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Bacevich BM, Smith RDJ, Reihl AM, Mazzocca AD, Hutchinson ID. Advances with Platelet-Rich Plasma for Bone Healing. Biologics 2024; 18:29-59. [PMID: 38299120 PMCID: PMC10827634 DOI: 10.2147/btt.s290341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
Despite significant advances in the understanding and delivery of osteosynthesis, fracture non-union remains a challenging clinical problem in orthopaedic surgery. To bridge the gap, basic science characterization of fracture healing provides a platform to identify and target biological strategies to enhance fracture healing. Of immense interest, Platelet-rich plasma (PRP) is a point of care orthobiologic that has been extensively studied in bone and soft tissue healing given its relative ease of translation from the benchtop to the clinic. The aim of this narrative review is to describe and relate pre-clinical in-vitro and in-vivo findings to clinical observations investigating the efficacy of PRP to enhance bone healing for primary fracture management and non-union treatment. A particular emphasis is placed on the heterogeneity of PRP preparation techniques, composition, activation strategies, and delivery. In the context of existing data, the routine use of PRP to enhance primary fracture healing and non-union management cannot be supported. However, it is acknowledged that extensive heterogeneity of PRP treatments in clinical studies adds obscurity; ultimately, refinement (and consensus) of PRP treatments for specific clinical indications, including repetition studies are warranted.
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Affiliation(s)
- Blake M Bacevich
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Richard David James Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Alec M Reihl
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Augustus D Mazzocca
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
- Medical Director, Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Brigham, Boston, MA, USA
| | - Ian D Hutchinson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
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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.
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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
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Zhang M, Matinlinna JP, Tsoi JK, Liu W, Cui X, Lu WW, Pan H. Recent developments in biomaterials for long-bone segmental defect reconstruction: A narrative overview. J Orthop Translat 2020; 22:26-33. [PMID: 32440496 PMCID: PMC7231954 DOI: 10.1016/j.jot.2019.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022] Open
Abstract
Reconstruction of long-bone segmental defects (LBSDs) has been one of the biggest challenges in orthopaedics. Biomaterials for the reconstruction are required to be strong, osteoinductive, osteoconductive, and allowing for fast angiogenesis, without causing any immune rejection or disease transmission. There are four main types of biomaterials including autograft, allograft, artificial material, and tissue-engineered bone. Remarkable progress has been made in LBSD reconstruction biomaterials in the last ten years. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Our aim is to summarize recent developments in the divided four biomaterials utilized in the LBSD reconstruction to provide the clinicians with new information and comprehension from the biomaterial point of view.
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Key Words
- ADSC, allogenic adipose-derived stem cells
- ALLO, partially demineralized allogeneic bone block
- ALP, alkaline phosphatase
- ASC, adipose-derived stem cell
- Allograft
- Artificial material
- Autograft
- BMP-2 & 4, bone morphogenetic protein-2 & 4
- BMSC, bone marrow–derived mesenchymal stem cell
- BV, baculovirus
- Biomaterial
- CS, chitosan
- DBM, decalcified bone matrix
- FGF-2, Fibroblast Growth Factor-2
- HDB, heterogeneous deproteinized bone
- LBSD, long-bone segmental defect
- Long-bone segmental defect reconstruction
- M-CSF, macrophage colony-stimulating factor
- MIC, fresh marrow-impregnated ceramic block
- MSC, autologous mesenchymal stem cells
- PCL, polycaprolactone
- PDGF, Platelet-Derived Growth Factor
- PDLLA, poly(DL-lactide)
- PET/CT, positron emission- and computed tomography
- PLA, poly(lactic acid)
- PPF, propylene fumarate
- SF, silk fibroin
- TCP, tricalcium phosphate
- TEB, combining ceramic block with osteogenic-induced mesenchymal stem cells and platelet-rich plasma
- TGF-β, Transforming Growth Factor-β
- Tissue engineering
- VEGF, Vascular Endothelial Growth Factor
- bFGF, basic Fibroblast Growth Factor
- htMSCs, human tubal mesenchymal stem cells
- nHA, nano-hydroxyapatite
- poly, (L-lactide-co-D,L-lactide)
- rADSC, rabbit adipose-derived mesenchymal stem cell
- rVEGF-A, recombinant vascular endothelial growth factor-A
- rhBMP-2, recombinant human bone morphogenetic protein-2
