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PRP: Do you know what you are injecting?

PRP: Do you know what you are injecting?
Blood is blood. But the way it is treated to produce platelet-rich plasma (PRP) for a variety of indications, including cosmetic treatments, can make a difference in the results of PRP treatment.As consumer demand for PRP, ranging from joint and sexual health to hair restoration and skin rejuvenation, is increasing, competition for the best PRP preparation system intensifies. However, if companies can say what is important for the treatment of PRP, they lack reliable data.

In a recent white paper titled “Platelet Rich Plasma: Be Confident in What You Inject”, the authors suggest that Eclipse PRP (Eclipse) outperforms other commercial methods of isolating PRP.

The document is an independent initiative led by three collaborators, Drs. Jeffrey Rapaport, Neil Sadick and Gordon Sasaki, and funded by Eclipse.

The authors write that it is important that aesthetic physicians and other specialists know that the variations in purity, yield, and composition of PRP resulting from the use of different isolation methods will likely affect the outcome of PRP treatment.

They argue that many books support the clinical benefits of PRP in the range of supraphysiological systems and that it is important to focus on increasing the platelet concentration over baseline, though that “oversold for marketing purposes”.

“The total number of platelets injected, the impurities that the PRP can contain and in particular the ease of use and the predictability of the PRP system are more important than the platelet concentration compared to the initial values”, write the authors of the white paper.

They refer to a study published in February 2011 in the American Journal of Sports Medicine, in which five healthy human beings gave 100 ml of blood, which the researchers treated with three systems of concentration of PRP to produce PRP. They found no significant difference in the average concentrations of platelets, red blood cells, active transforming growth factor β1, or fibrinogen in PRP between the PRP separation systems (which did not include PRP Eclipse). But the researchers noted a significant difference in the efficiency of platelet capture. They conclude that more research is needed to determine if and how these differences are clinically relevant. The authors of the white paper also cite unpublished data, including that of five healthy volunteers, who examined three methods of commercial isolation of PRP: Eclipse PRP, Selphyl (Factor Medical) and Arthrex ( Arthrex). According to the Eclipse report, while treatment with Arthrex resulted in the largest increase in platelet count, 6 times the baseline, Arthex also produced the highest levels of contaminating red and white blood cells.

“PRP Eclipse eliminates the most contaminating cells and causes an increase in the number of platelets by 3.1 x”, according to the newspaper.

The authors suggest that a supraphysiological platelet count of 1.5 to 3 times the baseline may be higher than a level of 5 or more times. But more studies are needed to better understand the optimal concentration of platelets, the total number of platelets and their importance for clinical results, they write.

Another question concerning the PRP which remains unresolved is the merit of using a PRP rich in white blood cells in the clinical environment – in particular for aesthetic treatments. PRP Eclipse eliminates the vast majority of white blood cells, the newspaper said.

The authors also emphasize the importance of using an FDA approved product and that the company that markets it uses the appropriate language for this approval. The use of PRP in aesthetics is considered non-compliant. It is important that clinicians use FDA approved systems for the preparation of PRP and that certain products are not on the FDA list or are authorized only as blood collection tubes and not for preparation and PRP injection to the patient at the point of care, according to the paper. According to the Eclipse website, Eclipse PRP is FDA approved as a Class II medical device. But Eclipse has not always been in line with the FDA’s promotional efforts. In a warning letter, the FDA accused Eclipse of providing false or misleading information on its website in 2015 when it promoted Eclipse PRP for cosmetic dermatology and treatment of hair loss. At the time, the FDA asked Eclipse to immediately stop promoting Eclipse PRP for unapproved uses.

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