in skin texture and shape of the breast. And there’s no worry of losing sensitivity. Some call the entire procedure as Platelet-Rich Plasma Facelift. Results generally last from 9-18 months.
This great procedure has boosted the confidence levels of thousands of women who wanted to overcome their unnatural shaping and aging of breasts. However, even though it works for all kind of breast sizes, it’s not recommended for women with:
Extreme Loss of Volume
Previous Breast Implants
- Only Platelet Rich Plasma For Breast Rejuvenation
This second procedure is purely PRP for rejuvenation purposes. It’s for women who’re happy with their breast size but would love to rejuvenate the skin for youthful looks, restore fullness for healthy breasts and regain sensitivity in areas where it’s diminished. The procedure is same as any other Platelet-Rich Plasma procedures. It starts with drawing 20ml of patient’s blood, spinning it (twice) in a tabletop centrifuge and then injecting to necessary areas. PRP injection not only enhances the looks, it actually produces new tissues in the area because of all that growth factors resulting in better cleavage and fullness.
So if any of your beautiful, intelligent and man-loving female patients need a little help in augmentation, you can confidently recommend these two Platelet-Rich Plasma procedures for breasts. It works.
Some of us in the medical profession hold the opinion that, “if you want to enlarge your breasts, stick with the gold standard. Breast Implants performed by a board certified plastic surgeon.” Artificial implants are anything but gold standard. Natural is the new gold. Besides, to implant artificial stuff you need to cut up the breasts. And the scars that results can take time to heal. Plus, implants may need to be replaced sometime after 10 or 20 years.
“It wasn’t just her beauty. It was the attitude in her smile, the tilt of her head, and the loving look in her eyes when she caught me sneaking a peek down her shirt.”
John L. Monk, Kick
Platelet-Rich Plasma has a proven record for healing soft-tissues and other living tissues. But can it actually heal the bones itself?
This could mean PRP, when applied to an affected area whether it’s an elbow joint or knee or back bone area, actually heals everything within it’s reach including the bones. Is that really why PRP actually works?
Platelet-Rich Plasma For Bone Healing
Bones are not just lifeless matter attached to living tissues. It’s as much living as the tissues themselves. And just like the tissues, it’s constantly changing too. The old bone cells are broken down and replaced with new ones in a three-part process called bone remodeling the involves resorption (digestion of old bone cells), reversal (new cells are birthed) and formation (new cells turn into fully formed bones).
This process, just like any other biological processes in the body, requires hormones and growth factors. Some of the names include parathyroid hormone (PTH), calcitriol, insulin-like growth factors (IGFs), prostaglandins, tumor growth factor-beta (TGF-beta), bone morphogenetic proteins (BMP), and plain old cytokines. For this discussion we need to remember only one thing: a large cytokines and growth factors are involved in bone remodeling process.
Which means we accelerate the bone remodeling process by supplying these cytokines and growth factors as suggested by studies like this, this, this, this, this and this.
Why Platelet-Rich Plasma?
Autologous Platelet-Rich Plasma (PRP), being completely “whole and natural” can more closely simulate a highly efficient in-vivo situation that anything else out there that are made up of artificial recombinant proteins. In PRP, we are taking advantage of the biological benefits of growth factors whose functions we know as well as those we do not know of yet. From the 15+ factors we know are in PRP including platelet derived growth factor (PDRF), transforming growth factor-beta (TGF-beta), platelet factor 4 (PF4), interleukin 1 (IL-1), platelet-derived angiogenesis factor (PDAF), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), platelet-derived endothelial growth factor (PDEGF), epithelial cell growth factor (ECGF), insulin-like growth factor (IGF), osteocalcin (Oc), osteonectin (On), fibrinogen (Fg), vitronectin (Vn), fibronectin (Fn) and thrombospontin-1 (TSP-1)… we’re actually supplying a “holistic” set of nutrients for healing that cannot be mimicked by those obtained artificially.
Platelet-Rich Plasma For Bone Healing
Organic Fertilizers For The Body
The PRP difference is like adding chemical fertilizers versus organic fertilizers on plants. Chemical fertilizers are rich in essential nutrients that we know are needed for crops. On the other hand, organic fertilizers supply nutrients not only to the plants but also to the soil, improving the soil structure and tilth, water holding capacity, reduces erosion as well as promote slow and consistent release of nutrients to the plants itself.
