1
|
Mohseni R, Mahdavi Sharif P, Khosravi A, Taheri AR, Behfar M, Zarrabi M, Jafari L, Jafari F, Nikfetrat Z, Naji P, Hamidieh AA. The Application of Umbilical Cord Blood-derived Platelet Gel for Skin Ulcers Associated With Chronic Graft-Versus-Host Disease in Pediatrics: A Randomized Trial. Transplant Cell Ther 2024; 30:694.e1-694.e10. [PMID: 38663767 DOI: 10.1016/j.jtct.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative strategy against a variety of malignant and nonmalignant disorders. However, acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively) commonly complicate this approach, culminating in substantial morbidities and mortalities. The integumentary system is the preponderant organ involved in cGVHD, and its response to existing treatments, including well-versed immunosuppressants and novel targeted therapies, is not desirable. Despite the rarity, ulcers of sclerotic skin cGVHD are treatment-refractory and associated with significant morbidities and an exaggerated risk of infectious complications. Platelet-rich plasma (PRP) and its derivatives are endowed with growth factors and proangiogenic molecules and hold regenerative potential. This study aimed to assess the safety and efficacy of the application of platelet gel-containing dressing against ulcerative skin cGVHD in pediatric patients. This randomized trial is conducted at the hematopoietic stem cell transplantation unit of the Children's Medical Center Hospital in Tehran, Iran. Twenty-one pediatric patients (aged between 5 and 15 years) were initially enrolled, and 16 met the inclusion criteria. All cases (4 females) were recipients of allo-HSCT who had been complicated with symmetrically or near-symmetrically ulcerative sclerotic skin cGVHD. Fresh umbilical cord blood (UCB) was obtained from healthy donors and underwent centrifugation using a novel PRP preparation kit in a single-step process. Platelet gel was produced by adding thrombin to the isolated buffy coat layer. Two similar ulcers of each patient were randomized to receive either conventional dressing or platelet gels up to 6 times. At each time point evaluation, ulcer size and its relative reduction compared to the basal size were recorded. Included patients received a total of 80 platelet gel-containing dressings. While the mean sizes of randomized ulcers at the beginning of the study were similar, their differences became significant 15 days after the initiation of intervention (P = .019). In addition, the mean reduction in the ulcers' surface area (in comparison to their baseline values) was significantly higher for the intervention arm at all evaluation points (P = .001 for day 5 and P < .001 for subsequent time points). At the end of the trial, the number of ulcers with a more than 50% reduction in size was 14 (87.5%) in the intervention arm (including 6 completely healed ulcers) versus 1 (6.25%, which was not completely healed) in the control arm (P < .001). None of the patients exhibited any localized or systemic treatment-related adverse events. In this study, using a relatively large number of cases, we showed that UCB-derived platelet gel is a safe, feasible, and effective curative approach for skin ulcers of sclerotic skin cGVHD in pediatric patients. Designing upcoming trials on the efficacy of this therapeutic approach for ocular, mucosal, and acute skin GVHD is prudent. Retrospectively registered at the Iranian Registry of Clinical Trials (registration number IRCT20190101042197N1) on August 24, 2020.
Collapse
Affiliation(s)
- Rashin Mohseni
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya Mahdavi Sharif
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Khosravi
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Taheri
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Behfar
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Zarrabi
- Department of Regenerative Medicine, Royan Institute for Stem Cell Biology and Technology, Tehran, Iran
| | - Leila Jafari
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Jafari
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeynab Nikfetrat
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Naji
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
2
|
Lambadiari V, Kountouri A, Psahoulia F, Koliou GA, Lazaris A, Michalopoulos E, Mallis P, Korakas E, Eleftheriadou I, Balampanis K, Sarris M, Tsirigotis P, Geroulakos G, Stavropoulos-Giokas C, Dimitriadis GD, Tentolouris N. Treatment with Umbilical Cord Blood Platelet Lysate Gel Improves Healing of Diabetic Foot Ulcer. J Clin Med 2024; 13:1310. [PMID: 38592188 PMCID: PMC10932121 DOI: 10.3390/jcm13051310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/14/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND This study was conducted to examine the hypothesis that umbilical cord blood platelet lysate (UCB-PL) gel has a significant impact on the healing rate of DFU. Μethods: In this open-labeled, randomized controlled trial, 110 patients were randomized to treatment with UCB-PL gel (UCB-PL group, n = 52) every three days for one month or dressing with normal saline (control group, n = 58). All participants were followed up for 20 weeks post treatment. Ulcer surface area was assessed with the imitoMeasure application at two, four, and six weeks, and two, four and six months. This study's main outcome was the reduction in ulcer size over the six-month study period. RESULTS The mean ulcer area at baseline was 4.1 cm2 in the UCB-PL group and 1.7 cm2 in the control group. At six months post treatment, patients on the UCB-PL treatment displayed a significant reduction in ulcer size compared to baseline 0.12 (0-8.16) in contrast to a more modest change in the control group 1.05 (0-24.7). The ulcer area was decreased at the end of the study in 40 patients (97.6%) in the UCB-PL group and 27 (73%) in the control group (Fisher's p = 0.002). CONCLUSIONS The application of UCB-PL gel in DFU resulted in a significant reduction in ulcer size compared to regular saline dressing.
Collapse
Affiliation(s)
- Vaia Lambadiari
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Aikaterini Kountouri
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Fοteini Psahoulia
- Department of Vascular Surgery, Attikon University Hospital, 12462 Athens, Greece; (F.P.); (A.L.); (G.G.)
| | - Georgia-Angeliki Koliou
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Andreas Lazaris
- Department of Vascular Surgery, Attikon University Hospital, 12462 Athens, Greece; (F.P.); (A.L.); (G.G.)
| | - Efstathios Michalopoulos
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (P.M.); (C.S.-G.)
| | - Panagiotis Mallis
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (P.M.); (C.S.-G.)
| | - Emmanouil Korakas
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.E.); (N.T.)
| | - Konstantinos Balampanis
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - Markos Sarris
- Health and Social Care Management, University of West Attica, 12241 Athens, Greece;
| | - Panagiotis Tsirigotis
- Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (G.-A.K.); (E.K.); (K.B.); (P.T.)
| | - George Geroulakos
- Department of Vascular Surgery, Attikon University Hospital, 12462 Athens, Greece; (F.P.); (A.L.); (G.G.)
| | - Catherine Stavropoulos-Giokas
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (P.M.); (C.S.-G.)
| | - George D. Dimitriadis
- Sector of Medicine, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Diabetes Centre, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (I.E.); (N.T.)
| |
Collapse
|
3
|
Hu Z, Wang S, Yang H, Xv H, Shan B, Lin L, Han X. Efficacy and safety of platelet-rich plasma in the treatment of venous ulcers: A systematic review and meta-analysis of randomized controlled trials. Int Wound J 2024; 21:e14736. [PMID: 38361238 PMCID: PMC10869651 DOI: 10.1111/iwj.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Considering the substantial impact of venous ulcers on quality of life and healthcare systems, this study evaluated the efficacy and safety of platelet-rich plasma (PRP) in comparison to conventional therapy. A systematic review of four databases identified 16 randomized clinical trials, including 20 study groups. PRP significantly enhanced complete ulcer healing, exhibiting an odds ratio (OR) of 5.06 (95% confidence interval [CI]: 2.35-10.89), and increased the percentage of healed ulcer area by a mean difference of 47% (95% CI: 32%-62%). Additionally, PRP shortened the time required for complete healing by an average of 3.25 months (95% CI: -4.06 to -2.43). Although pain reduction was similar in both groups, PRP considerably decreased ulcer recurrence rates (OR = 0.16, 95% CI: 0.05-0.50) without increasing the risks of infection or irritative dermatitis. These results suggest PRP as a viable, safe alternative for venous ulcer treatment, providing significant improvements in healing outcomes.
Collapse
Affiliation(s)
- Zhonglin Hu
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Senmao Wang
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Hao Yang
- Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Haona Xv
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Baozhen Shan
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lin Lin
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xuefeng Han
- Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
4
|
Tang B, Huang Z, Zheng X. Impact of autologous platelet concentrates on wound area reduction: A meta-analysis of randomized controlled trials. Int Wound J 2023; 20:4384-4393. [PMID: 37464541 PMCID: PMC10681409 DOI: 10.1111/iwj.14310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
This meta-analysis aimed to evaluate the impact of autologous platelet concentrates (APCs) on wound area reduction based on randomized controlled trials (RCTs). A comprehensive search was conducted in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Web of Science, and the Cochrane Library to identify relevant literature. The primary outcome measure was the percentage of wound area reduction. Secondary outcome measures included wound healing time and the incidence of infection. A total of 14 studies were included in the meta-analysis. The results showed that the percentage of wound area reduction was significantly greater in the APCs group compared to conventional treatments (standardized mean difference [SMD] 1.98, 95% confidence interval [CI]: 1.27-2.68, p < 0.001). Subgroup analysis revealed that the percentage of wound area reduction varied based on wound location, follow-up duration, and type of APCs used. The healing time and incidence of infection presented no significant difference between the two groups. The findings suggest that APCs can effectively reduce wound areas when compared to conventional treatments, without increasing the risk of infection. In addition, the effectiveness of APCs in wound area reduction may vary depending on factors such as wound location, type of APCs used, and follow-up duration.
Collapse
Affiliation(s)
- Bangli Tang
- Department of Dermatology, Mianyang Central HospitalSchool of Medicine University of Elctronic Science and Technology of ChinaMianyangChina
| | - Zhongkui Huang
- Department of Dermatology, Mianyang Central HospitalSchool of Medicine University of Elctronic Science and Technology of ChinaMianyangChina
| | - Xuhai Zheng
- Department of Dermatology, Mianyang Central HospitalSchool of Medicine University of Elctronic Science and Technology of ChinaMianyangChina
| |
Collapse
|
5
|
Shehab AW, Eleshra A, Fouda E, Elwakeel H, Farag M. Randomized prospective comparative study of platelet-rich plasma versus conventional compression in treatment of post-phlebitic venous ulcer. Vascular 2023; 31:1222-1229. [PMID: 35603798 DOI: 10.1177/17085381221104629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVES to assess the safety and efficacy of platelet-rich plasma (PRP) as adjunctive to compression therapy for post-phlebitic venous ulcers. METHODS This is a single-center randomized controlled trial on patients with persistent chronic post-phlebitic lower limb venous ulcers from March 2019 to March 2020. Patients were randomly allocated to one of two equal cohort groups. Patients group in which patients underwent combined PRP with compression therapy versus control group in which patients underwent placebo+ compression therapy alone. The primary endpoint of the study was the improvement in ulcer topographic measurement. Secondary endpoints included ulcer healing parameters, possible healing factors, reduction in pain score (VAS), and the achievement of complete healing. RESULTS Forty patients were available equally for randomization and analysis in both groups. The median number of PRP applications for every patient in the patient group was 6 (ranging from 3 to 6). There was a significant decline in the median length, width, and depth of ulcers in the patients group versus control group. Consequently, there was a significant decline of the median ulcer area, in the patient group versus control group (4 (3-9) cm2 vs. 10 (6-14) cm2, p = .036). Also, the median volume of the ulcers showed a significant decline in the patient group versus control group (1 (.7-3) cm3 vs 3 (2-6) cm3, p = .008). Complete healing was achieved in 45% of patient group. There was a significant decline in pain scores at 3- and 6 months from the therapy starting point in both groups (patient group: pre-VAS = 6.5 vs. post(3 months)-VAS = 1 vs. post(6 months)-VAS = 0.5) and (control group: pre-VAS = 6.4 vs. post(3 months)-VAS = 4.5 vs. post(6 months)-VAS = 2.2), (p < .0001 for each). On the other hand, the decline in pain scores between both groups was statistically significant in favor of the patient group, (post (3 months); PRP-VAS = 1 vs. control-VAS = 4.5, and post(6 months); PRP-VAS = 0.5 vs. control-VAS = 2.2), (p < .0001). CONCLUSION Platelet-rich plasma as an adjunct to compression therapy for chronic post-phlebitic venous ulcers is safe and effective as regards the ulcer healing and improvement of pain score. PRP may be useful adjunct in treatment of post-phlebitic venous ulcer. However, larger trials are warranted.
