Is all PRP (platelet rich plasma) created equal?

As we learn more and more about this fascinating regenerative treatment, the answer is an unequivocal “no.”  The quality of platelet rich plasma (“PRP”) can vary widely depending on a number of important factors.

We have been using PRP here at Beacon Orthopaedics and Sports Medicine since 2007.  Initially, what we knew came from the racehorse industry and Europe.  Racehorses are “elite” athletes and part of a billion dollar industry, which to this day contributes much of the basic science that allows us to understand how PRP and stem cells work. Europe and the rest of world often gets a quite jump start on studying how treatments work in humans as there is much less government regulation.

Platelets are particles in our bloodstream that perform a number of functions. When there is an injury that involves bleeding, the first lines of defense to stop the bleeding are platelets.

They also serve as Mother Nature’s antibiotic. This is why most times when you scrape your knee or get a cut on your finger, you don’t need antibiotics.  Most importantly, they help heal injured tissue be it muscle, tendon, ligaments, by releasing proteins that aid in this process.

The amount and type of proteins produced and found in platelets number in the hundreds.

We all have different amounts of these proteins. Let’s use a protein called Vascular Endothelial Growth Factor or “VEGF” for short as an example.  Vascular refers to our blood vessels and endothelial refers to the inner lining of cells in the blood vessel much like the inside of the inner tube in a bicycle tire. Tissue needs blood to heal and repair itself.  Creating new blood vessels in injured tissue is one of the important ways PRP works.

Every person has different amounts of these proteins. Such may have very high levels of VEGF while others have very little. Some may have very high levels of proteins that are responsible for tendon regeneration, other not so much, but they may have more that work for osteoarthritis. This is genetically determined to a large extent in the same way some people have blue eyes, others brown and so on.  We are a few years away from being able to take a blood sample and measure these proteins, which can help determine the outcome of a specific treatment for a given injury.

regenerative medicine PRP InjectionWe have also learned that different injured structures need different concentrations of PRP.  Scientific studies have shown that for tendon repair, PRP concentration about 6 times normal work best, where higher or lower concentrations are sometimes detrimental to healing. We also know when treating osteoarthritis with PRP, a concentration of 6 times normal will have no effect. To be effective for osteoarthritis, platelet concentrations need to be about 20 times normal.
Some PRP contains white blood cells and some not. White blood cells in PRP are useful for tendons but not for arthritis.  Based on the all the research that has been done on PRP, none should contain red blood cells.

So how can PRP be made to deal with all these issues?  The answer is very simple and that is to produce PRP for an individual patient for a specific need be it osteoarthritis, tendon injuries, or muscle injuries.  This can only be done in a lab, which is precisely how my staff and I prepare your PRP using the Regenexx protocol.

There are many drug companies that produce centrifuges and kits that produce PRP such as Harvest, Arteriocyte, Emcyte, Depuy, and Megellan as examples.  These kits will almost always produce the same concentration, usually about 4-6 times normal.  Therefore, the PRP  they produce usually cannot help osteoarthritis. They will also exclusively produce PRP that does or does not have white blood cells but usually cant do both.  For the most part, these are “one size fits all.”

When considering PRP, one of the most important things to ask your doctor, is how do they make your PRP? Can they vary the concentration?  Does it contain red blood cells?  Can white blood cells be included or removed?

We are learning knew things about this exciting treatment and it is very important to consider the amount of experience your doctor has with this treatment.  No treatment in medicine is 100% guaranteed, but considering all the variables can certainly make a difference in the outcome of the treatment.