Clearly, organic fertilizers are better, aren’t they?
Platelet-Rich Plasma are like organic fertilizers for our body.
Bonus: Strong Antimicrobial Properties
It seems that the Platelet-Rich Plasma’s healing function has synergistic function to anti-microbial properties. A new study confirms that using Platelet-Rich Plasma in surgeries may have the potential to prevent infection and to reduce the need for costly post-operative treatments.
That’s a nice bonus for the organic fertilizer of our bodies. Perhaps, there are more. So why wouldn’t anyone not take advantage of them?
The scope of Platelet-Rich Plasma is growing as the scientific community continues to unearth its inherent properties. PRP is an unignorable, and unavoidable component of healing.
According to many physicians, PRP (Platelet-Rich Plasma) has been a lifesaver for their practice, while others claimed that it helped them become passionate about medicine again. This is because not only is it 100% from the body of the patient themselves, but it is also natural and comes with pretty much no side effects. It can also be used to treat a plethora of medical ailments, to the point where no other treatment options come close.
Although the above are all fantastic and solid reasons for offering PRP therapies, there are also a couple other reasons as well.
For instance, it is extremely simple compared to other treatment options. For about 1000$ as an initial investment, you can get started with offering PRP. The equipment is relatively cheap, and it pays for itself over a relatively short amount of time.
It also is not just a passing trend, as it has been going popular for a long time and shows no signs of slowing down. The market for PRP therapies is expected to reach almost 500 million dollars within the next 10 years, or an annual growth rate of 12.5% since 2015.
Patient satisfaction is another reason. In certain situations, the satisfaction rate for patients have been as high as 95%. This shocks many of the patients, who believe, although justifiably, that they cannot reverse or halt their condition without side effects, down time, and invasive surgeries.
The time for you to start including PRP into your practice is now, while the supply is low but the demand is booming. There is still a lot more promise when it comes to PRP as well, including combining PRP with other treatments to increase efficacy. Since no standard has yet to be established, you may be starting these standards yourself.
It is vital that we get more doctors to utilize PRP therapy so that they can be a pioneer in this field. PRP can turn medicine on its head, and missing out should not be a smart option.
The best part about it, is that PRP can be utilized in almost every field and specialty, from sports medicine, to pain management, skin rejuvenation, hair care, and even urology. Most of the physicians who utilize this treatment also saw higher patient retention rates as well.
So is there a legitimate reason to not add PRP to your practice?
Despite being rather simple, PRP extraction has been shrouded with debate on the reliability of the methods for the past decade. We are going to help clear up the debate by providing information on choosing the best PRP kit.
Using a kit is in itself vital to the creation of PRP. While it is possible to draw blood into a test tube and put it through a centrifuge and claim it is PRP, it’s otherwise ineffective. This is what is known as “bloody PRP,” and it might hold 1.5x the amount of blood platelets if you’re lucky, but it will also contain a ton of red and white blood cells. Because of this, this ineffective form of PRP can potentially cause flare ups after injection.
However, if you use a kit, that concentration of platelets can be as high as 5-7 times the baseline.
What Makes A PRP Kit Good?
This concentration of 5-7 times is vital for PRP to work, and kits allow you to choose whether or not you want to keep in the red and white blood cells, or whether you don’t. Each one would work on different ailments. However, some commercial kits may not deliver what you may want in your PRP, so it is good to know the difference between the kits.
- Gel Separators
Gel separators is pretty much just a test tube with some gel on the bottom. This gel is able to separate the blood from the platelets due to osmosis. The main issue is that when the test tube goes through the centrifuge, most of the platelets will also be caught by the gel as well. This will wind up with 1.5 times concentration of platelets at most, but it does take out the white and red blood cells as well, so that’s a plus.
- Buffy Coat
The kits that allow you to see a buffy coat are most likely to give you concentrations of 5-7 times. A buffy coat is a thin layer that is formed between the blood and the plasma after being in a centrifuge. This is mainly just platelets and white blood cells, with plasma on top, and packed blood underneath.
After this, you have to be able to separate the bufy coat from the red blood cells without contamination. This will help you to get PRP with less than 10% red blood cells.
- Buffy Coat with a Double Spin
The third and final type utilize a buffy coat which is devoid of red blood cells. This is the best kit on the market, because what you do is after separating the PRP from the red blood cells, you spin it again to further get rid of the red blood cells and to concentrate the platelets even more. After this, all that is needed to do is to separate the buffy coat, and this is PRP.