Collapse
Affiliation(s)
- Abdelrahman W Shehab
- Department of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Eleshra
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Elyamani Fouda
- Department of General Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hossam Elwakeel
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Farag
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
6
|
Fang Q, Zhang Y, Tang L, Li X, Zhang X, Gang JJ, Xu G. Clinical Study of Platelet-Rich Plasma (PRP) for Lower Extremity Venous Ulcers: A Meta-Analysis and Systematic Review. INT J LOW EXTR WOUND 2023; 22:641-653. [PMID: 34665051 DOI: 10.1177/15347346211046203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To systematically evaluate the clinical effects of platelet-rich plasma in the treatment of lower limb venous ulcers by applying a meta-analysis method. The Pubmed, Cochrance Library, Embase, and OVID EBM Reviews databases were searched for the search terms'platelet-rich plasma" or "Plasma, Platelet-Rich" or "Platelet Rich Plasma" and "lower extremity venous ulcers' or "Leg Ulcers' or "Ulcer, Leg", and a meta-analysis was performed on the published research literature on platelet-rich plasma for lower extremity venous ulcers from January 1900 to April 2021. The outcome indicators were: post-treatment trauma area and healing rate. Revman 5.3 statistical software was applied for meta-analysis. A total of 294 patients with lower extremity venous ulcers were included in six publications, including 148 patients in the experimental group treated with PRP versus 146 patients in the control group treated with conventional therapy. There was a statistically significant difference in the Formula of an ellipse at the end of treatment (CM²) between the experimental group and the control group, with a mean difference of -1.19 (95% CI -1.80 to -0.58, P = .0001; 6 studies, 294 participants moderate quality of evidence). The difference between the healing rate of the experimental group and the control group was statistically significant, with a risk ratio (RR) of 5.73 (95% CI 3.29 - 9.99, P < .00001; 5 studies, 248 participants moderate quality of evidence).There may be publication bias for both Formula of an ellipse at the end of treatment and healing rate. This comprehensive meta-analysis of available evidence suggests that the application of PRP for lower extremity venous ulcers accelerates the wound healing process and improves wound healing rates.
Collapse
Affiliation(s)
| | | | - Lijun Tang
- Dalian Medical University, Dalian, China
| | - Xiaomei Li
- Dalian Medical University, Dalian, China
| | - Xiaowei Zhang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University
| | - Junjun Jin Gang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University
| | - Gang Xu
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University
| |
Collapse
|
7
|
Zhu S, Gao J, Yu W, Xiong J. Platelet-rich plasma influence on the sternal wounds healing: A meta-analysis. Int Wound J 2023; 20:3794-3801. [PMID: 37350616 PMCID: PMC10588320 DOI: 10.1111/iwj.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023] Open
Abstract
A meta-analysis research was executed to appraise the effect of platelet-rich plasma (PRP) on sternal wound healing (SWH). Inclusive literature research till April 2023 was done and 1098 interconnected researches were revised. The 11 picked researches, enclosed 8961 cardiac surgery (CS) persons were in the utilised researchers' starting point, 3663 of them were utilising PRP, and 5298 were control. Odds ratio (OR) and 95% confidence intervals (CIs) were utilised to appraise the effect of PRP on the SWH by the dichotomous approach and a fixed or random model. PRP had significantly lower sternal wound infection (SWI) (OR, 0.11; 95% CI, 0.03-0.34, p < 0.001), deep SWI (OR, 0.29; 95% CI, 0.16-0.51, p < 0.001), and superficial SWI (OR, 0.20; 95% CI, 0.13-0.33, p < 0.001), compared to control in CS persons. PRP had significantly lower SWI, deep SWI, and superficial SWI, compared to control in CS persons. However, caution must be taken when interacting with its values since there was a low sample size of some of the nominated research found for the comparisons in the meta-analysis.
Collapse
Affiliation(s)
- Shenyu Zhu
- Department of Thoracic SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
- Ganzhou Key Lab of Brain Injury & Brain ProtectionGanzhouChina
| | - Jianfeng Gao
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Wenbo Yu
- The First Clinical Medical CollegeGannan Medical UniversityGanzhouChina
| | - Jianxian Xiong
- Department of Cardiovascular SurgeryThe First Affiliated Hospital of Gannan Medical UniversityGanzhouChina
| |
Collapse
|
8
|
Krizanova O, Penesova A, Hokynkova A, Pokorna A, Samadian A, Babula P. Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology-based treatment. Int Wound J 2023; 21:e14405. [PMID: 37858977 PMCID: PMC10824599 DOI: 10.1111/iwj.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
The chronic venous disease covers a wide spectrum of venous disorders that are characterized by severely impaired blood return that primarily affects veins in the lower extremities. Morphological and functional abnormalities of the venous system led to chronic venous insufficiency (CVI), and present as leg heaviness/achiness, edema, telangiectasia, and varices. The term 'chronic venous insufficiency' (CVI) refers to a disease of greater severity. Venous dysfunction is associated with venous hypertension and is associated with venous reflux due to poorly functioning or incompetent venous valves, which ultimately reduces venous return, leading to a cascade of morphological, physiological, and histologic abnormalities such as blood pooling, hypoxia, inflammation, swelling, skin changes (lipodermatosclerosis), and in severe cases, venous leg ulcers (VLU). This review summarizes recent knowledge about the aetiology, risk factors, and pathophysiology of VLU and compared the possibilities of their treatment.
Collapse
Affiliation(s)
- Olga Krizanova
- Institute of Clinical and Translational ResearchBiomedical Research Center SASBratislavaSlovakia
- Department of Chemistry, Faculty of Natural SciencesUniversity of Ss. Cyril and MethodiusTrnavaSlovakia
- Department of Physiology, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Adela Penesova
- Institute of Clinical and Translational ResearchBiomedical Research Center SASBratislavaSlovakia
| | - Alica Hokynkova
- Department of Burns and Plastic Surgery, Faculty of MedicineMasaryk University and University HospitalBrnoCzech Republic
| | - Andrea Pokorna
- Department of Health SciencesFaculty of Medicine, Masaryk UniversityBrnoCzech Republic
| | - Amir Samadian
- Department of Physiology, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Petr Babula
- Department of Physiology, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| |
Collapse
|
9
|
Wang Z, Feng C, Chang G, Liu H, Li S. The use of platelet-rich plasma in wound healing and vitiligo: A systematic review and meta-analysis. Skin Res Technol 2023; 29:e13444. [PMID: 37753680 PMCID: PMC10444946 DOI: 10.1111/srt.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/13/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To critically assess the effect and safety of platelet-rich plasma (PRP) in chronic wounds and vitiligo. METHODS A systematic literature searching was performed. Results were expressed as weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. RESULTS A total of 27 studies were included in this meta-analysis. In patients with chronic diabetic ulcers, PRP significantly increased proportion of complete wound healing, percentage of wound area healed, and shortened the complete wound healing. In venous ulcers, PRP improved the epithelialized area and percentage of wound area healed. In vitiligo, PRP had better results in degree of improvement and mean repigmentation than controls. Regarding the safety profile, PRP did not increase the risk of infection in patients with chronic diabetic ulcers. Meta-regression revealed that source of PRP and preparation method of PRP significantly affected the proportion of complete wound healing, whereas age, gender, country, duration of wound, and wound size had no impact on this outcome. CONCLUSION PRP is effective and safe, and can be used as a potential therapeutic adjunct or alternative treatment in chronic wounds of multiple etiologies and vitiligo.
Collapse
Affiliation(s)
- Zhi Wang
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Cheng Feng
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Guojing Chang
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Hao Liu
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| | - Shuo Li
- Department of Plastic & Cosmetic SurgeryPeking Union Medical College HospitalBeijingChina
| |
Collapse
|
10
|
The Efficiency and Safety of Platelet-Rich Plasma Dressing in the Treatment of Chronic Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pers Med 2023; 13:jpm13030430. [PMID: 36983611 PMCID: PMC10053387 DOI: 10.3390/jpm13030430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023] Open
Abstract
Recently, many clinical trials have applied platelet-rich plasma (PRP) dressings to treat wounds that have stopped healing, which are also called chronic wounds. However, the clinical efficiency of PRP dressings in treating chronic wounds is still controversial. Therefore, we conducted this study to compare PRP dressings with normal saline dressings in treating chronic wounds. Relevant randomized controlled trials focusing on utilizing PRP dressings in treating chronic wounds were extracted from bibliographic databases. Finally, 330 patients with chronic wounds, reported in eight randomized controlled trials, were included in this study. In total, 169 out of 330 (51.21%) were treated with PRP dressings, and 161 out of 330 (48.79%) were treated with normal saline dressings. The pooled results showed that the complete healing rate of the PRP group was significantly higher than that of saline group at 8 weeks and 12 weeks, respectively. In addition, there were no significant differences in wound infection and adverse events. Compared with normal saline dressing, the PRP dressing could effectively enhance the prognosis of chronic wounds. Furthermore, the PRP did not increase wound infection rate or occurrence of adverse events as an available treatment for chronic wounds.
Collapse
|
11
|
Meznerics FA, Fehérvári P, Dembrovszky F, Kovács KD, Kemény LV, Csupor D, Hegyi P, Bánvölgyi A. Platelet-Rich Plasma in Chronic Wound Management: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med 2022; 11:jcm11247532. [PMID: 36556151 PMCID: PMC9785167 DOI: 10.3390/jcm11247532] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic wounds place a heavy burden on the healthcare system due to the prolonged, continuous need for human resources for wound management. Our aim was to investigate the therapeutic effects of platelet-rich plasma on the treatment of chronic wounds. METHODS The systematic literature search was performed in four databases. Randomized clinical trials reporting on patients with chronic wounds treated with platelet-rich plasma (PRP) were included, comparing PRP with conventional ulcer therapy. We pooled the data using the random effects model. Our primary outcome was the change in wound size. RESULTS Our systematic search provided 2688 articles, and we identified 48 eligible studies after the selection and citation search. Thirty-three study groups of 29 RCTs with a total of 2198 wounds showed that the odds for complete closure were significantly higher in the PRP group than in the control group (OR = 5.32; CI: 3.37; 8.40; I2 = 58%). CONCLUSIONS PRP is a safe and effective modality to enhance wound healing. By implementing it in clinical practice, platelet-rich plasma could become a widely used, valuable tool as it could not only improve patients' quality of life but also decrease the healthcare burden of wound management.
