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Everts PA, Lana JF, Alexander RW, Dallo I, Kon E, Ambach MA, van Zundert A, Podesta L. Profound Properties of Protein-Rich, Platelet-Rich Plasma Matrices as Novel, Multi-Purpose Biological Platforms in Tissue Repair, Regeneration, and Wound Healing. Int J Mol Sci 2024; 25:7914. [PMID: 39063156 PMCID: PMC11277244 DOI: 10.3390/ijms25147914] [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: 05/26/2024] [Revised: 07/07/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Autologous platelet-rich plasma (PRP) preparations are prepared at the point of care. Centrifugation cellular density separation sequesters a fresh unit of blood into three main fractions: a platelet-poor plasma (PPP) fraction, a stratum rich in platelets (platelet concentrate), and variable leukocyte bioformulation and erythrocyte fractions. The employment of autologous platelet concentrates facilitates the biological potential to accelerate and support numerous cellular activities that can lead to tissue repair, tissue regeneration, wound healing, and, ultimately, functional and structural repair. Normally, after PRP preparation, the PPP fraction is discarded. One of the less well-known but equally important features of PPP is that particular growth factors (GFs) are not abundantly present in PRP, as they reside outside of the platelet alpha granules. Precisely, insulin-like growth factor-1 (IGF-1) and hepatocyte growth factor (HGF) are mainly present in the PPP fraction. In addition to their roles as angiogenesis activators, these plasma-based GFs are also known to inhibit inflammation and fibrosis, and they promote keratinocyte migration and support tissue repair and wound healing. Additionally, PPP is known for the presence of exosomes and other macrovesicles, exerting cell-cell communication and cell signaling. Newly developed ultrafiltration technologies incorporate PPP processing methods by eliminating, in a fast and efficient manner, plasma water, cytokines, molecules, and plasma proteins with a molecular mass (weight) less than the pore size of the fibers. Consequently, a viable and viscous protein concentrate of functional total proteins, like fibrinogen, albumin, and alpha-2-macroglobulin is created. Consolidating a small volume of high platelet concentrate with a small volume of highly concentrated protein-rich PPP creates a protein-rich, platelet-rich plasma (PR-PRP) biological preparation. After the activation of proteins, mainly fibrinogen, the PR-PRP matrix retains and facilitates interactions between invading resident cells, like macrophages, fibroblast, and mesenchymal stem cells (MSCs), as well as the embedded concentrated PRP cells and molecules. The administered PR-PRP biologic will ultimately undergo fibrinolysis, leading to a sustained release of concentrated cells and molecules that have been retained in the PR-PRP matrix until the matrix is dissolved. We will discuss the unique biological and tissue reparative and regenerative properties of the PR-PRP matrix.
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Affiliation(s)
- Peter A. Everts
- Gulf Coast Biologics, A Non-Profit Organization, Fort Myers, FL 33916, USA
- OrthoRegen Group, Max-Planck University, Indaiatuba 13334-170, SP, Brazil;
| | - José Fábio Lana
- OrthoRegen Group, Max-Planck University, Indaiatuba 13334-170, SP, Brazil;
| | - Robert W. Alexander
- Regenevita Biocellular Aesthetic & Reconstructive Surgery, Cranio-Maxillofacial Surgery, Regenerative and Wound Healing, Hamilton, MT 59840, USA;
- Department of Surgery & Maxillofacial Surgery, School of Medicine & Dentistry, University of Washington, Seattle, WA 98195, USA
| | - Ignacio Dallo
- Unit of Biological Therapies and MSK Interventionism, Department of Orthopaedic Surgery and Sports Medicine, Sport Me Medical Center, 41013 Seville, Spain;
| | - Elizaveta Kon
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Mary A. Ambach
- BioEvolve, San Diego Orthobiologics and Sports Center, San Diego, CA 92024, USA
| | - André van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Brisbane and The University of Queensland, Brisbane 4072, Australia;
| | - Luga Podesta
- Bluetail Medical Group & Podesta Orthopedic Sports Medicine, Naples, FL 34109, USA;
- Physical Medicine & Rehabilitation Orlando College of Osteopathic Medicine, Orlando, FL 32806, USA
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Wang Y, Wang X, Chen R, Gu L, Liu D, Ruan S, Cao H. The Role of Leukocyte-Platelet-Rich Fibrin in Promoting Wound Healing in Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2024; 23:306-314. [PMID: 34775872 DOI: 10.1177/15347346211052811] [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: 01/28/2023]
Abstract
To explore the effect of leukocyte-platelet-rich fibrin (L-PRF) on promoting wound healing in diabetic foot ulcers. A total of 42 patients with diabetic foot ulcers at our hospital from January 2017 to July 2020 were retrospectively analyzed. A control group and a PRF group were established. The two groups of patients underwent debridement. In the platelet-rich fibrin (PRF) group, autologous L-PRF was used to cover ulcer wounds. One time each week, Vaseline gauze was used to cover the ulcer wounds. In contrast, the control group was treated with the external application of mupirocin ointment and recombinant human epidermal growth factor gel (yeast). Two times each week, the sterile Vaseline gauze was covered with a bandage. Both groups were treated for 5 weeks. The wound recovery of the two groups was observed. During the early stage of treatment (first and second weeks) for diabetic foot ulcers, the wound healing rate was significantly better with L-PRF treatment than traditional treatment. For later-stage treatment (third to fifth weeks), the overall cure rate was higher with L-PRF than the traditional treatment method. L-PRF can effectively promote wound healing in diabetic foot ulcers.