The Biosafe Kit
Although there are many kits that create PRP, the Biosafe kit has to be the best on the market. This is because it give you full control over the end product. Using this machine, you wind up with 10cc of usable product, which you can then double spin for that 5-7 times concentration. You can also choose whether or not you want some red blood cells in the finished product as well.
What is Leukocyte-poor PRP?
Leukocytes are otherwise known as White Blood Cells, and some researchers believe that they can be detrimental to PRP therapy. While there is no consensus as of yet, it is believed by many that these blood cells may trigger an inflammatory response, and even prevent growth factors from creating new cells.
However, some researchers believe that white blood cells are vital to a beneficial response. They believe that without these cells, you will be left with a lot of scar tissue at the site of healing. This Leukocyte-rich PRP also tends to have much more growth factors as well.
If you want to try leukocyte-poor PRP, you will need a Leukocyte Reduction filter, also known as an LR filter. These filters use electrostatic attraction to separate the white blood cells from the rest of the PRP. Although some filters can get clogged, a CIF-LR filter will be able to prevent that and filter out 99.99% of white blood cells.
There Is Plenty Of Evidence To Back This Up
Many people are highly skeptical about PRP, and are willing to ignore it without tons of randomized double-blind studies. Ignoring that some of the things that they do in their practice is also not proven in this manner. Many refuse to even look at the evidence, including the long line of evidence since the 1970’s, ranging over 6000 scientific studies.
The best evidence is how much clients will pay for this despite not being covered by insurance. This shows without any doubt that something about this treatment must be working. As long as there are clients, Adimarket will be there to provide the equipment for practices.
Although the clinical demand for bioengineered blood vessels continues to rise, current options for vascular conduits remain limited. The synergistic combination of emerging advances in tissue fabrication and stem cell engineering promises new strategies for engineering autologous blood vessels that recapitulate not only the mechanical properties of native vessels but also their biological function. Here we explore recent bioengineering advances in creating functional blood macro and microvessels, particularly featuring stem cells as a seed source. We also highlight progress in integrating engineered vascular tissues with the host after implantation as well as the exciting pre-clinical and clinical applications of this technology.
Ischemic diseases, such as atherosclerotic cardiovascular disease (CVD), remain one of the leading causes of mortality and morbidity across the world (GBD 2015 Mortality and Causes of Death Collaborators, 2016, Mozaffarian et al., 2016). These diseases have resulted in an ever-persistent demand for vascular conduits to reconstruct or bypass vascular occlusions and aneurysms. Synthetic grafts for replacing occluded arterial vessels were first introduced in the 1950s following surgical complications associated with harvesting vessels, the frequent shortage of allogeneic grafts, and immunologic rejection of large animal-derived vessels. However, despite advances in pharmacology, materials science, and device fabrication, these synthetic vascular grafts have not significantly decreased the overall mortality and morbidity (Nugent and Edelman, 2003, Prabhakaran et al., 2017). Synthetic grafts continue to exhibit a number of shortcomings that have limited their impact. These shortcomings include low patency rates for small diameter vessels (< 6 mm in diameter), a lack of growth potential for the pediatric population necessitating repeated interventions, and the susceptibility to infection. In addition to grafting, vascular conduits are also needed for clinical situations such as hemodialysis, which involves large volumes of blood that must be withdrawn and circulated back into a patient several times a week for several hours.
In addition to large-scale vessel complications, ischemic diseases also arise at the microvasculature level (< 1 mm in diameter), where replacing upstream arteries would not address the reperfusion needs of downstream tissues (Hausenloy and Yellon, 2013, Krug et al., 1966). Microvascularization has proven to be a critical step during regeneration and wound healing, where the delay of wound perfusion (in diabetic patients, for example) significantly slows down the formation of the granulation tissue and can lead to severe infection and ulceration (Baltzis et al., 2014, Brem and Tomic-Canic, 2007, Randeria et al., 2015).