Collapse
Affiliation(s)
- Fanni Adél Meznerics
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Fehérvári
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Biostatistics, University of Veterinary Medicine, 1085 Budapest, Hungary
| | - Fanni Dembrovszky
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
| | - Kata Dorottya Kovács
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Lajos Vince Kemény
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
- HCEMM-SU Translational Dermatology Research Group, Department of Physiology, Semmelweis University, 1094 Budapest, Hungary
| | - Dezső Csupor
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, Szentágothai Research Centre, University of Pécs, 7624 Pécs, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary
| | - András Bánvölgyi
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
- Correspondence:
| |
Collapse
|
12
|
Chueh KS, Huang KH, Lu JH, Juan TJ, Chuang SM, Lin RJ, Lee YC, Long CY, Shen MC, Sun TW, Juan YS. Therapeutic Effect of Platelet-Rich Plasma Improves Bladder Overactivity in the Pathogenesis of Ketamine-Induced Ulcerative Cystitis in a Rat Model. Int J Mol Sci 2022; 23:ijms23105771. [PMID: 35628581 PMCID: PMC9147926 DOI: 10.3390/ijms23105771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 12/15/2022] Open
Abstract
The present study attempted to elucidate whether intravesical instillation of platelet-rich plasma (PRP) could decrease bladder inflammation and ameliorate bladder hyperactivity in ketamine ulcerative cystitis (KIC) rat model. Female Sprague Dawley (S-D) rats were randomly divided into control group, ketamine-treated group, ketamine with PRP treated group, and ketamine with platelet-poor plasma (PPP) treated group. Cystometry and micturition frequency/volume studies were performed to investigate bladder function. The morphological change of bladder was investigated by Mason’s trichrome staining. Western blotting analysis were carried out to examine the protein expressions of inflammation, urothelial differentiation, proliferation, urothelial barrier function, angiogenesis and neurogenesis related proteins. The results revealed that treatment with ketamine significantly deteriorated bladder capacity, decreased voiding function and enhanced bladder overactivity. These pathological damage and interstitial fibrosis may via NF-κB/COX-2 signaling pathways and muscarinic receptor overexpression. PRP treatment decreased inflammatory fibrotic biosynthesis, attenuated oxidative stress, promoted urothelial cell regeneration, and enhanced angiogenesis and neurogenesis, thereafter recovered bladder dysfunction and ameliorate the bladder hyperactivity in KIC rat model. These findings suggested that the PRP therapy may offer new treatment options for those clinical KIC patients.
Collapse
Affiliation(s)
- Kuang-Shun Chueh
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (K.-S.C.); (C.-Y.L.)
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (S.-M.C.); (M.-C.S.); (T.-W.S.)
| | - Kuan-Hua Huang
- Divisions of Urological Oncology, Department of Surgery, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Jian-He Lu
- Emerging Compounds Research Center, Department of Environmental Science and Engineering, College of Engineering, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
| | - Tai-Jui Juan
- Department of Medicine, National Defense Medical College, Taipei 11490, Taiwan;
| | - Shu-Mien Chuang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (S.-M.C.); (M.-C.S.); (T.-W.S.)
| | - Rong-Jyh Lin
- Department of Parasitology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Yi-Chen Lee
- Department of Anatomy, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Cheng-Yu Long
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (K.-S.C.); (C.-Y.L.)
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung 80708, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Mei-Chen Shen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (S.-M.C.); (M.-C.S.); (T.-W.S.)
| | - Ting-Wei Sun
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (S.-M.C.); (M.-C.S.); (T.-W.S.)
| | - Yung-Shun Juan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (K.-S.C.); (C.-Y.L.)
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan; (S.-M.C.); (M.-C.S.); (T.-W.S.)
- Correspondence: ; Tel.: +886-7-3121101
| |
Collapse
|
13
|
Biazar E, Heidari Keshel S, Rezaei Tavirani M, Kamalvand M. Healing effect of acellular fish skin with plasma rich in growth factor on full-thickness skin defects. Int Wound J 2022; 19:2154-2162. [PMID: 35441469 DOI: 10.1111/iwj.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
Acellular skin as a scaffold has a good potential to regenerate or repair damaged tissues. Growth factors such as Plasma Rich in Growth Factor (PRGF) as a rich source of active proteins can accelerate tissue regeneration. In this study, an acellular scaffold derived from fish skin with growth factors was used to repair full-thickness skin defects in a rat model. Cellular results demonstrated that epithelial cells adhere well to acellular scaffolds. The results of animal studies showed that the groups treated with acellular scaffold and growth factor have a high ability to close and heal wounds on the 28th day after surgery. Histological and staining results showed that in the treated groups with scaffold and growth factor, an epidermal layer was formed with some skin appendages similar to normal skin. Overall, such scaffolds with biological agents can cause an acceptable synergistic effect on skin regeneration and wound healing.
Collapse
Affiliation(s)
- Esmaeil Biazar
- Tissue Engineering Group, Department of Biomedical Engineering, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Saeed Heidari Keshel
- Medical Nanotechnology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Tissue Engineering and Applied Cell Science, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mahshad Kamalvand
- Tissue Engineering Group, Department of Biomedical Engineering, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| |
Collapse
|
14
|
Moreno DR, Domingues EA, Vallim CA, Silva RS, Fonseca JPS, Noguchi TB. PLASMA RICO EM PLAQUETAS NA CICATRIZAÇÃO DE ÚLCERA VENOSA: RELATO DE CASO. ESTIMA 2022. [DOI: 10.30886/estima.v20.1158_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:Avaliar a evolução da reparação tecidual de úlcera venosa (UV) tratada com plasma rico em plaquetas (PRP). Métodos: Trata-se de relato de caso com aplicação de PRP para tratamento de UV em uma clínica especializada de uma cidade do sul de Minas Gerais. A cada sessão foram coletados 20 mL de sangue distribuídos em quatro tubos com citrato de sódio. O sangue passou por centrifugação para a extração do PRP. O plasma foi aplicado na ferida após a limpeza com água destilada e solução de polihexametileno biguanida. Posteriormente, a lesão foi coberta com gazes impregnada com petrolato e gazes estéreis como cobertura secundária, associado à terapia compressiva elástica. Resultados: Anteriormente à terapia, a úlcera apresentava 1,18 cm² de área. Após quatro semanas de tratamento com PRP, ocorreu a completa cicatrização. Conclusão: O tratamento mostrou-se eficaz e houve 100% de redução de área.
Collapse
|
15
|
Moreno DR, Domingues EA, Vallim CA, Silva RS, Fonseca JPS, Noguchi TB. PLATELET-RICH PLASMA IN VENOUS ULCER HEALING: CASE REPORT. ESTIMA 2022. [DOI: 10.30886/estima.v20.1158_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective:To evaluate the evolution of tissue repair in venous ulcers treated with platelet-rich plasma. Methods: This is a case report with the application of platelet-rich plasma for the treatment of venous ulcers in a specialized clinic in a city in the south of Minas Gerais. At each session, 20 mL of blood was collected and distributed into four tubes with sodium citrate. The blood was centrifuged to extract platelet-rich plasma. Plasma was applied to the wound after cleaning with distilled water and polyhexamethylene biguanide solution. Subsequently, the lesion was covered with gauze impregnated with petrolatum and sterile gauze as a secondary coverage, associated with elastic compression therapy. Results: Prior to therapy, the ulcer had an area of 1.18 cm². After five weeks of treatment with platelet-rich plasma, complete healing has occurred. Conclusion: Tissue repair occurred after five weeks of treatment without any complications.
Collapse
|
16
|
Yammine K, Ghanimeh J, Jil Agopian S, Assi C, Hayek F. PRP Versus Standard of Care for Venous leg Ulcers: A Systematic Review and Meta-Analysis of Prospective Comparative Studies. INT J LOW EXTR WOUND 2022:15347346221094424. [PMID: 35422142 DOI: 10.1177/15347346221094424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Venous leg ulcers (VLUs) are chronic and recalcitrant lower limb wounds that affect millions of patients annually, severely reducing their quality of life, and causing a significant burden on the health care system. Recently, Platelet rich plasma (PRP) has been used to improve healing of VLUs. This systematic review aimed at evaluating the effectiveness of PRP versus the standard of care commonly used to treat VLUs. Ten prospective studies (8 randomized) met the inclusion criteria comprising 451 patients with 527 VLUs. Results were as follows: a) the weighted Odds Ratio (OR) of the mean healing rate was 2.84 (95% CI = 1.160 to 5.056, I2 = 41.4%, p = 0.0004), b) the mean healed ulcer areas were 79.2 ± 19% for the PRP group and 51.7 ± 36% for the control group (p = 0.007) in favor of the PRP group, and c) the weighted infection OR showed no significant difference between both groups. Additionally, negative correlations were found between healing rate and duration of VLUs and initial size of the ulcers. This meta-analysis demonstrated significant beneficial effects of PRP versus standard of care on healing rate, reduction in surface, and reduction in healing time of VLUs. Infection and other complications were similar to standard of care. Therefore, our analytical data would support the use of PRP as a safe and effective treatment for VLUs.
Collapse
Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
- Diabetic Foot Clinic, 502749Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research
| | - Joe Ghanimeh
- Observer doctor at the Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Sira Jil Agopian
- Observer doctor at the Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research
| | - Fady Hayek
- Vascular Division, Department of General Surgery, 502749Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| |
Collapse
|
17
|
Qu S, Hu Z, Zhang Y, Wang P, Li S, Huang S, Dong Y, Xu H, Rong Y, Zhu W, Tang B, Zhu J. Clinical Studies on Platelet-Rich Plasma Therapy for Chronic Cutaneous Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Wound Care (New Rochelle) 2022; 11:56-69. [PMID: 33607926 PMCID: PMC9831249 DOI: 10.1089/wound.2020.1186] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Significance: Platelet-rich plasma (PRP) may be a potential drug for treatment of chronic refractory ulcers, which increase the risk of systemic infection and local canceration. However, the efficacy and safety of clinical application of PRP are still controversial. Thus, this study was aimed to assess the efficacy and safety of PRP in patients with chronic ulcers. Recent Advances: For this meta-analysis, Cochrane's Library, MEDLINE, EMBASE, PubMed, Web of Science, and CINAHL (Cumulate Index to Nursing and Allied Health Literature) databases were searched. Results were pooled using a random-effects model. The primary outcome was the proportion of completely healed chronic ulcers. Critical Issues: Seventeen randomized controlled trials were included. Compared with the control group, PRP significantly increased the fraction of healed ulcers (pooled risk ratio [RR] = 1.50; 95% confidence interval [CI] = 1.20 to 1.87; I2 = 47.8%). In autologous PRP (APRP) and homologous PRP (HPRP) subgroups, there were statistical differences between the control group versus treatment subgroup (pooled RR = 1.30, 95% CI = 1.10 to 1.54, I2 = 25.7%; pooled RR = 3.53, 95% CI = 1.94 to 6.43, I2 = 0.0%, respectively). In terms of percent of chronic ulcers area healed, there was a statistically significant difference between the PRP-treated group versus the control group (standard mean difference [SMD] = 1.37, 95% CI = 0.91 to 1.82, I2 = 22.1%). As for PRP safety, there existed a statistically significant difference between the APRP subgroup and the HPRP subgroup, respectively (pooled RR = 0.58; 95% CI = 0.35 to 0.98; I2 = 0.0%) and (pooled RR = 4.12; 95% CI = 1.55 to 10.96; I2 = 6.8%). Future Directions: Our findings shows that PRP may be a beneficial treatment of chronic skin ulcers and that APRP may be much safer than HPRP.
Collapse
Affiliation(s)
- Shanqiang Qu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Guangzhou, People's Republic of China
| | - Zhicheng Hu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yi Zhang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Peng Wang
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shuting Li
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shaobin Huang
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunxian Dong
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hailin Xu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanchao Rong
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenkai Zhu
- Department of Chemistry, Portland State University, Portland, USA
| | - Bing Tang
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China,
| | - Jiayuan Zhu
- Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Correspondence: Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, China,
| |
Collapse
|
18
|
Healing of Chronic Wounds with Platelet-Derived Growth Factors from Single Donor Platelet-Rich Plasma following One Freeze-Thaw Cycle. A Cross-Sectional Study. J Clin Med 2021; 10:jcm10245762. [PMID: 34945062 PMCID: PMC8705371 DOI: 10.3390/jcm10245762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022] Open
Abstract
Chronic non-healing wounds (CNHWs) may be associated with trauma or idiopathic in nature and are difficult to treat. Our objective was to assess the use of platelet-derived growth factor (PDGF) from single-donor platelets (al-PRP), using one freeze-thaw cycle, for treating CNHWs. We conducted a cross-sectional study. A total of 23 CNHWs being treated with al-PRP. The al-PRP treatment can be considered successful in well over half (n = 13, 56.5%) of the wounds. We found that all the wounds treated for up to 7 weeks showed partial or complete healing, while those treated for between 8 and 12 weeks did not show healing, healing again being successful in cases in which treatment was extended to more than 13 weeks (85.7%). Using chi-square tests, this relationship was found to be highly significant (p < 0.001, chi2 = 19.51; p value = 0.00006). Notably, Cramer's V coefficient was very high (0.921), indicating that the effect size of PRP treatment duration on healing is very large (84.8%). We could suggest that the use of al-PRP in the healing of CNHWs is a promising approach. Further studies with larger sample sizes and long follow-ups are needed to obtain multivariate models to explain which factors favour the healing of ulcers treated with PRP.
