V.N. Obolenskiy, D.A. Еrmolova, M.S. Makarov, N.V. Borovkova and L.A. Laberko
City Hospital #13 (Moscow, Russia), Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia
Aim: to study the effectivenes of platelet rich plasma (PRP) for clinical use.
Methods. Blood collected from a peripheral vein of the patients with chronic wounds of various etiologies was usedas a biological material. PRP was obtained by separating blood with the use of BTI equipment*). Whole blood platelets were stained with vital fluorochrome dye for further morpho-functional analysison a fluorescence microscope. Concentration of platelet-derived growth factor (PDGF) in blood serum was determined by enzyme-linked immunosorbent assay (ELISA) using reagents «Qantikine, Human PDGF-BB Immunoassay» and system «Multiskan ascent». Proliferative activity of human fibroblast culture M-22 was assessed in the wells containing different amount of serum PDGF and also using fluorochrome vital dyes.
In a clinical study analysis of the treatment outcomes of 81 patients with chronic wounds (CW) of various etiologies was performed. For the treatment of the 44 patients (experimental group: 17 males, 27 females, the mean age - 56.0±3.1; trophic venous ulcers (TVU) 3, ulcers of combined etiology (CEU) 8, related to diabetic foot syndrome (DFS) 12, scar-trophic ulcer (STU) - 14 and bedsores (BU) - 7, the mean CW area was 90.2±14.1 cm2), we used PRP flat clot therapy starting from phase II of wound healing process. Frequency of dressing changes once in 7 days, which allows patient transfers to outpatient care. For the treatment of the 37 patients (control group: 17 males, 20 females, mean age was 69.5±2.2; TVU-5, CEU-12, DFS-8, STU–5, BU-7; 79.6±12.3 cm2), traditional topical agents were used.
Results. A direct correlation between concentration and morpho-functional parameters of whole blood platelets and concentration of PDGF in the serum has been observed. Degranulation of platelets is associated with the massive release of PDGF. The study finding was that the content of PDGF in one well equal to 150 pg is associated with the maximum gain of proliferative activity of fibroblastswith their viability being preserved; at the higher PDGF concentrations fibroblasts viability decreased and cells death was observed.
In a clinical study 85.4% patients achieved complete CW epithelialization within 46.4±4.3 days (experimental group). In the control group only 11.8% patients achieved wound epithelialization within 3 months. Mean duration of hospital stay was 11.0±2.5 days in the experimental group and 23.1±1.5 days in the control.
Conclusions. These data allow recommending the clinical use of PRP for stimulation of the regenerative processes. *) BTI, Spain