Platelet-rich plasma: support for its use in wound healing

Kathleen M Lacci, Alan Dardik, Kathleen M Lacci, Alan Dardik

Abstract

Previous topical growth factor studies have shown that recombinant human platelet-derived growth factor-BB isomer (rhPDGF-BB) is an efficacious treatment of chronic diabetic foot ulceration. A newer treatment, autologous platelet-rich plasma (PRP), represents a greater similarity to the natural healing process as a composite of multiple growth factors, is safe due to its autologous nature, and is produced as needed from patient blood. A review of the literature shows few studies performed with scientific rigor, although the safety of PRP appears to be validated. As the use of PRP increases, additional studies may establish PRP as an efficacious treatment modality and guide future treatment of chronic diabetic foot ulceration.

Keywords: autologous; diabetic foot; platelet-rich plasma; therapy; ulcer; wound healing; wounds.

References

    1. Mehta S, Watson JT. Platelet rich concentrate: basic science and current clinical applications. J Orthop Trauma. 2008;22(6):432–438.
    1. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225–228.
    1. Driver VR, Hanft J, Fylling CP, Beriou JM. Autologel Diabetic Foot Ulcer Study Group. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage. 2006;52(6):68-70, 72, 74 passim.
    1. Petrova N, Edmonds M. Emerging drugs for diabetic foot ulcers. Expert Opin Emerg Drugs. 2006;11(4):709–724.
    1. Millington JT, Norris TW. Effective treatment strategies for diabetic foot wounds. J Fam Pract. 2000;49(11 Suppl):S40–S48.
    1. Steed DL, Goslen JB, Holloway GA, Malone JM, Bunt TJ, Webster MW. Randomized prospective double-blind trial in healing chronic diabetic foot ulcers. CT-102 activated platelet supernatant, topical versus placebo. Diabetes Care. 1992;15(11):1598–1604.
    1. Everts PA, Brown Mahoney C, Hoffmann JJ. et al. Platelet-rich plasma preparation using three devices: implications for platelet activation and platelet growth factor release. Growth Factors. 2006;24(3):165–171.
    1. Pietrzak WS, Eppley BL. Platelet rich plasma: biology and new technology. J Craniofac Surg. 2005;16(6):1043–1054.
    1. Eppley BL, Pietrzak WS, Blanton M. Platelet-rich plasma: a review of biology and applications in plastic surgery. Plast Reconstr Surg. 2006;118(6):147e–159e.
    1. Salemi S, Rinaldi C, Manna F, Guarneri GF, Parodi PC. Reconstruction of lower leg skin ulcer with autologous adipose tissue and platelet-rich plasma. J Plast Reconstr Aesthet Surg. 2008;61(12):1565–1567.
    1. Lindeboom JA, Mathura KR, Aartman IH, Kroon FH, Milstein DM, Ince C. Influence of the application of platelet-enriched plasma in oral mucosal wound healing. Clin Oral Implants Res. 2007;18(1):133–139.
    1. El-Sharkawy H, Kantarci A, Deady J. et al. Platelet-rich plasma: growth factors and pro- and anti-inflammatory properties. J Periodontol. 2007;78(4):661–669.
    1. Nikolidakis D, Jansen JA. The biology of platelet-rich plasma and its application in oral surgery: literature review. Tissue Eng Part B Rev. 2008;14(3):249–258.
    1. Shashikiran ND, Reddy VV, Yavagal CM, Zakirulla M. Applications of platelet-rich plasma (PRP) in contemporary pediatric dentistry. J Clin Pediatr Dent. 2006;30(4):283–286.
    1. Wrotniak M, Bielecki T, Gazdzik TS. Current opinion about using the platelet-rich gel in orthopaedics and trauma surgery. Ortop Traumatol Rehabil. 2007;9(3):227–238.
    1. Mishra A, Woodall J Jr, Vieira A. Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med. 2009;28(1):113–125.
    1. Frechette JP, Martineau I, Gagnon G. Platelet-rich plasmas: growth factor content and roles in wound healing. J Dent Res. 2005;84(5):434–439.
    1. Bhanot S, Alex JC. Current applications of platelet gels in facial plastic surgery. Facial Plast Surg. 2002;18(1):27–33.