Collapse
|
19
|
Cecerska-Heryć E, Goszka M, Serwin N, Roszak M, Grygorcewicz B, Heryć R, Dołęgowska B. Applications of the regenerative capacity of platelets in modern medicine. Cytokine Growth Factor Rev 2021; 64:84-94. [PMID: 34924312 DOI: 10.1016/j.cytogfr.2021.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023]
Abstract
Platelets produce platelet growth factors such as PDGF, IGF-1, EGF-, HGF, TGFβ, bFGF, and VEGF, which are crucial in regulating all stages of the wound healing process. The source of these substances is platelet-rich plasma (PRP). Over the past five decades, the interest and use of the regenerative properties of platelets have increased significantly in many different fields of medicine around the world. PRP and PRF plate preparations are used in: 1. Dentistry (they reduce bleeding, facilitate and accelerate soft tissue healing and bone regeneration - FGF 2, IGF-1, IGF-2, TGF-β1, and PDGF); 2. Sports medicine - IGF-1, IGF-2, TGF-β, VEGF, PDGF and bFGF, EGF); 3. dermatology and cosmetology (treatment of alopecia, hair reconstruction - FGF-7, HGF, acne scars, skin rejuvenation and regeneration, treatment of chronic and poorly healing wounds, burns, and acquired vitiligo); 4. Gynecology and reproductive medicine (treatment of infertility, erectile dysfunction - PDGF-β, TGF-β, IGF-1, in sexual dysfunction - PDGF, in vaginal atrophy); 5 Ophthalmology (in the healing of corneal epithelial wounds, in the treatment of dormant corneal ulcers, dry eye syndrome and the reconstruction of the corneal surface; 6. Neurology (regeneration of neurons, pain alleviation, and clinical symptoms - TGF-β 1, IGF-1, PDGF, VEGF) and FGF). Platelet-rich plasma therapy is a very interesting alternative and complement to traditional methods of treatment. However, the potential for using platelets is still not fully understood. The composition of platelet-rich plasma depends on many factors that may affect its use's efficacy and clinical benefits. Further research is necessary to standardize PRP delivery's preparation procedures and methods for a specific disease entity or clinical case.
Collapse
Affiliation(s)
- Elżbieta Cecerska-Heryć
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland.
| | - Małgorzata Goszka
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Natalia Serwin
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Marta Roszak
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Bartłomiej Grygorcewicz
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Rafał Heryć
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Barbara Dołęgowska
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| |
Collapse
|
20
|
Huber SC, de Moraes Martinelli B, Quintero M, de Paula LÍS, Cataldo JL, de Lima Montalvão SA, Annichino-Bizzacchi JM. A case series of platelet rich plasma in chronic venous ulcers. Regen Ther 2021; 18:51-58. [PMID: 33869687 PMCID: PMC8027535 DOI: 10.1016/j.reth.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Venous ulcers are the most common type of leg wounds (80%) and the main cause is chronic venous insufficiency. Autologous platelet-rich plasma (PRP) is a potential wound healing treatment due to its great variety of growth factors. The aim of this study was to describe in a case series the results of poor-leukocyte PRP (P-PRP) or saline for the treatment of chronic non-healing ulcers of the lower extremity. METHODS Eight patients were treated according to the topical therapy: saline solution or P-PRP gel. All patients used double compression stocks and were assisted by a vascular practitioner for up to 12 months or until wound healing. The treatment was performed weekly with cleaning of the affected area, macroscopic evaluation (area measurement and photos) and P-PRP or saline application, and closure with Tegaderm®. Trial Registration: Retrospectively approved by Brazilian Clinical Trials, register number RBR-7zhgb3 (http://www.ensaiosclinicos.gov.br/rg/RBR-7zhgb3/). RESULTS All patients showed signs of wound healing with a reduction in wound size and ulcer numbers, but more evident with P-PRP application. CONCLUSIONS The results suggested that P-PRP presented a better result when compared to saline solution in the healing process of long clinical course chronic venous ulcers, when associated to compressive stocks and topical care.
Collapse
Affiliation(s)
- Stephany Cares Huber
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Melissa Quintero
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Jose Luiz Cataldo
- Hematology and Hemotherapy Center, Hemocentro, University of Campinas (UNICAMP), Campinas, Brazil
| | | | | |
Collapse
|
21
|
Lee Y, Lee MH, Phillips SA, Stacey MC. Growth factors for treating chronic venous leg ulcers: A systematic review and meta-analysis. Wound Repair Regen 2021; 30:117-125. [PMID: 34783408 DOI: 10.1111/wrr.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/13/2021] [Accepted: 10/18/2021] [Indexed: 01/20/2023]
Abstract
Chronic venous leg ulcers (VLU) are wounds that commonly occur due to venous insufficiency. Many growth factors have been introduced over the past two decades to treat VLU. This systematic review and meta-analysis evaluates the impact of growth factor treatments of VLU in comparison to control for complete wound healing, percent reduction in wound area, time to wound healing, and adverse events. A systematic review and meta-analysis of randomised trials was conducted. MEDLINE and EMBASE were searched up to December 2020. Studies were included if they compared a growth factor versus placebo or standard care in patients with VLU. From 1645 articles, 13 trials were included (n = 991). There was a significant difference between any growth factor and placebo in complete wound healing (P = 0.04). Any growth factor compared to placebo significantly increased the likelihood of percent wound reduction by 48.80% (P = <0.00001). There was no difference in overall adverse event rate. Most comparisons have low certainty of evidence according to Grading of Recommendations, Assessment, Development, and Evaluation. This meta-analysis suggests that growth factors have a beneficial effect in complete wound healing of VLU. Growth factors may also increase percent reduction in wound area. The suggestion of benefit for growth factors identified in this review is not a strong one based on the low quality of evidence.
Collapse
Affiliation(s)
- Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Phillips
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael C Stacey
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
22
|
Attili AR, Iacoucci C, Serri E, Cuteri V, Cantalamessa A, Linardi M, Rifici C, Mazzullo G, Rossi G, Galosi L, Tambella AM. Antibacterial Properties of Canine Platelet-Rich Plasma and Other Non-Transfusional Hemo-Components: An in vitro Study. Front Vet Sci 2021; 8:746809. [PMID: 34671662 PMCID: PMC8520915 DOI: 10.3389/fvets.2021.746809] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 01/13/2023] Open
Abstract
This in vitro study was carried out to evaluate the potential antibacterial properties of canine non-transfusional hemo-components. Therapeutic formulations commonly used for regenerative medicine purposes (platelet-rich plasma, platelet gel, platelet lysate, fibrin glue), considering both leukocyte-rich and leukocyte-poor formulations, but also platelet-poor plasma and activating substances (thrombin, calcium gluconate), were tested to detect elements with potential antimicrobial properties. The antibacterial effect was tested on different bacterial strains (Staphylococcus aureus subspecies aureus, Staphylococcus cohnii subspecies cohnii, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae subspecies pneumoniae) isolated from canine wounds and classified as susceptible, multidrug-, extensively, and pandrug-resistant bacteria toward a known panel of human and veterinary antibiotics. The evaluation was carried out by agar gel diffusion method (Kirby-Bauer) and micro-inhibition in broth using microplates and spectrophotometer reading. The study findings confirmed the hypothesized antibacterial properties of canine non-transfusional hemo-components. A more effective bacteriostatic effect was found against Gram-negative bacteria, drug-resistant too. The presence of leukocytes or platelets does not appear to be essential for the antibacterial effect. Further studies should be conducted to evaluate the exact mechanism of action of the antimicrobial activity. However, non-transfusional hemo-components could be a useful natural aid in controlling bacterial infections in dogs.
Collapse
Affiliation(s)
- Anna-Rita Attili
- Laboratory of Medical Microbiology and Infectious Diseases, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Cristina Iacoucci
- Laboratory of Medical Microbiology and Infectious Diseases, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Evelina Serri
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Vincenzo Cuteri
- Laboratory of Medical Microbiology and Infectious Diseases, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Andrea Cantalamessa
- Laboratory of Medical Microbiology and Infectious Diseases, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Martina Linardi
- Laboratory of Medical Microbiology and Infectious Diseases, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Claudia Rifici
- Pathology Laboratory, Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Giuseppe Mazzullo
- Pathology Laboratory, Department of Veterinary Sciences, University of Messina, Messina, Italy
| | - Giacomo Rossi
- Pathology Laboratory, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Livio Galosi
- Pathology Laboratory, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| | - Adolfo Maria Tambella
- Veterinary Teaching Hospital, School of Biosciences and Veterinary Medicine, University of Camerino, Matelica, Italy
| |
Collapse
|
23
|
Qu W, Wang Z, Hunt C, Morrow AS, Urtecho M, Amin M, Shah S, Hasan B, Abd-Rabu R, Ashmore Z, Kubrova E, Prokop LJ, Murad MH. The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds: A Systematic Review and Meta-analysis. Mayo Clin Proc 2021; 96:2407-2417. [PMID: 34226023 DOI: 10.1016/j.mayocp.2021.01.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and adverse events of autologous platelet-rich plasma (PRP) in individuals with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers. PATIENTS AND METHODS We searched multiple databases from database inception to June 11, 2020, for randomized controlled trials and observational studies that compared PRP to any other wound care without PRP in adults with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers. RESULTS We included 20 randomized controlled trials and five observational studies. Compared with management without PRP, PRP therapy significantly increased complete wound closure in lower-extremity diabetic ulcers (relative risk, 1.20; 95% CI, 1.09 to 1.32, moderate strength of evidence [SOE]), shortened time to complete wound closure, and reduced wound area and depth (low SOE). No significant changes were found in terms of wound infection, amputation, wound recurrence, or hospitalization. In patients with lower-extremity venous ulcers or pressure ulcers, the SOE was insufficient to estimate an effect on critical outcomes, such as complete wound closure or time to complete wound closure. There was no statistically significant difference in adverse events. CONCLUSION Autologous PRP may increase complete wound closure, shorten healing time, and reduce wound size in individuals with lower-extremity diabetic ulcers. The evidence is insufficient to estimate an effect on wound healing in individuals with lower-extremity venous ulcers or pressure ulcers. TRIAL REGISTRATION PROSPERO Identifier: CRD42020172817.