In order to design advanced grafts, it is important to take structural components of a blood vessel into consideration, as understanding these elements is required for rational biomaterial design and choosing an appropriate cell source. Many of the different blood vessel beds also share some common structural features. Arteries, veins, and capillaries have a tunica intima comprised of endothelial cells (EC), which regulate coagulation, confer selective permeability, and participate in immune cell trafficking (Herbert and Stainier, 2011, Potente et al., 2011). Arteries and veins are further bound by a second layer, the tunica media, which is composed of smooth muscle cells (SMC), collagen, elastin, and proteoglycans, conferring strength to the vessel and acting as effectors of vascular tone. Arterioles and venules, which are smaller caliber equivalents of arteries and veins, are comprised of only a few layers of SMCs, while capillaries, which are the smallest vessels in size, have pericytes abutting the single layer of ECs and basement membrane. Vascular tissue engineering has evolved to generate constructs that incorporate the functionality of these structural layers, withstand physiologic stresses inherent to the cardiovascular system, and promote integration in host tissue without mounting immunologic rejection (Chang and Niklason, 2017).
A suitable cell source is also critical to help impart structural stability and facilitate in vivo integration. Patient-derived autologous cells are one potential cell source that has garnered interest because of their potential to minimize graft rejection. However, isolating and expanding viable primary cells to a therapeutically relevant scale may be limited given that patients with advanced arterial disease likely have cells with reduced growth or regenerative potential. With the advancement of stem cell (SC) technology and gene editing tools such as CRISPR, autologous adult and induced pluripotent stem cells (iPSCs) are emerging as promising alternative sources of ECs and perivascular SMCs that can be incorporated into the engineered vasculature (Chan et al., 2017, Wang et al., 2017).
Importantly, a viable cell source alone is not sufficient for therapeutic efficacy. Although vascular cells can contribute paracrine factors and have regenerative capacity, merely delivering a dispersed mixture of ECs to the host tissue has shown limited success at forming vasculature or integrating with the host vasculature (Chen et al., 2010). Therefore, recent tissue engineering efforts have instead focused on recreating the architecture and the function of the vasculature in vitro before implantation, with the hypothesis that pre-vascularized grafts and tissues enhance integration with the host. In this review, we explore recent advances in fabricating blood vessels of various calibers, from individual arterial vessels to vascular beds comprised of microvessels, and how these efforts facilitate the integration of the implanted vasculature within a host. We also discuss the extent to which SC-derived ECs and SMCs have been incorporated into these engineered tissues.
The first reported successful clinical application of TEBV in patients was performed by Shin’oka et al., who implanted a biodegradable construct as a pulmonary conduit in a child with pulmonary atresia and single ventricle anatomy (Shin’oka et al., 2001). The construct was composed of a synthetic polymer mixture of L-lactide and e-caprolactone, and it was reinforced with PGA and seeded with autologous bone marrow-derived mesenchymal stem cells (BM-MSCs). The authors demonstrated patency and patient survival 7 months post-implant, and expanded their study to a series of 23 implanted TEBVs and 19 tissue patch repairs in pediatric patients (Hibino et al., 2010). They were noted to have no graft-related mortality, and four patients required interventions to relieve stenosis at a mean follow-up of 5.8 years. The first sheet-based technology to seed cultured autologous cells, developed by L’Heureux et al., was iterated by the group to induce cultured fibroblast cell sheet over a 10-week maturation period and produce tubules of endogenous ECM over a production time ranging between 6 and 9 months. They dehydrated and provided a living adventitial layer before seeding the constructs with ECs (L’Heureux et al., 2006). Their TEBV, named the Lifeline graft, was implanted in 9 of 10 enrolled patients with end-stage renal disease on hemodialysis and failing access grafts in a clinical trial. Six of the nine surviving patients had patent grafts at 6 months, while the remaining grafts failed due to thrombosis, rejection, and failure (McAllister et al., 2009). An attempt to create an “off the shelf” version of this graft in which pre-fabricated, frozen scaffolds were seeded with autologous endothelium prior to implantation led to 2 of the 3 implanted grafts failing due to stenosis, and one patient passed away due to graft infection (Benrashid et al., 2016).