    1. Henderson JL, Cupp CL, Ross EV. et al. The effects of autologous platelet gel on wound healing. Ear Nose Throat J. 2003;82(8):598–602.
    1. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114(6):1502–1508.
    1. Knighton DR, Ciresi KF, Fiegel VD, Austin LL, Butler EL. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF) Ann Surg. 1986;204(3):322–330.
    1. Knighton DR, Doucette M, Fiegel VD, Ciresi K, Butler EL, Austin L. The use of platelet derived wound healing formula in human clinical trials. Prog Clin Biol Res. 1988;266:319–329.
    1. Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg. 2004;62(4):489–496.
    1. Pietramaggiori G, Kaipainen A, Czeczuga JM, Wagner CT, Orgill DP. Freeze-dried platelet-rich plasma shows beneficial healing properties in chronic wounds. Wound Repair Regen. 2006;14(5):573–580.
    1. Gonshor A. Technique for producing platelet-rich plasma and platelet concentrate: background and process. Int J Periodontics Restorative Dent. 2002;22(6):547–557.
    1. Robson MC, Phillips LG, Thomason A. et al. Recombinant human platelet-derived growth factor-BB for the treatment of chronic pressure ulcers. Ann Plast Surg. 1992;29(3):193–201.
    1. Weibrich G, Kleis WK, Kunz-Kostomanolakis M, Loos AH, Wagner W. Correlation of platelet concentration in platelet-rich plasma to the extraction method, age, sex, and platelet count of the donor. Int J Oral Maxillofac Implants. 2001;16(5):693–699.
    1. Harrison P, Cramer EM. Platelet alpha-granules. Blood Rev. 1993;7(1):52–62.
    1. McAleer JP, Sharma S, Kaplan EM, Persich G. Use of autologous platelet concentrate in a nonhealing lower extremity wound. Adv Skin Wound Care. 2006;19(7):354–363.
    1. Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Krol W, Wielkoszynski T. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: an in vitro study. J Bone Joint Surg Br. 2007;89(3):417–420.
    1. Tang YQ, Yeaman MR, Selsted ME. Antimicrobial peptides from human platelets. Infect Immun. 2002;70(12):6524–6533.
    1. Gandhi A, Bibbo C, Pinzur M, Lin SS. The role of platelet-rich plasma in foot and ankle surgery. Foot Ankle Clin. 2005;10(4):621-37, viii.
    1. Rozman P, Bolta Z. Use of platelet growth factors in treating wounds and soft-tissue injuries. Acta Dermatovenerol Alp Panonica Adriat. 2007;16(4):156–165.
    1. Mazzucco L, Balbo V, Cattana E, Borzini P. Platelet-rich plasma and platelet gel preparation using Plateltex. Vox Sang. 2008;94(3):202–208.
    1. AutoloGel System [Internet]. Cytomedix: Regenerative Biotherapies. [place unknown]: AutoloGel System; 2009. [cited 3 May 2009]. Available from: .
    1. Ulbrecht JS, Cavanagh PR, Caputo GM. Foot problems in diabetes: an overview. Clin Infect Dis. 2004;39(Suppl 2):S73–S82.
    1. Williams DT, Harding KG. New treatments for diabetic neuropathic foot ulceration: views from a wound healing unit. Curr Diab Rep. 2003;3(6):468–474.
    1. Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ. Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol. 2008;58(2):185–206.
    1. Stojadinovic A, Carlson JW, Schultz GS, Davis TA, Elster EA. Topical advances in wound care. Gynecol Oncol. 2008;111(2 Suppl):S70–S80.
    1. Steed DL, Donohoe D, Webster MW, Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg. 1996;183(1):61–64.
    1. Cavanagh PR, Ulbrecht JS, Caputo GM. New developments in the biomechanics of the diabetic foot. Diabetes Metab Res Rev. 2000;16(Suppl 1):S6–S10.
    1. Boulton AJ. Pressure and the diabetic foot: clinical science and offloading techniques. Am J Surg. 2004;187(5A):17S–24S.
    1. Kunimoto BT. Growth factors in wound healing: the next great innovation? Ostomy Wound Manage. 1999;45(8):56-64; quiz 65-66.
    1. Mason J, O’Keeffe C, Hutchinson A, McIntosh A, Young R, Booth A. A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. II: treatment. Diabet Med. 1999;16(11):889–909.
    1. Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess. 2001;5(9):1–221.