Collapse
Affiliation(s)
- Wenchun Qu
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Department of Pain Medicine, Mayo Clinic, Jacksonville, FL
| | - Zhen Wang
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | - Christine Hunt
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Division of Pain Medicine, Department of Anaesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Allison S Morrow
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Meritxell Urtecho
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mustapha Amin
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sahrish Shah
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Bashar Hasan
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Rami Abd-Rabu
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Zack Ashmore
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Division of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Eva Kubrova
- Department of Pain Medicine, Mayo Clinic, Jacksonville, FL
| | - Larry J Prokop
- Department of Library-Public Services, Mayo Clinic, Rochester, MN
| | - Mohammad Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| |
Collapse
|
24
|
Muthuprabakaran K, Pai VV, Ahmad S, Shukla P. A cross-sectional analysis of the effects of various centrifugation speeds and inclusion of the buffy coat in platelet-rich plasma preparation. Indian J Dermatol Venereol Leprol 2021; 87:792-799. [PMID: 34245527 DOI: 10.25259/ijdvl_1050_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Platelet-rich plasma is an autologous blood preparation which is used in various medical specialties because of its regenerative properties. There is a wide variation in platelet-rich plasma preparation protocols and attaining the ideal platelet yield (>1 million platelets/μL) in a clinic setting can be challenging. We aimed at analyzing the centrifuge spin rates at which to attain an ideal platelet-rich plasma yield and also to study the effect of inclusion of the buffy coat after the first spin on the final platelet concentration in platelet-rich plasma. METHODS Seventy-five whole blood samples were obtained and divided into two groups - (1) leukocyte-rich platelet-rich plasma group and (2) leukocyte-poor platelet-rich plasma group. Samples in both groups were centrifuged using the dual spin method, at one of three centrifugation speed combinations (initial "soft" spin and second "hard" spin speeds, respectively): (1) 100 g/400 g, (2) 350 g/1350 g and (3) 900 g/1800 g. Platelet, red blood cell (RBC) and white blood cell (WBC) counts in both groups were compared. RESULTS The 100 g/400 g spin gave a high platelet yield (increase of 395.4 ± 111.1%) in the leukocyte-poor-platelet-rich plasma group, while in the leukocyte-rich platelet-rich plasma group both 100 g/400 g and 350 g/1350 g spins resulted in significantly higher yields with an increase of 691.5 ± 316.3% and 738.6 ± 193.3%, respectively. LIMITATIONS The study was limited by a smaller sample size in the pure platelet-rich plasma (leukocyte-poor platelet-rich plasma) group. CONCLUSION Ideal platelet yields can be achieved with both the 100 g/400 g as well as the 350 g/1350 g spins using the buffy coat inclusion method while the 100 g/400 g spin for "pure" platelet-rich plasma accomplishes a near-ideal platelet count with significantly reduced contamination with other cells.
Collapse
Affiliation(s)
- K Muthuprabakaran
- Department of Dermatology, Goa Medical College, Bambolim, Goa, India
| | | | - Suhail Ahmad
- Department of Dermatology, Goa Medical College, Bambolim, Goa, India
| | - Pankaj Shukla
- Department of Dermatology, Goa Medical College, Bambolim, Goa, India
| |
Collapse
|
25
|
He M, Guo X, Li T, Jiang X, Chen Y, Yuan Y, Chen B, Yang G, Fan Y, Liang Z, Armstrong DG, Deng W. Comparison of Allogeneic Platelet-rich Plasma With Autologous Platelet-rich Plasma for the Treatment of Diabetic Lower Extremity Ulcers. Cell Transplant 2021; 29:963689720931428. [PMID: 32510240 PMCID: PMC7563928 DOI: 10.1177/0963689720931428] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Autologous platelet-rich plasma (au-PRP) has been widely used for the management of refractory chronic wounds. However, patients with diabetic lower extremity ulcers (DLEUs) usually have complicated clinical conditions, and the utility of au-PRP is limited. In this study, the feasibility, effectiveness, and safety of allogeneic platelet-rich plasma (al-PRP) and au-PRP were investigated and compared in the treatment of DLEUs. A total of 75 in-patients with type 2 diabetes were assigned to the al-PRP group (n = 20), au-PRP group (n = 25), and conventional wound therapeutic (CWT) group (n = 30) matched by the ankle brachial index and ulcer size from December 2015 to August 2018. Based on metabolic and nutritional regulation, infective control, and topical wound management, al-PRP, au-PRP, and CWT were administered to each group, respectively. Evaluation of treatment outcomes was determined by the parameters of wound healing and adverse reactions. The therapeutic times and average concentration of platelets were not significantly different between the au-PRP and al-PRP groups. The wound healing times of the al-PRP group (56.9 ± 29.22 d) and au-PRP group (55.6 ± 33.8 d) were significantly shorter than those of the CWT group (88.0 ± 43.4 d) (P < 0.01), but there was no significant difference between the groups with PRP treatment. Although there was no significant difference in the daily healing area among all groups (P > 0.05), the trend of the healing rate in the al-PRP group (16.77 ± 12.85 mm2), au-PRP group (14.31 ± 18.28 mm2), and CWT group (9.90 ± 8.51 mm2) gradually decreased. No obvious adverse reactions (fever, edema, pain, skin itching, rash, or other sensory abnormalities) were observed in either the au-PRP or the al-PRP groups. Both al-PRP and au-PRP could effectively and safely promote wound healing in patients with DLEUs. Alternatively, al-PRP could be used for DLEUs as an off-the-shelf solution when au-PRP is limited.
Collapse
Affiliation(s)
- Min He
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China.,Department of Endocrinology, Chongqing Southwest Hospital, China.,These authors contributed equally to this article
| | - Xuewen Guo
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China.,Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, China.,These authors contributed equally to this article
| | - Tao Li
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China.,Department of Endocrinology, Chongqing Southwest Hospital, China.,These authors contributed equally to this article
| | - Xiaoyan Jiang
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| | - Yan Chen
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| | - Yi Yuan
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| | - Bing Chen
- Department of Endocrinology, Chongqing Southwest Hospital, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, China
| | - Yahan Fan
- Department of Blood Transfusion, Southwest Hospital, Chongqing, China
| | - Ziwen Liang
- Department of Endocrinology, Chongqing Southwest Hospital, China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Wuquan Deng
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| |
Collapse
|
26
|
Review of the Current Evidence for Topical Treatment for Venous Leg Ulcers. J Vasc Surg Venous Lymphat Disord 2021; 10:241-247.e15. [PMID: 34171531 DOI: 10.1016/j.jvsv.2021.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/06/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The development of a venous leg ulcer (VLU) represents the most severe clinical manifestation of a chronic venous disease. Despite major progress, there is a limited understanding of VLU pathogenesis and wound healing biology. Treatment of VLUs remains a serious challenge for physicians of different specialties. This communication focuses on describing the rationale and scientific basis for topical wound care in the management of VLUs. METHODS A literature review was performed to summarize methods with proven efficacy in VLU management. A systematic literature search was also performed to identify new evidence from the randomized controlled trials published within 2014-2021. The scientific challenges, clinical practice concerns, economic obstacles, and possible directions for further research have been discussed. RESULTS Hundreds of topical products have been advertised for the treatment of VLUs. Published data on topical treatment of venous ulcers is insufficient, scattered, weak, and has significant methodological flaws. Forty-three randomized controlled trials on topical treatment of VLUs have been published within 2014-2021. Clinical practice guidelines need to be updated. Major gaps in knowledge have been identified, and suggestions for future research directions have been provided. CONCLUSIONS The American Venous Forum Research Committee would like to bring attention to topical wound care for VLUs as a critical gap in knowledge, and encourage scientists, practitioners, and industry to collaborate to fill this gap.
Collapse
|
27
|
Brewer CF, Smith A, Miranda BH. The use of platelet-rich products for skin graft donor site healing: a systematic review and meta-analysis. J Plast Surg Hand Surg 2021; 55:133-140. [PMID: 33190577 DOI: 10.1080/2000656x.2020.1846544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/29/2020] [Indexed: 01/13/2023]
Abstract
Split thickness skin grafting is a common reconstructive technique which carries unavoidable donor site morbidity. The aim of this systematic review and meta-analysis is to present the evidence for the use of platelet rich plasma as an adjunct to donor site wound healing. A comprehensive literature search was performed, according to PRISMA guidelines from inception to August 2020, for studies regarding platelet rich plasma and skin graft donor site healing. Animal studies, case series of less than three cases and studies reporting histological outcomes only were excluded. The literature search identified 114 articles. After applying the exclusion criteria, four randomised control trials and two case-control studies remained, incorporating a total of 218 wounds in 139 patients. Four out of six studies reported total healing times for donor site wounds. Pooled analysis showed a significant reduction in healing time when donor wounds were treated with PRP versus controls [MD 5.95, 95% CI 5.04-6.85, p < 0.001]. Of the five studies which reported pain at dressing change, four showed significantly reduced pain scores for the platelet rich plasma treated wounds versus control. There were no significant complications recorded in the treated wounds. The current evidence basis for platelet rich plasma in donor site healing is limited by heterogeneous methodology and reporting outcomes and low powered studies. Nevertheless, the preponderance of data supports its use for accelerating wound healing and reducing pain at dressing change. These preliminary findings need to be substantiated with higher powered randomised controlled trials with standardised PRP manufacture and reporting structures.
Collapse
Affiliation(s)
- Christopher F Brewer
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Alexander Smith
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Ben H Miranda
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| |
Collapse
|
28
|
Kyriakidis C, Lali F, Greco KV, García-Gareta E. Chronic Leg Ulcers: Are Tissue Engineering and Biomaterials Science the Solution? Bioengineering (Basel) 2021; 8:bioengineering8050062. [PMID: 34068781 PMCID: PMC8150748 DOI: 10.3390/bioengineering8050062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 11/21/2022] Open
Abstract
Chronic leg ulcers (CLUs) are full thickness wounds that usually occur between the ankle and knee, fail to heal after 3 months of standard treatment, or are not entirely healed at 12 months. CLUs present a considerable burden on patients, subjecting them to severe pain and distress, while healthcare systems suffer immense costs and loss of resources. The poor healing outcome of the standard treatment of CLUs generates an urgent clinical need to find effective solutions for these wounds. Tissue Engineering and Biomaterials Science offer exciting prospects for the treatment of CLUs, using a broad range of skin substitutes or scaffolds, and dressings. In this review, we summarize and discuss the various types of scaffolds used clinically in the treatment of CLUs. Their structure and therapeutic effects are described, and for each scaffold type representative examples are discussed, supported by clinical trials. Silver dressings are also reviewed due to their reported benefits in the healing of leg ulcers, as well as recent studies on new dermal scaffolds, reporting on clinical results where available. We conclude by arguing there is a further need for tissue-engineered products specifically designed and bioengineered to treat these wounds and we propose a series of properties that a biomaterial for CLUs should possess, with the intention of focusing efforts on finding an effective treatment.
Collapse
Affiliation(s)
- Christos Kyriakidis
- Regenerative Biomaterials Group, The RAFT Institute & The Griffin Institute, Northwick Park and Saint Mark’s Hospital, London HA1 3UJ, UK;
| | - Ferdinand Lali
- The Griffin Institute, Northwick Park and Saint Mark’s Hospital, London HA1 3UJ, UK; (F.L.); (K.V.G.)
- Division of Surgery and Interventional Science, Royal Free Hospital Campus, University College London, London NW3 2QG, UK
| | - Karin Vicente Greco
- The Griffin Institute, Northwick Park and Saint Mark’s Hospital, London HA1 3UJ, UK; (F.L.); (K.V.G.)
- Division of Surgery and Interventional Science, Royal Free Hospital Campus, University College London, London NW3 2QG, UK
| | - Elena García-Gareta
- Regenerative Biomaterials Group, The RAFT Institute & The Griffin Institute, Northwick Park and Saint Mark’s Hospital, London HA1 3UJ, UK;
- Division of Biomaterials and Tissue Engineering, Royal Free Hospital Campus, Eastman Dental Institute, University College London, London NW3 2QG, UK
- Correspondence: ; Tel.: +44-0-20-3958-0500
| |
Collapse
|
29
|
Kuffler DP. Eliminating non-healing wounds: a review. Regen Med 2021; 16:391-404. [PMID: 33876695 DOI: 10.2217/rme-2020-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Non-healing cutaneous wounds, including pressure, diabetic and venous ulcers, are wounds where the skin and underlying tissues die due to ischemia, infection, metabolic conditions, immunosuppression or radiation. Some can be eliminated with relatively straightforward techniques, although they may continue to grow in diameter and depth, becoming increasingly painful and never heal. Others respond more slowly or poorly to treatment, while others are recalcitrant to treatments. This review examines the etiology of non-healing wounds and different wound management treatments. In addition, it examines the efficacy of platelet-rich plasma in promoting wound healing and its potential mechanisms of action. It is concluded that platelet-rich plasma alone, but more effectively when combined with another technique(s), has the greatest potential for promoting complete wound healing. However, further studies are required to determine whether the efficacy of wound healing induced by each of these techniques is enhanced by applying the techniques simultaneously.