- rhBMP-7, recombinant human bone morphogenetic protein 7
- sRANKL, soluble RANKL
- β-TCP, β-tricalcium phosphate
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Affiliation(s)
- Meng Zhang
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
| | - Jukka P. Matinlinna
- Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - James K.H. Tsoi
- Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Wenlong Liu
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
| | - Xu Cui
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
| | - William W. Lu
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
- Department of Orthopaedic and Traumatology, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Haobo Pan
- Research Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Shenzhen, 518055, China
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The role of fish scale derived scaffold and platelet rich plasma in healing of rabbit tibial defect: an experimental study. ACTA VET BRNO 2019. [DOI: 10.2754/avb201887040363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Fish scale is rich in collagen type I and hydroxyapatite, resembling bone structure. It is readily available, cost effective and can compensate for the limitations of grafting methods such as unavailability, zoonotic disease transmission, and high cost. The aim of this study was to evaluate in vivo the fish scale potential and the possible synergistic effect of platelet rich plasma (PRP) with this scaffold in bone regeneration. Fifteen male white New Zealand rabbits were randomly divided into six groups, each involving 5 limbs. Full thickness bicortical defects were created in the proximal tibia of both pelvic limbs of rabbits. The defect was left untreated in the negative control group. In experimental groups the defect was filled with PRP (group 1), cellular fish scale (group 2), combination of cellular fish scale and PRP (group 3), acellular fish scale (group 4), and a combination of acellular fish scale and PRP (group 5). Fresh fish scales were decellularized to increase biocompatibility and reduce immunity reactions. Decellularization was confirmed by DAPI (4',6-diamidino-2-phenylindole) staining. The microstructure and surface characteristics of fish scales were assessed by scanning electron microscopy (SEM). Histopathological evaluation of bone healing was performed on day 56. Although there was no significant difference in the bone union among experimental groups, the union was superior in all experimental groups compared to control. Spongiosa and cortex formation were superior in the acellular groups. Furthermore, PRP promoted bone marrow formation. We concluded that fish scale is a biocompatible scaffold with a high regenerative potential.
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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.
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Marcazzan S, Weinstein RL, Del Fabbro M. Efficacy of platelets in bone healing: A systematic review on animal studies. Platelets 2017. [PMID: 28643535 DOI: 10.1080/09537104.2017.1327652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In presence of large bone defects, delayed bone union, non-union, fractures, and implant surgery, bone reconstruction may be necessary. Different strategies have been employed to enhance bone healing among which the use of autologous platelet concentrates. Due to the high content of platelets and platelet-derived bioactive molecules (e.g., growth factors, antimicrobial peptides), they are promising candidates to increase bone healing. However, a high heterogeneity of both preclinical and clinical studies resulted in contrasting results. Aim of the present systematic review was to evaluate the efficacy of platelet concentrates in animal models of bone regeneration, considering the possible factors which might affect the outcome. An electronic search was performed on MEDLINE and SCOPUS databases. Animal studies with a minimum follow up of 2 weeks and a sample size of five subjects per group, using platelet concentrates for bone regeneration, were included. Articles underwent risk of bias assessment and further quality evaluation was done. Sixty studies performed on six animal species (rat, rabbit, dog, sheep, goat, and mini-pig) were included. The present part of the review considers only studies performed on rats and rabbits (35 articles). The majority of the studies were considered at medium risk of bias. Animal species, healthy models, platelet, growth factors and leukocytes concentration, and type of bone defect seemed to influence the efficacy of platelet concentrates in bone healing. However, final conclusions were not be drawn, since only few included studies evaluated leukocyte, growth factor content, or presence of other bioactive molecules in platelet concentrates. Further studies with a standardized protocol including characterization of the final products will provide useful information for clinical application of platelet concentrates in bone surgery.