    1. Kantor J, Margolis DJ. Management of leg ulcers. Semin Cutan Med Surg. 2003;22(3):212–221.
    1. Margolis DJ, Kantor K, Santanna J, Strom BL, Berlin JA. Effectiveness of platelet releasate for the treatment of diabetic neuropathic foot ulcers. Diabetes Care. 2001;24(3):483–488.
    1. Crovetti G, Martinelli G, Issi M. et al. Platelet gel for healing cutaneous chronic wounds. Transfus Apher Sci. 2004;30(2):145–151.
    1. O’Connell SM, Impeduglia T, Hessler K, Wang XJ, Carroll RJ, Dardik H. Autologous platelet-rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers. Wound Repair Regen. 2008;16(6):749–756.
    1. Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: the association of wound size, wound duration, and wound grade on healing. Diabetes Care. 2002;25(10):1835–1839.
    1. Ganio C, Tenewitz FE, Wilson RC, Moyles BG. The treatment of chronic nonhealing wounds using autologous platelet-derived growth factors. J Foot Ankle Surg. 1993;32(3):263–268.
    1. Krupski WC, Reilly LM, Perez S, Moss KM, Crombleholme PA, Rapp JH. A prospective randomized trial of autologous platelet-derived wound healing factors for treatment of chronic nonhealing wounds: a preliminary report. J Vasc Surg. 1991;14(4):526-532; discussion 532-536.
    1. Marston WA. Dermagraft Diabetic Foot Ulcer Study Group. Risk factors associated with healing chronic diabetic foot ulcers: the importance of hyperglycemia. Ostomy Wound Manage. 2006;52(3):26-8, 30, 32 passim.
    1. Guzman-Gardearzabal E, Leyva-Bohorquez G, Salas-Colin S, Paz-Janeiro JL, Alvarado-Ruiz R, Garcia-Salazar R. Treatment of chronic ulcers in the lower extremities with topical becaplermin gel .01%: a multicenter open-label study. Adv Ther. 2000;17(4):184–189.
    1. Abbott CA, Carrington AL, Ashe H. et al. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002;19(5):377–384.
    1. Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. Arch Dermatol. 2000;136(12):1531–1535.
    1. Steed DL. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers. Diabetic Ulcer Study Group. J Vasc Surg. 1995;21(1):79-78, discussion 79-81.
    1. Embil JM, Papp K, Sibbald G. et al. Recombinant human platelet-derived growth factor-BB (becaplermin) for healing chronic lower extremity diabetic ulcers: an open-label clinical evaluation of efficacy. Wound Repair Regen. 2000;8(3):162–168.
    1. Wieman TJ, Smiell JM, Su Y. et al. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 1998;21(5):822–827.
    1. Margolis DJ, Bartus C, Hoffstad O, Malay S, Berlin JA. Effectiveness of recombinant human platelet-derived growth factor for the treatment of diabetic neuropathic foot ulcers. Wound Repair Regen. 2005;13(6):531–536.
    1. Kanno T, Takahashi T, Tsujisawa T, Ariyoshi W, Nishihara T. Platelet-rich plasma enhances human osteoblast-like cell proliferation and differentiation. J Oral Maxillofac Surg. 2005;63(3):362–369.
    1. Balfour JA, Noble S. Becaplermin. BioDrugs. 1999;11(5):359–364.
    1. Cullinane AB, O’Callaghan P, McDermott K, Keohane C, Cleary PE. Effects of autologous platelet concentrate and serum on retinal wound healing in an animal model. Graefes Arch Clin Exp Ophthalmol. 2002;240(1):35–41.
    1. Govindarajan B, Shah A, Cohen C. et al. Malignant transformation of human cells by constitutive expression of platelet-derived growth factor-BB. J Biol Chem. 2005;280(14):13936–13943.
    1. Update of safety review: Follow-up to the March 27, 2008 communication about the ongoing safety review of Regranex (becaplermin). 6 June 2008. U.S. Food and Drug Administration Center for Drug Evaluation and Research [Internet] [Updated 2008]. [cited 6 May 2008]. Available from: .
    1. Edmonds M, Bates M, Doxford M, Gough A, Foster A. New treatments in ulcer healing and wound infection. Diabetes Metab Res Rev. 2000;16(Suppl 1):S51–S54.

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