Most recently, results were reported for the phase II trial of the decellularized engineered vessel Humacyte in end-stage renal disease patients surgically unsuitable for arterio-venous fistula creation (Lawson et al., 2016). This clinical scenario offers a relatively captive patient population in which graft complications are unlikely to be limb or life-threatening, and infectious and thrombotic event rates for traditional materials such as ePTFE are high (Haskal et al., 2010). The manufacturers seeded a 6mm PGA scaffold with SMCs from deceased organ and tissue donors and decellularized the scaffold following ECM production in an incubator coupled with a pulsatile pump prior to implantation. Humacyte demonstrated 63% primary patency at 6 months, 28% at 12 months, and 18% at 18 months post-implant in 60 patients. Ten grafts were abandoned. However, 12-month patency and mean procedure rate of 1.89 per patient-year to restore patency were comparable to PTFE grafts, while higher secondary patency rates were observed (89% versus 55%–65% at 1 year) (Huber et al., 2003, Lok et al., 2013). Although Humacyte revealed no immune sensitization and a lower infection rate than PTFEs (reported up to 12%) (Akoh and Patel, 2010), there remains much work to be done to improve primary patency and reduce the need for interventions.
Harnessing the regenerative functions reported in ECs derived from adult stem cells and iPSCs offers the promise of improving TEBV patency. Mcllhenny et al. generated ECs from adipose-derived stromal cells, transfected them with adenoviral vector carrying the endothelial nitric oxide synthase (eNOS) gene, and seeded the ECs onto decellularized human saphenous vein scaffolds (McIlhenny et al., 2015). They hypothesized that through inhibition of platelet aggregation and adhesion molecule expression, nitric oxide synthesis would prevent thrombotic occlusion in TEBV. Indeed, they reported patency with a non-thrombogenic surface 2 months post-implantation in rabbit aortas. While introducing additional complexities, engineering ECs and SMCs with other regenerative, anti-inflammatory, anti-thrombotic genes could perhaps bridge the functional difference between SC-derived cells and native primary cells.
Thousands of skincare centers across the nation provide at the very least one kind of PRP treatment. However, most do not go any farther than micro-needling with a topical solution. This is mainly because it is far simpler than all other methods, and it is incredibly popular. However, it would make more sense to many practices who have invested in equipment for add in PRP injections as well.
PRP Is Growing Substantially
Regardless of what is being treated, the protocol for obtaining PRP is the same: You draw the blood, place it in the centrifuge, and then take out the PRP from the rest of the material. This simplicity can be combined with PRP’s vast usability to create significant and mindblowing advances in modern medicine.
This includes skincare as well, as the PRP that you get from patients can be used in a plethora of ways. Here are a couple of examples of what can be performed by dermatologists and plastic surgeons the world over.
- Skin Augmentation
Adding a topical solution of PRP ccombined with microneedling can help to regenerate dying skin cells, and makes skin feel soft. Although this will probably work for most clients, many might want more. For instance, if you want to plump up the face, injecting PRPinto the dermis can help provide both beauty, as well as a healing process.
Although if you want to create volume, you will need a filler. One way to do this is by using a Platelet-Poor Plasma filler, or PPP, which is often left over from the PRP process. You can also use Hyaluronic Adic. A combination of these with PRP have been known to provide wonderful results, with some clinicians boasting a 100% success rate.
- Vitiligo Correction
Many companies will shill out millions of dollars to find out how to turn defective cells healthy again. Many are looking into DNA Technology. However, simply utilizing PRPP may provide the same results. Some studies have shown that adding CO2 laser therapy for correcting vitiligo to a PRP treatment can increase it’s effectiveness by 4 times. This can also be beneficial in other areas, such as correcting wrinkles, and even acne scars. So combining PRP treatments are conventional therapies can boost the effects tremendously.
So if PRP can help boost the effects of lasers, it may be able to also boost the effects of other skin therapies as well. It seems like a great opportunity to continue doing the work that you do, but this time it is more effective due to a simple method. This is something that hundreds of skin care facilities are already providing for their clients.
- Hair Rejuvenation
Mesotherapy is a common treatment that utilizes microinjections that deliver a medication throughout the skin’s service. This prodecure has been able to provide great quality results by adding peptides and vitamins to the mix as well. However, one of the best ways that you can incorporate this into your practice is by using PRP therapy.
Mesotherapy can also be used to provide an even amount of PRP all over the body, including face, neck, hands, etc. This helps to rejuvenate the skin and reduce wrinkles, discoloration, and stretch marks. However, this works best when it comes to hair loss treatments. In fact, adding PRP with mesotherapy has exceeding the expectations that the industry has set.
This is why we think PRP therapy is something that every skincare clinic should offer. Since hair loss effects both men and women, it is important to try to work to make your treatments as effective as possible. Your patients will benefit from it and satisfaction will rise, is there any other reason to put it off?