Collapse
Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico 00901, USA
| |
Collapse
|
30
|
Helmy Y, Farouk N, Ali Dahy A, Abu-Elsoud A, Fouad Khattab R, Elshahat Mohammed S, Abdullbary Gad L, Altramsy A, Hussein E, Farahat A. Objective assessment of Platelet-Rich Plasma (PRP) potentiality in the treatment of Chronic leg Ulcer: RCT on 80 patients with Venous ulcer. J Cosmet Dermatol 2021; 20:3257-3263. [PMID: 33880860 DOI: 10.1111/jocd.14138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Chronic venous leg ulcer reduces the patients' activities and their overall quality of life. Platelet-rich plasma (PRP) was previously investigated as promising less invasive management for leg ulcers. THIS STUDY AIMS To re-assess the efficacy and safety of PRP in the management of chronic leg ulcers due to venous factors. PATIENTS/METHODS RCT enrolled 80 patients who clinically presented with chronic venous leg ulcers. Forty patients were allocated randomly for the treatment with autologous platelet-rich plasma (PRP). Intradermal and subdermal injection of PRP by 27guage syringe weekly, in all edges and in the granular floor of the ulcer for 4-6 sessions. Another 40 patients managed by conventional treatment by compression and dressing for the same period were allocated as Group B. Objective assessment achieved by the percentage of reduction of the size of the ulcer area, rate of healing, incidence of recurrence, and if side effects have been reported. RESULTS PRP therapy showed better results and high p value significance when compared to conventional therapy. CONCLUSION This study shows that PRP is effective and significant in promoting the wound healing process in chronic leg venous ulcers. PRP is simple, safe, and has a short learning curve technique.
Collapse
Affiliation(s)
- Yasser Helmy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nehal Farouk
- Department of Vascular Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Asmaa Ali Dahy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Ahmed Abu-Elsoud
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (Assiut), Al-Azhar University, Cairo, Egypt
| | - Rania Fouad Khattab
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Sahar Elshahat Mohammed
- Department of Clinical Pathology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Lamia Abdullbary Gad
- Department of Clinical Pathology, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Ayman Altramsy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Emad Hussein
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Ayman Farahat
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
31
|
Wang S, Yang J, Zhao G, Liu R, Du Y, Cai Z, Luan J, Shen Y, Chen B. Current applications of platelet gels in wound healing-A review. Wound Repair Regen 2021; 29:370-379. [PMID: 33749992 DOI: 10.1111/wrr.12896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/27/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022]
Abstract
Human platelets play important roles in several physiologic and pathologic processes. Platelet concentrates are activated with thrombin or calcium, resulting in a viscous coagulum (platelet gel [PG]), composed of 95% platelets at least. PG is increasingly used for the treatment of a variety of soft and hard tissue defects, most notably in the management of chronic non-healing wounds. During wound healing, platelets not only play a critical role in primary hemostasis and thrombosis, but also release growth factors and cytokines to promote tissue regeneration, enhance collagen synthesis, and trigger an immune response. This review addresses a variety of aspects relevant to the functions of well-known platelet growth factors, animal and clinical studies of PG in the last decade, and different sources of platelets for PG. PG is used for non-healing chronic wounds, such as oral ulcerations related to epidermolysis bullosa and chronic graft-versus-host disease, for those, the traditional treatment effect is poor. PG maybe provide a new therapeutic direction for these diseases. Nevertheless, some uncertainty is present, the number of clinical studies is not enough. Hence, randomized controlled trials are still required to study the potential of the use of PG in the near future.
Collapse
Affiliation(s)
- Shujun Wang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Jinling Hospital Department Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Jie Yang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Guangchao Zhao
- Jinling Hospital Department Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Ran Liu
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ying Du
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Zhimei Cai
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Jianfeng Luan
- Jinling Hospital Department Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Yanfei Shen
- School of Medicine, Southeast University, Nanjing, China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
32
|
Oliveira BGRBD, Carvalho MRD, Ribeiro APL. Cost and effectiveness of Platelet Rich Plasma in the healing of varicose ulcer: Meta-analysis. Rev Bras Enferm 2021; 73:e20180981. [PMID: 32609173 DOI: 10.1590/0034-7167-2018-0981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the evidence on the cost and effectiveness of Plaque Rich Plasma in the treatment of venous ulcers compared to other topical therapies. METHODS systematic review, with search in the databases: COCHRANE, EMBASE, MEDLINE via PubMed, LILACS, CINAHL, SCOPUS, without temporal cut and in the English, Portuguese and Spanish languages. RESULTS fifteen articles were included, a cost-minimization analysis showed that the cost of Plaque Rich Plasma is € 163.00 ± 65.90, slightly higher than the cost of standard dressing. Regarding effectiveness, the results of the studies associated with the meta-analysis suggest a tendency that Plaque Rich Plasma is effective in the healing of venous ulcers. CONCLUSIONS it is concluded that there are few studies about the cost of Platelet Rich Plasma and this product tends to be effective in the healing of venous ulcers. However, more controlled and randomized clinical studies are necessary in order to establish a stronger recommendation.
Collapse
|
33
|
Liang Z, Huang D, Nong W, Mo J, Zhu D, Wang M, Chen M, Wei C, Li H. Advanced-platelet-rich fibrin extract promotes adipogenic and osteogenic differentiation of human adipose-derived stem cells in a dose-dependent manner in vitro. Tissue Cell 2021; 71:101506. [PMID: 33607525 DOI: 10.1016/j.tice.2021.101506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/01/2023]
Abstract
Advanced platelet-rich fibrin (A-PRF) is an autogenous biological material obtained from peripheral blood. A-PRF extract (A-PRFe) contains a high concentration of various cytokines that are increasingly appreciated for their roles in improving stem cell repairing function during tissue regeneration. However, the optimal A-PRFe concentration to stimulate stem cells is unknown. This study aimed to identify the optimal concentrations of A-PRFe to promote adipogenic and osteogenic differentiation of human adipose-derived stem cells (ASCs). We produced A-PRFe from A-PRF clots by centrifuging fresh peripheral blood samples and isolated and identified ASCs using surface CD markers and multilineage differentiation potential. Enzyme-linked immunosorbent assay (ELISA) showed the concentrations of several cytokines, including b-FGF, PDGF-BB, and others, increased gradually, peaked on day 7 and then decreased. Cell proliferation assays showed A-PRFe significantly stimulated ASC proliferation, and proliferation significantly increased at higher A-PRFe doses. The degree of adipogenic and osteogenic differentiation increased at higher A-PRFe concentrations in the culture medium, as determined by oil red O and alizarin red staining. Reverse transcription polymerase chain reaction (RT-PCR) showed that expression levels of genes related to adipogenic/osteogenic differentiation (PPARγ2, C/EBPα, FABP4, Adiponectin, and ALP, OPN, OCN, RUNX2), paracrine (HIF-1α, VEGF, IGF-2) and immunoregulation (HSP70, IL-8) function were higher in groups with a higher concentration of A-PRFe than in lower concentration groups. This study demonstrates that A-PRFe is ideal for use in ASC applications in regenerative medicine because it improves biological functions, including proliferation, adipogenic/osteogenic differentiation, and paracrine function in a dose-dependent manner.
Collapse
Affiliation(s)
- Zhijie Liang
- Department of Wound Repair Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China; Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Donglin Huang
- Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Wenhai Nong
- Department of Orthopaedics, the People's Hospital of Binyang County, Binyang, Guangxi, China
| | - Jinping Mo
- Department of Orthopaedics, the People's Hospital of Binyang County, Binyang, Guangxi, China
| | - Dandan Zhu
- Department of Wound Repair Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China
| | - Mengxin Wang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Maojian Chen
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Changyuan Wei
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Hongmian Li
- Department of Plastic and Aesthetic Surgery, The Fifth Affiliated Hospital of Guangxi Medical University & The First People's Hospital of Nanning, Nanning, China.
| |
Collapse
|
34
|
Ding ZY, Tan Y, Peng Q, Zuo J, Li N. Novel applications of platelet concentrates in tissue regeneration (Review). Exp Ther Med 2021; 21:226. [PMID: 33603835 PMCID: PMC7851614 DOI: 10.3892/etm.2021.9657] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
Numerous studies have explored the suitability of biocompatible materials in regenerative medicine. Platelet concentrates are derived from centrifuged blood and are named according to their biological characteristics, such as platelet-rich plasma, platelet-rich fibrin and concentrated growth factor. Platelet concentrates have gained considerable attention in soft and hard tissue engineering. Indeed, multiple components of autologous platelet concentrates, such as growth factors, fibrin matrix and platelets, serve essential roles in wound healing. Current studies are focused on cutting-edge strategies to meet the requirements for tissue restoration by improving the properties of autologous platelet concentrates. In the present review, applications of platelet concentrates for tissue engineering are discussed, presenting a selection of recent advances and novel protocols. In addition, several aspects of these strategies, such as the advantages of lyophilized platelet concentrates and the combination of platelet concentrates with biomaterials, stem cells or drugs are discussed. The present review aims to summarize novel strategies using platelet concentrates to improve the outcomes of wound healing.
Collapse
Affiliation(s)
- Zhen-Yu Ding
- Hunan Key Laboratory of Oral Health Research, Hunan 3D Printing Engineering Research Center of Oral Care, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ying Tan
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan 410008, P.R. China
| | - Qian Peng
- Hunan Key Laboratory of Oral Health Research, Hunan 3D Printing Engineering Research Center of Oral Care, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha, Hunan 410008, P.R. China
| | - Jun Zuo
- Hunan Key Laboratory of Oral Health Research, Hunan 3D Printing Engineering Research Center of Oral Care, Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ning Li
- Department of Blood Transfusion, Xiangya Hospital, Clinical Transfusion Research Center, Central South University, Changsha, Hunan 410008, P.R. China
| |
Collapse
|
35
|
Geisler AN, Taylor N. Venous Stasis Ulcers: an Update on Diagnosis and Management. CURRENT GERIATRICS REPORTS 2020. [DOI: 10.1007/s13670-020-00344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
36
|
Yao D, Feng G, Zhao F, Hao D. Effects of platelet-rich plasma on the healing of sternal wounds: A meta-analysis. Wound Repair Regen 2020; 29:153-167. [PMID: 33128501 DOI: 10.1111/wrr.12874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/08/2020] [Accepted: 10/26/2020] [Indexed: 01/13/2023]
Abstract
Sternal wound infection (SWI) is a devastating complication after cardiac surgery. Platelet-rich plasma (PRP) may have a positive impact on sternal wound healing. A systematic review with meta-analyses was performed to evaluate the clinical effectiveness of topical application of autologous PRP for preventing SWI and promoting sternal wound healing compared to placebo or standard treatment without PRP. Relevant studies published in English or Chinese were retrieved from the Cochrane Central Register of Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of Science, Springer Link, and the WHO International Clinical Trials Registry Platform (ICTRP) using the search terms "platelet-rich plasma" and "sternal wound" or "thoracic incision." References identified through the electronic search were screened, the data were extracted, and the methodological quality of the included studies was assessed. The meta-analysis was performed for the following outcomes: incidence of SWI, incidence of deep sternal wound infection (DSWI), postoperative blood loss (PBL), and other risk factors. In the systematic review, totally 10 comparable studies were identified, involving 7879 patients. The meta-analysis for the subgroup of retrospective cohort studies (RSCs) showed that the incidence of SWI and DSWI in patients treated with PRP was significantly lower than that in patients without PRP treatment. However, for the subgroup of randomized controlled trials (RCTs), there was no significant difference in the incidence of SWI or DSWI after intervention between the PRP and control groups. There was no significant difference in PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in-situ recurrences were reported. According to the results, PRP could be considered as a candidate treatment to prevent SWI and DSWI. However, the quality of the evidence is too weak, and high-quality RCTs are needed to assess its efficacy on preventing SWI and DSWI.
