Medical research in the area of PRP therapy (platelet-rich plasma) is continuing to gain notoriety in the mainstream press. Particularly, because high profile athletes are taking notice of the benefits of this treatment alternative. Kobe Bryant and Alex Rodriguez, to name a few, have recently both traveled to Germany where biologic treatments in the form of PRP are readily available. Scientists in the U.S., and at the Steadman Philippon Research Institute in Vail, agree that platelet-rich plasma treatment offers faster healing for sports injuries because the patient’s very own tissues are used to treat the injured cartilage, muscle, or tendon.
In the article, “Why Did Kobe Go To Germany?” the aging basketball star Kobe Bryant discusses his personal experience with PRP therapy and how it helps contribute to his playing ability on the court.
While research scientists and orthopaedic surgeons at SPRI agree that the therapy does have a promising future, they believe it needs additional analysis and that there is much still left to be discovered.
Dr. Robert F. LaPrade, Chief Medical Research Officer at the Steadman Philippon Research Institute and Partner at The Steadman Clinic specializing in complex knee injuries, recently led a successful international PRP/Biologic Treatment Symposium this past month in Vail. According to him, “Biological treatments to treat cartilage, muscle, and tendon injuries from sports injuries or aging have been recognized as one of the up and coming frontiers of sports medicine.”
He adds, “However, it is well recognized that the science behind these treatments has not been rigorously followed. A well defined scientific basis for determining the efficacy of these treatments should be determined prior to widespread use of any enhanced blood product, stem cell treatment, or biological factor enhancement to validate their use in patients. While it appears that many of these products have little known side-effects, one should verify their usefulness to justify their current cost, oftentimes which is now borne by patients because insurance companies often to do pay for these treatments.”
Dr. LaPrade continues to discuss biologic treatments and PRP therapy by explaining that it is strongly believed that growth factors can and will be manipulated in the near future to enhance healing of sports injuries and to counteract the effects of aging. However, there are potentially hundreds of individual growth factors within the alpha granules in platelets alone and only a small percentage of these have been studied in detail. In addition, while platelet rich plasma (PRP) has been used in many centers to treat injuries, the ideal platelet concentrations and the ratios of platelets to white blood cells has not been defined. In fact, there are over a half dozen different commercial devices for obtaining PRP with a great variation of platelet concentrations and platelet to white blood cell ratios. In effect, this means that one is not even sure if the PRP they are obtaining is efficacious and has the correct ratios of growth factors because the ideal ratios have still not been defined. Also, one should be certain that the PRP is injected into the correct area with either ultrasound or x-rays to verify it is being delivered into the exact area of the joint, muscle, or tendon where the treatment is being directed.
While it is accurate that many randomized controlled studies have not found any difference between the use of PRP and placebo, this may be because most of these studies did not have specific age ranges, defined methods to evaluate objectively the effects of the PRP on healing tissues, and the fact that the ideal concentration of platelet concentrations and ratios have not been defined. Thus, the jury is still out as to whether PRP injections work and when they should be utilized.
In the United States, the FDA regulates the manipulation of one’s blood and stem cell products. Current regulations only allow for “minimally manipulated” products. This has been generally interpreted to mean that one can centrifuge down blood and obtain PRP or harvest stem cells within the confines of a reasonable time frame in the operating room or clinic, but to manipulate it past that point has not been approved to date. Thus, current research strategies are attempting to focus on harvesting one’s own stem cells (adult progenitor cells) which have been demonstrated to be present in bone marrow, fat (adipose) tissues, muscle, and skin and to isolate and inject these cells with minimal manipulation or expansion in tissue cultures before reinjection into the patient.
The manipulation of one’s blood, as performed on Kobe Bryant and other American professional athletes in the German Regenokine process, is believed to activate the natural anti-inflammatory interleukin-1 receptor antagonist (IRAP). This product has proven promising in veterinary medicine where it has been injected into joints and has been reported to decrease swelling and possibly slow down the progression of osteoarthritis. Interleukin-1 is a natural biologic factor (a cytokine) which has been demonstrated to cause inflammation. The therapeutic uses of IRAP in humans are primarily to treat the more devastating effects of rheumatoid arthritis. There have been insufficient human clinical studies to determine one way or the other if this particular growth factor manipulation is beneficial for the treatment of osteoarthritis compared to current treatment methods of osteoarthritis or even placebo.
Dr. LaPrade adds, “We are currently on the frontier of the use of biologic treatments in sports medicine. Both the use and manipulation of one’s own growth factors will become mainstream medicine in the future. In addition, the use of stem cells for regeneration of tendon, ligament, muscle, and cartilage injuries will be possible. However, it is important that we not put the cart before the horse. We should require good scientific evidence of the efficacy of these treatments before they are widely utilized in patients.”
(Photo by Boixoesnois, Flickr Creative Commons)