The History of Platelet Rich Plasma (PRP)

About Platelet Rich Plasma (PRP)

Platelet-rich plasma (PRP) has comparable therapeutic value to stem cells and is currently one of the most promising therapeutic agents in regenerative medicine. It is increasingly used in different medical fields, including cosmetic dermatology, orthopedics, sports medicine and surgery.

In 1842, structures other than red and white blood cells were discovered in blood, which surprised his contemporaries. Julius Bizozero was the first to name the new platelet structure “le piastrine del sangue” – platelets. In 1882, he described the role of platelets in coagulation in vitro and their involvement in the etiology of thrombosis in vivo. He also found that blood vessel walls inhibit platelet adhesion. Wright made further progress in the development of regenerative therapy techniques with his discovery of macrokaryocytes, which are precursors to platelets. In the early 1940s, clinicians used embryonic “extracts” composed of growth factors and cytokines to promote wound healing. Rapid and efficient wound healing is critical to the success of surgical procedures. Therefore, Eugen Cronkite et al. introduced a combination of thrombin and fibrin in skin grafts. By using the above components, a firm and stable attachment of the flap is ensured, which plays an important role in this type of surgery.

In the early 20th century, clinicians recognized the urgent need to introduce platelet transfusions to treat thrombocytopenia. This has led to improvements in platelet concentrate preparation techniques. Supplementation with platelet concentrates can prevent bleeding in patients. At the time, clinicians and laboratory hematologists attempted to prepare platelet concentrates for transfusions. Methods to obtain concentrates have developed rapidly and have improved significantly, as isolated plates quickly lose their viability and must therefore be stored at 4 °C and used within 24 h.

Materials and Methods

In the 1920s, citrate was used as an anticoagulant to obtain platelet concentrates. Progress in the preparation of platelet concentrates accelerated in the 1950s and 1960s when flexible plastic blood containers were created. The term “platelet-rich plasma” was first used by Kingsley et al. in 1954 to refer to standard platelet concentrates used for blood transfusions. The first blood bank PRP formulations appeared in the 1960s and became popular in the 1970s. In the late 1950s and 1960s, “EDTA platelet packs” were used. The set contains a plastic bag with EDTA blood that allows platelets to be concentrated by centrifugation, which remain suspended in a small amount of plasma after surgery.

Result

It is speculated that growth factors (GFs) are further compounds of PRP that are secreted from platelets and are involved in its action. This hypothesis was confirmed in the 1980s. It turns out that platelets release bioactive molecules (GFs) to repair damaged tissue, such as skin ulcers. To date, a few studies exploring this issue have been conducted. One of the most studied subjects in this field is the combination of PRP and hyaluronic acid. Epidermal growth factor (EGF) was discovered by Cohen in 1962. Subsequent GFs were platelet-derived growth factor (PDGF) in 1974 and vascular endothelial growth factor (VEGF) in 1989.

Overall, advances in medicine have also led to rapid advances in platelet applications. In 1972, Matras first used platelets as a sealant to establish blood homeostasis during surgery. Furthermore, in 1975, Oon and Hobbs were the first scientists to use PRP in reconstructive therapy. In 1987, Ferrari et al first used platelet-rich plasma as an autologous source of blood transfusion in cardiac surgery, thereby reducing intraoperative blood loss, blood disorders of the peripheral pulmonary circulation, and subsequent use of blood products.

In 1986, Knighton et al. were the first scientists to describe a platelet enrichment protocol and named it autologous platelet-derived wound healing factor (PDWHF). Since the establishment of the protocol, the technique has been increasingly used in aesthetic medicine. PRP has been used in regenerative medicine since the late 1980s.

In addition to general surgery and cardiac surgery, maxillofacial surgery was another area where PRP became popular in the early 1990s. PRP was used to improve graft bonding in mandibular reconstruction. PRP has also begun to be implemented in dentistry and has been used since the late 1990s to improve the bonding of dental implants and to promote bone regeneration. In addition, fibrin glue was a well-known related material introduced at the time. The use of PRP in dentistry was further developed with the invention of platelet-rich fibrin (PRF), a platelet concentrate that does not require the addition of anticoagulants, by Choukroun.

PRF became increasingly popular in the early 2000s, with an increasing number of applications in dental procedures, including regeneration of hyperplastic gingival tissue and periodontal defects, palatal wound closure, gingival recession treatment, and extraction sleeves.

Discuss

Anitua in 1999 described the use of PRP to promote bone regeneration during plasma exchange. After observing the beneficial effects of the treatment, the scientists investigated the phenomenon further. His subsequent papers reported the effects of this blood on chronic skin ulcers, dental implants, tendon healing, and orthopaedic sports injuries. Several drugs that activate PRP, such as calcium chloride and bovine thrombin, have been used since 2000.

Due to its excellent properties, PRP is used in orthopaedics. The results of the first in-depth study of the effects of growth factors on human tendon tissue were published in 2005. PRP therapy is currently used to treat degenerative diseases and to promote the healing of tendons, ligaments, muscles and cartilage. Research suggests that the continued popularity of the procedure in orthopaedics may also be related to the frequent use of PRP by sports stars. In 2009, an experimental animal study was published that confirmed the hypothesis that PRP concentrates improve muscle tissue healing. The underlying mechanism of PRP action in the skin is currently the subject of intensive scientific research.

PRP has been used successfully in cosmetic dermatology since 2010 or earlier. After injecting PRP, skin looks younger and hydration, flexibility and color are significantly improved. PRP is also used to improve hair growth. There are two types of PRP currently used for hair growth treatment – inactive platelet-rich plasma (A-PRP) and active platelet-rich plasma (AA-PRP). However, Gentile et al. demonstrated that hair density and hair count parameters can be improved by injecting A-PRP. Additionally, it has been proven that using PRP treatment prior to hair transplantation can enhance hair growth and hair density. In addition, in 2009, studies showed that the use of a mixture of PRP and fat can improve fat graft acceptance and survival, which may enhance plastic surgery outcomes.

The latest findings from Cosmetic Dermatology show that a combination of PRP and CO2 laser therapy can reduce acne scars more significantly. Likewise, PRP and microneedling resulted in more organized collagen bundles in the skin than PRP alone. The history of PRP is not short, and the findings related to this blood component are significant. Clinicians and scientists are actively searching for new treatment modalities. As a means, PRP is used in many fields of medicine, including gynecology, urology, and ophthalmology.

The history of PRP is at least 70 years old. Therefore, the method is well established and can be widely used in medicine.

（The contents of this article are reprinted, and we do not provide any express or implied guarantee for the accuracy, reliability or completeness of the contents contained in this article, and are not responsible for the opinions of this article, please understand.）