Collapse
Affiliation(s)
- Dan Yao
- No. 3 Department of Burns and Plastic Surgery and Wound Healing Center, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guang Feng
- No. 3 Department of Burns and Plastic Surgery and Wound Healing Center, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fan Zhao
- No. 3 Department of Burns and Plastic Surgery and Wound Healing Center, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Daifeng Hao
- No. 3 Department of Burns and Plastic Surgery and Wound Healing Center, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
37
|
Perinelli DR, Bonacucina G, Pucciarelli S, Cespi M, Serri E, Polzonetti V, Tambella AM, Vincenzetti S. Rheological Properties and Growth Factors Content of Platelet-Rich Plasma: Relevance in Veterinary Biomedical Treatments. Biomedicines 2020; 8:biomedicines8100429. [PMID: 33081006 PMCID: PMC7603199 DOI: 10.3390/biomedicines8100429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Platelet-rich plasma (PRP) is a nontransfusional hemocomponent, considered as a powerful concentrate of growth factors (GFs) therapeutically used to stimulate tissue regeneration. The use of autologous PRP, as the patient’s own biological material, for therapeutic purposes represents a safe and effective alternative to conventional treatments in both human and veterinary medicine. The aim of this study was the characterization of canine PRP from rheological and biological points of view. Thus, a characterization of the viscoelastic properties of the PRP systems was performed in order to clarify the influence of different calcium concentrations, in the presence of autologous thrombin-rich solution, on the PRP gels’ mechanical properties, from which the applicability of these systems in biomedical treatments is strongly dependent. Then, an evaluation of the content of GFs in PRP, activated or not with thrombin, and stored at different temperatures (37 °C and −20 °C) was performed over time, outlining, for the first time, the importance of the effect of physiological temperature (37 °C) on the production of GFs. A clinical case study conducted in a dog with a complete rupture of the common calcaneal tendon (Achilles tendon) confirmed the relevance of this hemocomponent in the daily veterinary clinical activity and the potential translational value for human health.
Collapse
Affiliation(s)
- Diego Romano Perinelli
- School of Pharmacy, University of Camerino, 62032 Camerino (MC), Italy; (D.R.P.); (G.B.); (M.C.)
| | - Giulia Bonacucina
- School of Pharmacy, University of Camerino, 62032 Camerino (MC), Italy; (D.R.P.); (G.B.); (M.C.)
| | - Stefania Pucciarelli
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy; (S.P.); (E.S.); (V.P.); (S.V.)
| | - Marco Cespi
- School of Pharmacy, University of Camerino, 62032 Camerino (MC), Italy; (D.R.P.); (G.B.); (M.C.)
| | - Evelina Serri
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy; (S.P.); (E.S.); (V.P.); (S.V.)
| | - Valeria Polzonetti
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy; (S.P.); (E.S.); (V.P.); (S.V.)
| | - Adolfo Maria Tambella
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy; (S.P.); (E.S.); (V.P.); (S.V.)
- Correspondence: ; Tel.: +39-0737-403417
| | - Silvia Vincenzetti
- School of Biosciences and Veterinary Medicine, University of Camerino, 62032 Camerino (MC), Italy; (S.P.); (E.S.); (V.P.); (S.V.)
| |
Collapse
|
38
|
Elgarhy LH, El-Ashmawy AA, Bedeer AE, Al-Bahnasy AM. Evaluation of safety and efficacy of autologous topical platelet gel vs platelet rich plasma injection in the treatment of venous leg ulcers: A randomized case control study. Dermatol Ther 2020; 33:e13897. [PMID: 32579773 DOI: 10.1111/dth.13897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 01/13/2023]
Abstract
Various management options were tried for Chronic venous leg ulcers (VLUs) with no satisfactory results. Platelet-rich plasma (PRP) is promising in enhancing chronic wound healing by releasing various growth factors. We evaluated the safety and efficacy of topical platelet gel (PG) vs PRP injection in treatment of venous leg ulcers. 20 patients were treated with topical PG (group I), 20 patients received PRP injection (group II), and 20 patients were treated with saline dressing and compression as controls (group III) weekly for 6 weeks. Ulcer improvement was evaluated by pressure ulcer scale for healing (PUSH). Histopathological evaluation and immunohistochemical staining using anti-CD34 were performed before and after treatment. There was significant improvement in PUSH score in group (I) and (II) compared to group (III; P value: .001). However, there was no statistically significant difference in improvement between group I and II (P value = .83). However, topical PG was more effective in diabetics and PRP was more effective in long standing fibrosed ulcers. Histopathology showed reduction of the inflammatory cells infiltrates and well-formed granulation tissue with no difference in immunostaining. So, both topical PG and PRP injection were effective, low cost, and safe procedures in enhancing healing of chronic VLUs.
Collapse
Affiliation(s)
- Lamia Hamouda Elgarhy
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University, Tanta, Egypt.,Faculty of Medicine, Department of Pathology, Tanta University, Tanta, Egypt
| | - Amal Ahmad El-Ashmawy
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University, Tanta, Egypt.,Faculty of Medicine, Department of Pathology, Tanta University, Tanta, Egypt
| | - Asmaa Elsayed Bedeer
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University, Tanta, Egypt.,Faculty of Medicine, Department of Pathology, Tanta University, Tanta, Egypt
| | - Aya Mohammed Al-Bahnasy
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University, Tanta, Egypt.,Faculty of Medicine, Department of Pathology, Tanta University, Tanta, Egypt
| |
Collapse
|
39
|
Platelet-Released Growth Factors and Platelet-Rich Fibrin Induce Expression of Factors Involved in Extracellular Matrix Organization in Human Keratinocytes. Int J Mol Sci 2020; 21:ijms21124404. [PMID: 32575800 PMCID: PMC7378768 DOI: 10.3390/ijms21124404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Platelet-released growth factor (PRGF) is a thrombocyte concentrate lysate which, like its clinically equivalent variations (e.g., Vivostat PRF® (platelet-rich fibrin)), is known to support the healing of chronic and hard-to-heal wounds. However, studies on the effect of PRGF on keratinocytes remain scarce. This study aims to identify genes in keratinocytes that are significantly influenced by PRGF. Therefore, we performed a whole transcriptome and gene ontology (GO) enrichment analysis of PRGF-stimulated human primary keratinocytes. This revealed an increased expression of genes involved in extracellular matrix (ECM) organization. Real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) analysis confirmed the PRGF-mediated induction of selected ECM-related factors such as transforming growth factor beta-induced protein, fibronectin 1, matrix metalloproteinase-9, transglutaminase 2, fermitin family member 1, collagen type I alpha 1 and collagen type XXII alpha 1. PRGF-induced expression of the above factors was influenced by blockade of the epidermal growth factor receptor (EGFR), a receptor playing a crucial role in wound healing. A differential induction of the investigated factors was also detected in skin explants exposed to PRGF and in experimentally generated in vivo wounds treated with Vivostat PRF®. Together, our study indicates that the induction of ECM-related factors may contribute to the beneficial wound-healing effects of PRGF-based formulations.
Collapse
|
40
|
The effect of platelet-rich plasma on the achievement of pregnancy during frozen embryo transfer in women with a history of failed implantation. Heliyon 2020; 6:e03577. [PMID: 32195397 PMCID: PMC7075971 DOI: 10.1016/j.heliyon.2020.e03577] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 11/13/2019] [Accepted: 03/09/2020] [Indexed: 12/23/2022] Open
Abstract
Objective The aim of this study was to evaluate the effect of platelet-rich plasma (PRP) on the rate of implantation and pregnancy in women with repeated failed implantation during frozen embryo transfer. Methods This study was conducted on 50 infertile women candidates (who were referred to the Infertility Treatment Center of Besat Hospital in Sanandaj) with a history of failed implantation for the purpose of frozen embryo transfer. The participants were randomly divided into two groups (n = 25). In the first group (control), the intrauterine infusion of 0.5 ml of Ringer serum was done 48 h before embryo transfer. In the second group (treatment), the intrauterine infusion of 0.5 ml of PRP was performed 48 h before embryo transfer. Results In this study, there was no significant difference between the two groups in the rate of chemical and clinical pregnancy. The rate of chemical pregnancy was 28% in the treatment group and 36% in the control group, while the rate of clinical pregnancy was 28% in the treatment group and 24% in the control group. Conclusion The intrauterine infusion of PRP before frozen embryo transfer in infertile women with a history of failed implantation will not make any significant effect on the result of pregnancy.
Collapse
|
41
|
Acebes-Huerta A, Arias-Fernández T, Bernardo Á, Muñoz-Turrillas MC, Fernández-Fuertes J, Seghatchian J, Gutiérrez L. Platelet-derived bio-products: Classification update, applications, concerns and new perspectives. Transfus Apher Sci 2019; 59:102716. [PMID: 31928859 DOI: 10.1016/j.transci.2019.102716] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Platelet derived bio-products in the form of platelet rich plasma, plasma rich in growth factors, or plasma-free platelet releasates, are being studied worldwide with the aim of proving their efficacy in tissue regeneration within many different clinical areas, such as traumatology, maxillofacial surgery, ophthalmology, dermatology and otorhinolaryngology, amongst others. The current lack of consensus in the preparation method and application form, or in the quality assessment of each bio-product, precludes adequate interpretation of the relevance of reported clinical outcomes, and, while many in clinicians are very positive about them, many are sceptic. Relevant aspects of these products are considered to propose a classification nomenclature which would aid a comprehensive comparison of clinical outcomes of bio-products of the same characteristics. Finally, the uses of platelet-derived bio-products in in vitro culture (for cell therapy purposes) as a substitute of animal-origin sera, and other future perspectives of applications of platelet-derived bio-products are discussed.
Collapse
Affiliation(s)
- Andrea Acebes-Huerta
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Tamara Arias-Fernández
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ángel Bernardo
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Hospital Universitario Central de Asturias (HUCA), Laboratorio de Diagnóstico Clínico Hematología, Oviedo, Spain
| | - María Carmen Muñoz-Turrillas
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Centro Comunitario de Sangre y Tejidos de Asturias, Oviedo, Spain
| | - Judit Fernández-Fuertes
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Cabueñes Hospital Universitario (CAHU), Servicio de Cirugía Ortopédica y Traumatología (COT), Gijón, Spain
| | - Jerard Seghatchian
- International consultancy in blood components quality / safety and DDR strategies, London, UK
| | - Laura Gutiérrez
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Dept. of Medicine, University of Oviedo, Spain.
| |
Collapse
|
42
|
Ribeiro APL, Oliveira BGRBD. Production cost of autologous platelet rich plasma gel. Rev Lat Am Enfermagem 2019; 27:e3221. [PMID: 31826162 PMCID: PMC6896805 DOI: 10.1590/1518-8345.3265.3221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: to estimate the direct cost of producing autologous platelet rich plasma gel. Method: an economic, prospective, longitudinal study with direct cost estimation, from the perspective of the Unified Health System, conducted in a university hospital in the state of Rio de Janeiro, over a period of 12 weeks. It was approved by the Ethics Committee of the School of Medicine. Direct observation of 18 participants was conducted. Material and human resources categories were analyzed for production costs. Results: the cost of producing platelet rich plasma gel was US $4.88 per session, for a total of US $5.16, when the material resources per unit were considered in the Unified Health System. The time to complete the procedure was approximately 22 minutes. Conclusion: the production of platelet rich plasma gel involves low cost material resources for both blood collection and preparation, enabling universal access to treatment. The procedure requires trained staff in an appropriate location; it is a safe and inexpensive technology.