“But I Never Heard Of Them!”
Some of these treatments and combinations are incredibly new, so new, that many might not have heard of them before. However, this is why signing up to use them as soon as possible is vital. This way, you can bee a step ahead of the competition when it comes to providing great services.
The demand for PRP is only growing over time, and the sooner you can get on board, the better off your practice will be. If you are interested in learning more about PRP therapy, or checking out our line of PRP equipment, you can do so by going to the Adimarket website and checking it out for yourself.
PRP provides more effective treatments for less time, less money, and more satisfaction. Tons off practices have been putting their trust in this treatment and have been reaping the benefits long term. PRP is here to stay, so are you ready to seize the potential of this great medical revolution?,
PRP is a powerful means of regenerating tissues, and has pretty a pretty large growth in popularity among patients, especially those who suffer from alopecia. This is despite the apparently lack of evidence that supposedly surrounds the treatment.
Is It A Lack Of Evidence Or Just A Lack Of Funding?The lack of widespread research may have more to do with funding than anything else. Many of the studies that are currently out there about PRP were unfunded, especially on the subject of Hair Regeneration. However, despite this lack of funding, the demand for PRP treatments for hair loss is growing at an unprecedented rate.
When it comes to PRP kits, there are three kinds to choose from. Ones that use gels, one that create a buffy coat, and one that creates a buffy coat utilizing a double spin. It is pretty unanimous that the last option creates the most reliable and concentrated form of PRP possible, at 5-7 times the baseline amount of platelets.
This concentration level also has the most nutrients which helps for the regeneration of blood vessels and stem cells. One commonly recommended tactic is to combine PRP hair regeneration with micro-needling with a topical layer of PRP. This may be beneficial in some cases.
Micro-needling is a way to create small amounts of trauma, which the body reacts to via a healing response. This response, mixed with PRP, can help to stimulate the growth of new cells.
In some instances, a dermatologist might have three sessions, with the first two being PRP injections, and the middle one being a micro-needling with a PRP topical solution. However, micro-needling is completely optional. Whether you choose to use this method or not, you will still be injecting the patient with PRP at the scalp.
Combining PRP with an Allograft Matrix
One thing that many hair regeneration experts do is combine PRP with an Allograft matrix. These are often used when healing wounds, as it changes inactive adult stem cells back into an active form. This makes the wounds heal faster.
This is because an allograft acts like a scaffold that proliferates cell regrowth and speeds up the healing process. Many experts in the fields have noted a high degree of success by using this method.
Allografts are generally made from using the bladder tissue of pigs. However, a better type of allograft is made from amniotic tissues and fluid. This type of allograft can be utilized with little or no chance of being rejected by the body, as opposed to those made from pig bladders.
Medications Vs PRP
The main drugs that are commonly used to regrow hair are Minoxidil and Finasteride. These were designed to be able to prevent male pattern hair loss, but did almost nothing when it came to regrowing lost hair. However, these drugs have been well known to only be temporary solutions, and if the patients stopped taking the drugs, the benefits of them would quickly reverse. These are also not 100% effective at stopping hair loss either, but it can slow the progression.
However, PRP is different. It may actually be the only treatment on the market that has been clinically proven to regrow hair and heal hair follicles. This means that it only only slows down hair loss, but actually helps with hair growth.
Many may ask how temporary the solution is, saying that the other drugs on the market are just temporary solutions. However, many pateints report that a PRP and allograft combination treatment was able to give them great results that lasted for nearly half a decade or more with just one treatment. However, each patient is indeed different.
Aside from drugs, we only had one other choice when it came to hair loss, and that was hair transplants. This is why PRP has been growing in popularity in hair regrowth groups lately. Although those other treatments are not obsolete in the slightest, adding PRP therapy can be both beneficial and safe to patients in the long run.
Some people combine the two, and use PRP alongside Minoxidil and Finasteride with little to no side effects seen to date. You can even combine PRP with laser light scalp stimulation therapy, but that is up to you.
So Try It Out
PRP for hair regeneration, skin rejuvination, and even facelifts is going strong with no sign of stopping. Many dermatologists have already taken the plunge, and since this treatment is not going anywhere anytime soon, it may behoove you to join in on it too.
For more information about PRP including equipment, check out the Adimarket website. We provide great tools for any practice to utilize.