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Affiliation(s)
- Yuqi Wang
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
- Jinzhou Medical University Union Training Base, Shiyan, Hubei, P.R. China
| | - Xiaotao Wang
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Rong Chen
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Liuwei Gu
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
- Jinzhou Medical University Union Training Base, Shiyan, Hubei, P.R. China
| | - Desen Liu
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Siyuan Ruan
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Hong Cao
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
- Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Shiyan, Hubei, P.R. China
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Browne S, Petit N, Quondamatteo F. Functionalised biomaterials as synthetic extracellular matrices to promote vascularisation and healing of diabetic wounds. Cell Tissue Res 2024; 395:133-145. [PMID: 38051351 DOI: 10.1007/s00441-023-03849-4] [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: 03/08/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023]
Abstract
Diabetic foot ulcers (DFU) are a type of chronic wound that constitute one of the most serious and debilitating complications associated with diabetes. The lack of clinically efficacious treatments to treat these recalcitrant wounds can lead to amputations for those worst affected. Biomaterial-based approaches offer great hope in this regard, as they provide a template for cell infiltration and tissue repair. However, there is an additional need to treat the underlying pathophysiology of DFUs, in particular insufficient vascularization of the wound which significantly hampers healing. Thus, the addition of pro-angiogenic moieties to biomaterials is a promising strategy to promote the healing of DFUs and other chronic wounds. In this review, we discuss the potential of biomaterials as treatments for DFU and the approaches that can be taken to functionalise these biomaterials such that they promote vascularisation and wound healing in pre-clinical models.
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Affiliation(s)
- Shane Browne
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Dublin 2, Dublin, Ireland.
- CÚRAM, Centre for Research in Medical Devices, University of Galway, H91 W2TY, Galway, Ireland.
- Trinity Centre for Biomedical Engineering, Trinity College Dublin, Dublin 2, Ireland.
| | - Noémie Petit
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Dublin 2, Dublin, Ireland
| | - Fabio Quondamatteo
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Dublin 2, Dublin, Ireland.
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Milovanovic D, Vukman P, Gavrilovic D, Begovic N, Stijak L, Sreckovic S, Kadija M. The Influence of Platelet-Rich Fibrin on the Healing of Bone Defects after Harvesting Bone-Patellar Tendon-Bone Grafts. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:154. [PMID: 38256414 PMCID: PMC10820173 DOI: 10.3390/medicina60010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: A bone-patellar tendon-bone (BTB) autograft in anterior cruciate ligament reconstruction (ACLR) is still considered the gold standard among many orthopedic surgeons, despite anterior knee pain and kneeling pain being associated with bone defects at the harvest site. Bioregenerative products could be used to treat these defects, perhaps improving both the postoperative discomfort and the overall reconstruction. Materials and methods: During a year-long period, 40 patients were enrolled in a pilot study and divided into a study group, in which bone defects were filled with Vivostat® PRF (platelet-rich fibrin), and a standard group, in which bone defects were not filled. The main outcome was a decrease in the height and width of the bone defects, as determined by magnetic resonance imaging on the control exams during the one-year follow-up. The secondary outcomes included an evaluation of kneeling pain, measured with a visual analog scale (VAS), and an evaluation of the subjective knee scores. Results: The application of Vivostat® PRF resulted in a more statistically significant reduction in the width of the defect compared with that of the standard group, especially at 8 and 12 months post operation (p < 0.05). Eight months following the surgery, the study group's anterior knee pain intensity during kneeling was statistically considerably lower than that of the standard group (p < 0.05), and the statistical difference was even more obvious (p < 0.01) at the last follow-up. Each control examination saw a significant decrease in pain intensity in both the groups, with the values at each exam being lower than those from the prior exam (p < 0.01). A comparison of subjective functional test results 12 months post operation with the preoperative ones did not prove a statistically significant difference between the groups. Conclusions: The use of Vivostat® PRF reduces kneeling pain and accelerates the narrowing of bone defects after ACLR with a BTB graft, but without confirmation of its influence on the subjective knee score.
