Why doesn’t Platelet Rich Plasma PRP work for arthritis? What’s it good for? Is it good for anything

Clam Chowder

Why doesn’t Platelet Rich Plasma PRP work for arthritis? What’s it good for? Is it good for anything?

Austin Yeargan III MD

In this setting of cell transplant procedures, which do work by virtue of the signaling cell fraction, the easiest analogy to make is to a recipe for clam chowder. Think of half and half as PRP. It’s an ingredient that makes the chowder tastier, but it’s by no means the essential ingredient. Clearly, clam chowder doesn’t work without clams, potatoes and the other ingredients that make it clam chowder.

Signaling cells, which include all of the nucleated cells inside the bone marrow that are concentrated for cell transplant procedures (some of which are often erroneously referred to as stem cell injections), constitute the clams and the rest of the ingredients you need for the ideal chowder, or in our case, the best signaling cell transplant.

PRP delivery has become synonymous with ‘growth factor injection’ due to the fact that it can contain up to approximately 4-6 times the normal number of platelets found in normal serum after centrifugation. Platelets are broken off pieces of cells called megakaryocytes that contain granules where the growth factors are sequestered. Platelets also contain peroxisomes and T granules that were recently discovered.

There are two types of granules, alpha granules and dense granules. The biogenesis of each follows similar but distinct pathways. Alpha granules expression P-selectin (an adhesion molecule) and CD63. Dense platelet granules contain Transforming growth factor Beta (TGF-B)Platelet Derived Growth Factor 4 (PDGF4), Insulin like growth factor 1 (IGF1), Platelet factor 4, thrombospondin, fibronectin Factors V, VII and fibrinogen. The dense bodies are composed of serotonin, ADP and calcium. In addition, platelets contain hydrolytic enzymes which are thought to cause catabolic changes in tissues that we want to avoid.

While all of these biogenic factors play important roles in acute and chronic inflammation (inflammation IS healing remember), without nucleated signaling cells to direct a healing response, their effect is immunomodulatory and anti-inflammatory in isolation.

In actuality, PRP has demonstrated very little value clinically for any indication in spite of efforts by many to ‘find’ a PRP formulation that ‘works’ for anything. In fact, more studies have shown a detrimental effect when combined with surgical and non-surgical approaches. Where it has an apparent role lies in the fact that treatment with PRP has been shown to provide clinical relief that is equivalent to corticosteroids and hyaluronic acid. The advantage of PRP is that corticosteroids are diretly damaging to articular cartilage. A simple injection of corticosteroid into the joint prompts fissure formation and leads to progressive arthritis. PRP can be anticipated to provide approximately 6 months of pain relief and is an anabolic treatment, in contrast to corticosteroids, which are catabolic treatments.

Author
S. Austin Yeargan III, MD Orthopedic Surgeon Molecular Immunobiologist

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