– What You and Your Doctor Need to Know, Part 1
By Dr. Glenn Wilcox, DOM
Regenerative medicine is an exciting, recently developed branch of medicine. It’s been part of my practice for two decades. As with any innovation in medicine, lack of knowledge clouds the competent providing of regenerative medical therapies and undermines the remarkable benefits that are possible. Let’s explore together.
Regenerative Medicine: Regenerative medicine may be defined as the process of replacing or regenerating human cells, tissues or organs to restore, establish or optimize normal function and structure. This may be accomplished by replacing damaged cells and tissues, and by stimulating the body’s own repair mechanisms to heal and revive tissues and organs. The term was first used in 1992. Since then, a number of innovative, therapeutic tools are providing results.
The Therapeutic Tools of Regenerative Medicine: The most commonly recognized therapeutic tool in regenerative medicine is the injection of what many doctors refer to as stem cells. However, these “stem cell” injections contain unverifiable numbers of stem cells, and in my candid opinion, the benefits have often not lived up to expectations. More recently, the use of exosomes in regenerative medicine has gained attention. Many scientists now believe exosomes are the next evolution in stem cell medical technology. Exosomes are nano-sized vesicles containing biological signaling molecules that mediate cell to cell signaling. Finally, perhaps the simplest, safest, least expensive and most effective tool currently being used in regenerative medicine is PRP (Platelet Rich Plasma).
PRP – Platelet Rich Plasma: PRP is a therapeutic product isolated from the blood of the person being treated. (Stay with me here. The following is important for understanding PRP, but it gets a bit chewy. If all the the detail about blood is not for you, skip to the next paragraph for the exciting information!) Blood contains red and white blood cells suspended in plasma. Plasma is the blood fluid that also contains blood clotting agents such as platelets and fibrinogen. When blood is spun in a centrifuge, the red blood cells are heaviest and sink to the bottom with the white blood cells above them. The clear pale-yellow fluid above those cells is either serum or plasm. If nothing is added to the blood before it is spun, the platelets and fibrinogen coagulate with the red and white blood cells below and on top of that is serum. Therefore, serum is the clear, pale yellow liquid part of the blood after coagulation that contains no clotting factors or blood cells. Serum does contain many important substances such as glucose, vitamins, electrolytes, hormones, antibodies, other regulatory proteins, and more. However, if an anticoagulant such as heparin or sodium citrate is added to the blood when it is collected, the blood does not coagulate when it is spun, but the layers are created – red blood cells on the bottom, then white blood cells with the plasma above that. In that plasma are platelets that have not coagulated. If one draws off that plasma and spins it again, the platelets, which are heavier, sink to the bottom of the plasma. The Platelet Poor Plasma (PPP) on top can be drawn off this plasma and what is left at the bottom is PRP – Platelet Rich Plasma!
Why Are Platelets Important? Now it gets exciting! Platelets contain growth factors. When you are cut or injured, platelets move to the area to help stop bleeding. The platelets also release growth factors to aid in healing the injury. Doctors can make use of these growth factors to help regenerate your tissues in many areas of your body. First, blood is drawn from your vein and the PRP is harvested. This PRP contains a much higher than normal concentration platelets. Calcium is added to the PRP which causes the concentrated platelets to immediately release their growth factors. This fluid is then injected into or applied on an area that has been damaged or has degenerated and the growth factors help activate regeneration of the tissues. The PRP also attracts your own stem cells to that area!
What Can Be Treated with PRP? Here’s a good example. Perhaps you have a joint problem due to a partially torn tendon or ligament. Maybe the ligament is stretched and lax from an old injury and cannot maintain the stability of the joint. The cartilage may have been slightly torn or has degenerated. The PRP injection can help stimulate regeneration of those tissues resulting in reduced pain, greater joint mobility and restored function. PRP can be injected into the scalp to regenerate hair. The face can be treated by first micro-needling the skin (a virtually painless procedure) after which the PRP is applied topically and absorbed. This stimulates collagen production in your facial skin. You look younger! PRP can help regenerate male and female sexual organs. This can help with erectile dysfunction, lack of pleasurable sensation, thinning vaginal tissues and even urinary incontinence in women. Part of the benefit of PRP treatment of the sexual organs is stimulation of angiogenesis, the process by which new blood vessels take shape from existing blood vessels. Exciting!
Not All PRP is Created Equal: Let the buyer beware! This includes your doctor. Not all PRP is as concentrated or pure as it needs to be for effectiveness. There are many PRP devices available. Each sales rep will proclaim their device is the best. Very, very few produce PRP that is truly therapeutically effective. One of my mentors, Lisbeth Roy, D.O., did a study of all PRP devices and found that only one was capable of concentrating enough platelets for the PRP to be effective, while allowing the doctor to choose therapeutically important variations in the purity of the PRP. That device is the EmCyte Executive Series Centrifuge II. That’s the device I have always used!
There are two techniques used to obtain PRP – closed and open. The EmCyte system I use employs the closed technique in which the PRP product is not exposed to the environment. This is highly recommended to minimize the potential for contamination. With the open technique, the PRP product is exposed to the environment of the working area. This must be done in an appropriate clean room or “glove box” to guarantee that the product is not contaminated during handling. Real knowledge and skill are required to do this properly.
The clinical definition of PRP developed by Dr. Robert Marx after extensive studies, is it must contain at least one million platelets per microliter of PRP. That number may need to be higher for injecting spinal discs. Since the normal average number of platelets in human blood varies from 100,000 to 350,000 per microliter, extracting PRP from blood will vary with each person. Doing a blood test to count platelets prior to proceeding with PRP therapy is essential. Studies show that PRP containing 500,000 platelets per microliter performs no better than PPP (Platelet Poor Plasma). The math is simple. For example, if you have a low normal platelet count of 100,000 per microliter, your doctor must have a device or a technique that concentrates the platelets at least 10 times more than baseline for the PRP to be effective. Unfortunately, most PRP devices achieve a concentration of PRP that is only two or maybe five times the baseline platelet concentration. PRP prepared with such a device would not be effective for you given your low normal platelet count. The good news is the EmCyte Executive Series Centrifuge II closed system, that I use, will work for you.
The Studies: Unfortunately, studies on the effectiveness of PRP therapy have been inconsistent. As a result, conventional medical doctors have not embraced this valuable and effective treatment. In my opinion, the obvious reasons for this variation in outcomes are simple. First, a clear definition of what is an appropriate concentration of platelets has not been agreed upon. Second, there has not been an agreement about when it is appropriate to use pure PRP without inclusion of small amounts red and white blood cells, and when it might be more effective to use PRP with small amounts of specific blood cells included. Finally, the studies have used a variety of devices and techniques to harvest the PRP resulting in unknown variations in platelet concentrations and purity. It’s time to bring scientific rigor into the studies!
Conclusion: PRP therapy is a powerful and effective tool with great potential in regenerative medicine when properly performed. In my next article, I’ll continue our exploration of regenerative medicine and explain more about stem cells and exosomes.