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Affiliation(s)
- Darko Milovanovic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (P.V.); (M.K.)
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia; (N.B.)
| | - Petar Vukman
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (P.V.); (M.K.)
| | - Dusica Gavrilovic
- Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia
| | - Ninoslav Begovic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia; (N.B.)
- Institute for Mother and Child Health Care of Serbia, Radoja Dakica 6-8, 11070 Belgrade, Serbia
| | - Lazar Stijak
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia; (N.B.)
| | - Svetlana Sreckovic
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (P.V.); (M.K.)
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia; (N.B.)
- Center for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Marko Kadija
- Clinic for Orthopedic Surgery and Traumatology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (P.V.); (M.K.)
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia; (N.B.)
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Wong AYW, Ong BSY, Lee ARYB, Mai AS, Selvarajan S, Lakshminarasappa SR, Tay SM. Topical Biological Agents as Adjuncts to Improve Wound Healing in Chronic Diabetic Wounds: A Systematic Review of Clinical Evidence and Future Directions. Cureus 2022; 14:e27180. [PMID: 36035037 PMCID: PMC9398533 DOI: 10.7759/cureus.27180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/05/2022] Open
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Agapov MA, Markaryan DR, Garmanova TN, Kazachenko EA, Tsimailo IV, Kakotkin VV. VIVOSTAT ® SYSTEM AS A METHOD OF PREVENTING ANASTOMOTIC LEAKAGE FOLLOWING LOW ANTERIOR RECTAL RESECTION: CLINICAL CASE. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-2-84-92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: According to current literature, anastomosis leakage holds a leading position among all complications of colorectal surgery. A particular area of prevention of this complication in colorectal oncology is the research of the possibilities of using biological adhesive compounds as a universal biological and mechanical barrier to the spread of intraluminal microflora and tumor cells.Clinical case: A 65-year-old patient (female) was hospitalized with a diagnosis of rectal cancer cT3cN1cM0 (stage III) after neoadjuvant chemoradiotherapy. Surgical treatment was performed: the laparoscopic low anterior resection of the rectum with expanded lymphodissection, protective loop ileostomy. The anastomosis was formed at a height of 4 cm from the anus. Intraoperatively, the anastomosis line was strengthened using the Vivostat R system product. The technology of on-site preparation and application of the compound is described in the paper.. The postoperative period passed without complications.Conclusion: Due to the possible economic, oncological and postoperative advantages, the use of modern fibrin adhesive compositions is quite promising for introduction into surgical practice. It is required to conduct research aimed at studying the effectiveness of this method of preventing the leakage of colorectal anastomoses.
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Affiliation(s)
- M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - D. R. Markaryan
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - T. N. Garmanova
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - E. A. Kazachenko
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - I. V. Tsimailo
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
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Singh M, Akkaya S, Preuß M, Rademacher F, Tohidnezhad M, Kubo Y, Behrendt P, Weitkamp JT, Wedel T, Lucius R, Gläser R, Harder J, Bayer A. Platelet-Released Growth Factors Influence Wound Healing-Associated Genes in Human Keratinocytes and Ex Vivo Skin Explants. Int J Mol Sci 2022; 23:ijms23052827. [PMID: 35269967 PMCID: PMC8911300 DOI: 10.3390/ijms23052827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Platelet-released growth factors (PRGFs) or other thrombocyte concentrate products, e.g., Platelet-Rich Fibrin (PRF), have become efficient tools of regenerative medicine in many medical disciplines. In the context of wound healing, it has been demonstrated that treatment of chronic or complicated wounds with PRGF or PRF improves wound healing in the majority of treated patients. Nevertheless, the underlying cellular and molecular mechanism are still poorly understood. Therefore, we aimed to analyze if PRGF-treatment of human keratinocytes caused the induction of genes encoding paracrine factors associated with successful wound healing. The investigated genes were Semaphorin 7A (SEMA7A), Angiopoietin-like 4 (ANGPLT4), Fibroblast Growth Factor-2 (FGF-2), Interleukin-32 (IL-32), the CC-chemokine-ligand 20 (CCL20), the matrix-metalloproteinase-2 (MMP-2), the chemokine C-X-C motif chemokine ligand 10 (CXCL10) and the subunit B of the Platelet-Derived Growth Factor (PDGFB). We observed a significant gene induction of SEMA7A, ANGPLT4, FGF-2, IL-32, MMP-2 and PDGFB in human keratinocytes after PRGF treatment. The CCL20- and CXCL10 gene expressions were significantly inhibited by PRGF therapy. Signal transduction analyses revealed that the PRGF-mediated gene induction of SEMA7A, ANGPLT4, IL-32 and MMP-2 in human keratinocytes was transduced via the IL-6 receptor pathway. In contrast, EGF receptor signaling was not involved in the PRGF-mediated gene expression of analyzed genes in human keratinocytes. Additionally, treatment of ex vivo skin explants with PRGF confirmed a significant gene induction of SEMA7A, ANGPLT4, MMP-2 and PDGFB. Taken together, these results describe a new mechanism that could be responsible for the beneficial wound healing properties of PRGF or related thrombocytes concentrate products such as PRF.