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Affiliation(s)
- Sabrina Marcazzan
- a Dipartimento di Scienze Biomediche , Chirurgiche e Odontoiatriche, Università degli Studi di Milano , Milan , Italy.,b Department of Nanomedicine , Houston Methodist Research Institute , Houston , TX , USA
| | - Roberto Lodovico Weinstein
- a Dipartimento di Scienze Biomediche , Chirurgiche e Odontoiatriche, Università degli Studi di Milano , Milan , Italy.,c IRCCS Istituto Ortopedico Galeazzi , via Riccardo Galeazzi 4, Milan , Italy
| | - Massimo Del Fabbro
- a Dipartimento di Scienze Biomediche , Chirurgiche e Odontoiatriche, Università degli Studi di Milano , Milan , Italy.,c IRCCS Istituto Ortopedico Galeazzi , via Riccardo Galeazzi 4, Milan , Italy
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Schneppendahl J, Jungbluth P, Sager M, Benga L, Herten M, Scholz A, Wild M, Hakimi M, Windolf J, Grassmann JP. Synergistic effects of HBO and PRP improve bone regeneration with autologous bone grafting. Injury 2016; 47:2718-2725. [PMID: 27817884 DOI: 10.1016/j.injury.2016.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/29/2016] [Indexed: 02/02/2023]
Abstract
Bone defects remain a challenge for patients and orthopaedic surgeons. Autologous transfer of cancellous bone grafts remains the standard of care. However, in recent years various osteoinductive substitute materials, such as platelet rich plasma (PRP) and hyperbaric oxygen therapy (HBO) have been shown to improve bone healing. This study evaluates the effects of a combined application of PRP and HBO with autologous bone grafting in an animal model. In 48 New Zealand White rabbits bone defects at the radius were filled with autologous bone harvested at the iliac crest. This was combined with application of autologous PRP and/or HBO treatment for the duration of this study. After 3 and 6 weeks histomorphometric, immunohistochemical and radiologic evaluations were performed. All animals tolerated the treatment well. Improved bone regeneration was shown in all groups at 6 weeks compared to 3 weeks. Additional application of PRP and HBO resulted in an increase in new bone formation and increased neovascularization at 3 and 6 weeks. There was no statistical significant difference between PRP and HBO application in these regards. A combinatory use of PRP and HBO resulted in an increased bone regeneration and neovascularization compared to all other groups. This study provides evidence for an improvement of bone regeneration with the combinatory application of PRP and HBO to autologous cancellous bone grafts in a model of weight bearing bone defects in rabbits. Also synergistic effects of these two measures on angiogenesis were evident.
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Affiliation(s)
- Johannes Schneppendahl
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Pascal Jungbluth
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany.
| | - Martin Sager
- Heinrich Heine University Hospital Duesseldorf, Animal Research Institute, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Laurentiu Benga
- Heinrich Heine University Hospital Duesseldorf, Animal Research Institute, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Monika Herten
- University Hospital Muenster, Department for Vascular and Endovascular Surgery, Waldeyerstraße 30, 48149 Münster, Germany
| | - Armin Scholz
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Michael Wild
- Department of Orthopaedic, Trauma, and Hand Surgery, Klinikum Darmstadt, Grafenstraße 9, 64283 Darmstadt, Germany
| | - Mohssen Hakimi
- Department of Trauma, Orthopaedic, and Hand Surgery, Vivantes Klinikum am Urban, Dieffenbachstraße 1, 10967 Berlin, Germany
| | - Joachim Windolf
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Jan-Peter Grassmann
- Heinrich Heine University Hospital Düsseldorf, Department of Trauma and Hand Surgery, Moorenstrasse 5, 40225 Düsseldorf, Germany
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Platelet-rich plasma for the treatment of bone defects: from pre-clinical rational to evidence in the clinical practice. A systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 41:221-237. [PMID: 27888295 DOI: 10.1007/s00264-016-3342-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE The treatment of large bone defects represents a significant challenge for orthopaedic surgeons. In recent years, biologic agents have also been used to further improve bone healing. Among these, platelet-rich plasma (PRP) is the most exploited strategy. The aim of the present study was to systematically review the available literature to identify: 1) preclinical in-vivo results supporting the rational of PRP use for bone healing; 2) evidence from the clinical practice on the actual clinical benefit of PRP for the treatment of fractures and complications such as delayed unions and non-unions. METHODS A systematic review of the literature was performed on the application of PRP in bone healing, using the following inclusion criteria: pre-clinical and clinical reports of any level of evidence, written in English language, published in the last 20 years (1996-2016), on the use of PRP to stimulate long-bone defect treatment, with focus on fracture and delayed/non-unions healing. RESULTS The search in the Pubmed database identified 64 articles eligible for inclusion: 45 were preclinical in-vivo studies and 19 were clinical studies. Despite the fact that the overall pre-clinical results seem to support the benefit of PRP in 91.1 % of the studies, a more in depth analysis underlined a lower success rate, with a positive outcome of 84.4 % in terms of histological analysis, and even lower values considering radiological and biomechanical results (75.0 % and 72.7 % positive outcome respectively). This was also mirrored in the clinical literature, where the real benefit of PRP use to treat fractures and non-unions is still under debate. CONCLUSION Overall, the available literature presents major limitations in terms of low quality and extreme heterogeneity, which hamper the possibility to optimize PRP treatment and translate it into a real clinical benefit despite positive preclinical findings on its biological potential to favour bone healing.
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Promotion of Bone Regeneration. Vet Comp Orthop Traumatol 2015; 28:V. [DOI: 10.3415/vcot-15-04-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 11/17/2022]
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