Collapse
Affiliation(s)
- Andrea Pinto Leite Ribeiro
- Fundação Osvaldo Cruz (FIOCRUZ), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brazil.,Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | |
Collapse
|
43
|
Tsai HC, Lehman CW, Chen CM. Use of platelet-rich plasma and platelet-derived patches to treat chronic wounds. J Wound Care 2019; 28:15-21. [PMID: 30625042 DOI: 10.12968/jowc.2019.28.1.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the healing results between platelet-rich plasma (PRP) and platelet-derived patches versus traditional advanced wound dressings in patients with chronic wounds. METHOD Patients with and without diabetes were divided into two groups, each of which received either PRP patch treatments or the advanced wound dressings. All wounds were cleaned, debrided and assessed by physicians. The data were analysed and represented as mean ± standard deviation (SD). Student's t-test was used to calculate the significance of differences between both groups. Values of p<0.05 were considered statistically significant. RESULTS Patients with and without diabetes receiving PRP patch treatments saw improvement in wound healing in two weeks (p=0.0083). Patients with diabetes who received platelet-derived patch treatment and PRP injection experienced wound size reduction to <25% of the original area by the fourth week of treatment, and >90% of the subjects had wounds of <10% their original size in the last three weeks of the trial. Conversely, the wound area in the control subjects receiving traditional advanced wound dressings remained at 25-50% of their original size from the fourth week of treatment to the end of the trial. The healing process of the PRP patch experimental group was statistically significant compared with the control group (p<0.0001). CONCLUSION Combining treatments of PRP injections and platelet-derived patches significantly improved the healing outcomes of patients with chronic wounds, most notably in patients with diabetes, when compared with a traditional treatment of advanced wound dressings.
Collapse
Affiliation(s)
- Hsin-Chung Tsai
- Department of Surgery, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Caitlin W Lehman
- National Center for Biodefense and Infectious Diseases, George Mason University, Manassas, VA, US
| | - Chuan-Mu Chen
- Department of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| |
Collapse
|
44
|
Daradka M, Alardah MM, Ismail ZB. Effects of autologous platelet-rich plasma coated sutures on intestinal anastomotic healing in rabbits. Heliyon 2019; 5:e02713. [PMID: 31840125 PMCID: PMC6893086 DOI: 10.1016/j.heliyon.2019.e02713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/22/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to investigate the intestinal anastomotic healing enhancing effect of platelets-rich plasma (PRP) using PRP-coated sutures in a rabbit model. A total of 30 mature male rabbits were divided into 3 groups (10 rabbits per group). Group 1 received uncoated sutures, group 2 received sodium acetate-coated sutures, and group 3 received PRP-coated sutures. Polyglactin 910 (Vicryl, USA), size 4-0 was used in all groups. Five rabbits of each group were euthanized on day 3 following the surgery while the remaining 5 rabbits were euthanized on day 10. Gross evaluation of the anastomotic site in PRP-coated sutures group demonstrated significantly (P < 0.05) lower adhesion formation scores on both days 3 and 10 of the study while in the control groups, evidence of leakage at the anastomotic site was present along with signs of haemorrhage and local inflammation. On day 10 in the control groups, there were strands of strong adhesions between the ileum, colon and cecum with large amount of fibrin deposited at the site of the anastomosis. Tissues of the anastomotic site revealed a significant level of hydroxyproline on day 10 in PRP-coated sutures group compared with control groups. Histopathological evaluation revealed significantly (P < 0.05) less inflammatory infiltration, and more angiogenesis and collagen deposition on day 10 in PRP-coated sutures group compared to the control groups. Results of this study clearly indicate promising healing enhancing effects of using PRP-coated sutures at intestinal anastomotic site with little to no obvious disadvantages.
Collapse
Affiliation(s)
- Mousa Daradka
- Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mira M Alardah
- Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Zuhair Bani Ismail
- Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| |
Collapse
|
45
|
Carvalho MRD, Silveira IA, Oliveira BGRBD. Treatment of venous ulcers with growth factors: systematic review and meta-analysis. Rev Bras Enferm 2019; 72:200-210. [PMID: 30916287 DOI: 10.1590/0034-7167-2017-0865] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/08/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To identify evidence about the effects of growth factor application on venous ulcer healing. METHOD Systematic review and meta-analysis, including Randomized Clinical Trials. Searches: Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, LILACS, Web of Science, Digital Library of Theses and Dissertations; Google Scholar and list of references. RESULTS 802 participants were recruited from the 10 included studies: 472 in the intervention group (growth factors) and 330 as control. The relative risk for the complete healing outcome was 1.06 [95% CI 0.92-1.22], p = 0.41. Participants who received Platelet-Rich Plasma and Epidermal Growth Factor showed a slight tendency to achieve complete healing, but without statistical relevance (p <0.05). Most of the studies were classified as moderate risk of bias. CONCLUSION The effect of the application of growth factors for complete healing in venous ulcers is not clear, and clinical trials with methodological quality are required for more accurate recommendations.
Collapse
Affiliation(s)
- Magali Rezende de Carvalho
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brazil
| | - Isabelle Andrade Silveira
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa. Niterói, Rio de Janeiro, Brazil
| | | |
Collapse
|
46
|
Berndt S, Turzi A, Pittet-Cuénod B, Modarressi A. Autologous Platelet-Rich Plasma (CuteCell PRP) Safely Boosts In Vitro Human Fibroblast Expansion. Tissue Eng Part A 2019; 25:1550-1563. [PMID: 30896295 DOI: 10.1089/ten.tea.2018.0335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Nowadays autologous fibroblast application for skin repair presents an important clinical interest. In most cases, in vitro skin cell culture is mandatory. However, cell expansion using xenogeneic or allogenic culture media presents some disadvantages, such as the risk of infection transmission or slow cell expansion. In this study, we investigated an autologous culture system to expand human skin fibroblast cells in vitro with the patient's own platelet-rich plasma (PRP). Human dermal fibroblasts were isolated from patients undergoing abdominoplasty, and blood was collected to prepare nonactivated PRP using the CuteCell™ PRP medical device. Cultures were followed up to 7 days using a medium supplemented with either fetal bovine serum (FBS) or PRP. Fibroblasts cultured in medium supplemented with PRP showed dose-dependently significantly higher proliferation rates (up to 7.7 times with 20% of PRP) and initiated a faster migration in the in vitro wound healing assay compared with FBS, while chromosomal stability was maintained. At high concentrations, PRP changed fibroblast morphology, inducing cytoskeleton rearrangement and an increase of alpha-smooth muscle actin and vimentin expression. Our findings show that autologous PRP is an efficient and cost-effective supplement for fibroblast culture, and should be considered as a safe alternative to xenogeneic/allogenic blood derivatives for in vitro cell expansion. Impact Statement Autologous dermal fibroblast graft is an important therapy in skin defect repair, but in vitro skin cell culture is mandatory in most cases. However, cell expansion using xenogeneic/allogenic culture media presents some disadvantages, such as the risk of infection transmission. We demonstrated that an autologous culture system with the patient's own platelet-rich plasma is an efficient, cost-effective, and safe supplement for fibroblast culture. As it respects the good manufacturing practices and regulatory agencies standards, it should be considered as a potent alternative and substitute to xenogeneic or allogenic blood derivatives for the validation of future clinical protocols using in vitro cell expansion.
Collapse
Affiliation(s)
- Sarah Berndt
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland.,Regen Lab SA, Le Mont-sur-Lausanne, Switzerland
| | | | - Brigitte Pittet-Cuénod
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Ali Modarressi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| |
Collapse
|
47
|
Team V, Chandler PG, Weller CD. Adjuvant therapies in venous leg ulcer management: A scoping review. Wound Repair Regen 2019; 27:562-590. [PMID: 31025794 DOI: 10.1111/wrr.12724] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 12/12/2022]
Abstract
Compression therapy is the current evidence-based approach to manage venous leg ulcers (VLU); however, adherence is a major barrier to successful treatment. Combination approaches may relieve the burden of treatment by shortening the time to ulcer healing. This scoping review conducted by Australian researchers aimed to establish the evidence of effectiveness of various adjuvant methods on wound healing and recurrence. Randomized Controlled Trials (RCTs), and Systematic Reviews (SR) and Meta-Analyses (MA) on VLU management approaches published from January 2015 to December 2018 were included in this review. The articles included in the scoping review were grouped according to the management approaches, including (1) pharmaceutical interventions, (2) surgical interventions, (3) topical agents, (4) the use of devices, and (5) other, such as physiotherapy and psychological interventions. Results of this scoping review indicate that there is a limited high-quality evidence of effectiveness in most adjuvant therapies on wound healing and recurrence. Given the low-quality evidence observed in this scoping review for adjuvant treatments, the implication for practice is that current management guidelines be followed. Further rigorous studies have the potential to produce better quality evidence. Quality of evidence can be improved by ensuring large sample sizes of a single etiology wounds, standardizing reporting outcomes, and maintaining detailed and evidence-based protocols in physiological or psychological interventions.
Collapse
Affiliation(s)
- Victoria Team
- Monash Nursing and Midwifery, Level 3, 35 Rainforest Walk, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
| | - Peter G Chandler
- Monash Nursing and Midwifery, Level 3, 35 Rainforest Walk, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
| | - Carolina D Weller
- Monash Nursing and Midwifery, Level 3, 35 Rainforest Walk, Monash University, Wellington Road, Clayton, 3800, Victoria, Australia
| |
Collapse
|
48
|
Platelet-rich plasma and its utility in medical dermatology: A systematic review. J Am Acad Dermatol 2019; 81:834-846. [PMID: 31009668 DOI: 10.1016/j.jaad.2019.04.037] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 02/06/2023]
Abstract
The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile.
Collapse
|
49
|
Andia I, Maffulli N. A contemporary view of platelet-rich plasma therapies: moving toward refined clinical protocols and precise indications. Regen Med 2018; 13:717-728. [PMID: 30246605 DOI: 10.2217/rme-2018-0042] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The positive extensive clinical experience with platelet-rich plasma (PRP) in different medical areas has prompted researchers to explore clinical opportunities for optimized PRP therapies. PRP is safe but we have to make it more effective. The growing diversity of formulations and presentations enrich the field of PRP research and offer hope to refine clinical indications. Moving toward targeting the right disease phenotypes with the right PRP formulation or combination product (PRP + cell products) can offer opportunities to change treatment options in osteoarthritis and nonhealing wounds. Both are active areas of research that could offer opportunities, although cost efficacy is still an open question. Our position is to believe that these serious disease areas are likely to benefit from PRP therapies.
Collapse
Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine & Dentristry, Salerno, Italy.,Queen Mary University of London, Barts & the London School of Medicine & Dentistry, London, UK
| |
Collapse
|
50
|
Combined plasma rich in growth factors and adipose-derived mesenchymal stem cells promotes the cutaneous wound healing in rabbits. BMC Vet Res 2018; 14:288. [PMID: 30241533 PMCID: PMC6151009 DOI: 10.1186/s12917-018-1577-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/16/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The use of Plasma Rich in Growth Factors (PRGF) and Adipose Derived Mesenchymal Stem Cells (ASCs) are today extensively studied in the field of regenerative medicine. In recent years, human and veterinary medicine prefer to avoid using traumatic techniques and choose low or non-invasive procedures. The objective of this study was to evaluate the efficacy of PRGF, ASCs and the combination of both in wound healing of full-thickness skin defects in rabbits. With this purpose, a total of 144 rabbits were used for this study. The animals were divided in three study groups of 48 rabbits each depending on the administered treatment: PRGF, ASCs, and PGRF+ASCs. Two wounds of 8 mm of diameter and separated from each other by 20 mm were created on the back of each rabbit: the first was treated with saline solution, and the second with the treatment assigned for each group. Macroscopic and microscopic evolution of wounds was assessed at 1, 2, 3, 5, 7 and 10 days post-surgery. With this aim, 8 animals from each treatment group and at each study time were euthanized to collect wounds for histopathological study. RESULTS Wounds treated with PRGF, ASCs and PRGF+ASCs showed significant higher wound healing and epithelialization rates, more natural aesthetic appearance, significant lower inflammatory response, significant higher collagen deposition and angiogenesis compared with control wounds. The combined treatment PRGF+ASCs showed a significant faster cutaneous wound healing process. CONCLUSIONS The combined treatment PRGF+ASCs showed the best results, suggesting this is the best choice to enhance wound healing and improve aesthetic results in acute wounds.
Collapse
|