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Affiliation(s)
- Michael Singh
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Serhat Akkaya
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Mark Preuß
- Department for Vascular Medicine, Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Franziska Rademacher
- Department of Dermatology, Venerology and Allergology, Kiel University, 24105 Kiel, Germany; (F.R.); (R.G.); (J.H.)
| | - Mersedeh Tohidnezhad
- Department of Anatomy and Cell Biology, RWTH Aachen University, 52074 Aachen, Germany; (M.T.); (Y.K.)
| | - Yusuke Kubo
- Department of Anatomy and Cell Biology, RWTH Aachen University, 52074 Aachen, Germany; (M.T.); (Y.K.)
| | - Peter Behrendt
- Department of Trauma Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany;
| | - Jan-Tobias Weitkamp
- Department of Oral and Maxillofacial Surgery, University Medical Center of Schleswig-Holstein, Campus Kiel, 24015 Kiel, Germany;
| | - Thilo Wedel
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Ralph Lucius
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
| | - Regine Gläser
- Department of Dermatology, Venerology and Allergology, Kiel University, 24105 Kiel, Germany; (F.R.); (R.G.); (J.H.)
| | - Jürgen Harder
- Department of Dermatology, Venerology and Allergology, Kiel University, 24105 Kiel, Germany; (F.R.); (R.G.); (J.H.)
| | - Andreas Bayer
- Institute of Anatomy, Kiel University, 24098 Kiel, Germany; (M.S.); (S.A.); (T.W.); (R.L.)
- Correspondence:
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Bacci S. Cellular Mechanisms and Therapies in Wound Healing: Looking toward the Future. Biomedicines 2021; 9:biomedicines9111611. [PMID: 34829840 PMCID: PMC8615875 DOI: 10.3390/biomedicines9111611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Stefano Bacci
- Department of Biology, Research Unit of Histology and Embriology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Platelet-Released Growth Factors Induce Genes Involved in Extracellular Matrix Formation in Human Fibroblasts. Int J Mol Sci 2021; 22:ijms221910536. [PMID: 34638874 PMCID: PMC8508971 DOI: 10.3390/ijms221910536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023] Open
Abstract
Platelet concentrate products are increasingly used in many medical disciplines due to their regenerative properties. As they contain a variety of chemokines, cytokines, and growth factors, they are used to support the healing of chronic or complicated wounds. To date, underlying cellular mechanisms have been insufficiently investigated. Therefore, we analyzed the influence of Platelet-Released Growth Factors (PRGF) on human dermal fibroblasts. Whole transcriptome sequencing and gene ontology (GO) enrichment analysis of PRGF-treated fibroblasts revealed an induction of several genes involved in the formation of the extracellular matrix (ECM). Real-time PCR analyses of PRGF-treated fibroblasts and skin explants confirmed the induction of ECM-related genes, in particular transforming growth factor beta-induced protein (TGFBI), fibronectin 1 (FN1), matrix metalloproteinase-9 (MMP-9), transglutaminase 2 (TGM2), fermitin family member 1 (FERMT1), collagen type I alpha 1 (COL1A1), a disintegrin and metalloproteinase 19 (ADAM19), serpin family E member 1 (SERPINE1) and lysyl oxidase-like 3 (LOXL3). The induction of these genes was time-dependent and in part influenced by the epidermal growth factor receptor (EGFR). Moreover, PRGF induced migration and proliferation of the fibroblasts. Taken together, the observed effects of PRGF on human fibroblasts may contribute to the underlying mechanisms that support the beneficial wound-healing effects of thrombocyte concentrate products.
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