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PRP therapy as an alternative method in the practice of a trich

  • Today, PRP therapy is on everyone's lips. Many questions are asked by patients who find information on the Internet. Colleagues are also interested, asking: what is this method? What opportunities does it have? Is it worth doing this in trichology?

    We will try to summarize the available information about PRP - therapy, once again concretize the term "PRP - therapy", why it was called that way, what its capabilities are used in medicine, and how we can use it in our trichological practice.

    Today, the issues of research and use of autologous products are relevant, since this makes it possible to control the process of tissue regeneration. Until recently, these studies were more of an episodic, local nature. They have not been widely used in clinical practice.

    History

    PRP - therapy is one of the autologous products used in the treatment of a number of diseases. Surgeons were the first to use enriched plasma in their practice. Then research and experience of application appeared among maxillofacial surgeons. Orthopedic work was carried out using this method. Further, this technique began to be used in the rehabilitation of athletes in cases of injury.

    PRP - therapy has gained popularity in this direction, because thanks to this treatment regimen, the regeneration of injured muscles, ligaments and tendons was much more successful. Over the past few years, PRP therapy has become of interest to doctors of other specialties, in particular, cosmetologists.

    PRP (platelet-rich plasma) - platelet-rich plasma. In whole blood, the average number of platelet cells is 150,000-300,000 per microliter of plasma. So, in rich plasma, the number of platelet cells can be more than 1,000,000 per 1 microliter of plasma.

     

    Why platelets?

    Platelets contain growth factors The main target cells for these factors are blood vessel cells, fibroblasts, and mesenchymal stem cells. The main functions they perform are differentiation, cell growth, synthesis, etc. We look at the table.

     

     

    Factor

    Target

    Functions

    PD-EGF

    Blood vessel cells, outer skin cells, fibroblasts, and many other cell types

    Cell growth, recruitment, differentiation, skin wound closure, cytokine secretion

    PDGF A + B

    Fibroblasts, smooth muscle cells, chondrocytes, osteoblasts, mesenchymal stem cells

    Strong cell growth, recruitment, blood vessel growth, granulation, secretion of growth factors, collagen and bone matrix formation involving bone morphogenetic proteins (BMP)

    TGF-β1

    Blood vessel tissue, outer skin cells, fibroblasts, monocytes, TGF class including BMP, osteoblasts - highest level of TGF-βr

    Blood vessels (±, collagen synthesis, growth inhibition, apoptosis, differentiation, activation

    IGF-I, II

    Bone, blood vessels, skin, and other tissues; fibroblasts

    Cell growth, differentiation, recruitment, collagen synthesis with the participation of PDGF

    VEGF, ECGF

    Blood vessel cells

    Cell growth, migration, new blood vessel growth, antiapoptosis

    bFGF

    Blood vessels, smooth muscle, skin, fibroblasts, and other cell types

    Cell growth, cell migration, blood vessel growth

    PD-EGF - epidermal platelet growth factor, PDGF - platelet growth factor, BMP - bone morphogenetic protein, TGF - transforming growth factor, IGF - insulin-like growth factor, VEGF - vascular endothelial growth factor, ECGF - endothelial cell growth factor, bFGF - basic fibroblast growth factor.

     

    In addition to growth factors, platelets also contain a large number of other active cytokines, which, in fact, are not growth factors, but play a very important role in the healing of damage.

    How to prepare platelet-rich plasma

    Venous blood is drawn from the patient immediately before the procedure, which is placed in a container with an anticoagulant. After that, the blood is centrifuged. As a result of spinning on the centrifuge, the detachment of the shaped elements from the plasma occurs. Since red blood cells are heavier cells, they settle down as a red sediment. Platelets - cells are slightly smaller and lighter than erythrocytes, so they remain at the border of the layers. At the same time, at the very top of the platelets, the smallest number. This layer is called PPP (platelet poor lasma) - platelet-poor plasma. If we use a separating gel, some techniques also offer such a set of drugs, then platelets remain in the upper part of the plasma. Thus, a more diffuse distribution of platelets is carried out, there is no clear stratification and difference in concentration.

    Anticoagulants used in receiving PRP

    Heparin, EDTA - irreversibly inhibit the ability of platelets to aggregate.

    Sodium citrate, ACD-A - in contrast to the anticoagulants mentioned above, inhibit platelet aggregation reversibly, without damaging the cell membrane.

     

     

    Platelet count in PRP

    The situation is considered on the example of one of the patients. The initial platelet count was not large - 190,000 per microliter of plasma. After the first centrifugation using a prp tube and a separating gel, a platelet count of 2-2.5 times the initial value remained in the upper part of the tube. If we do not use a separating gel, there are 7.9 times more platelets in the lower plasma layer. It turned out that some part of the platelets also remains in PPP.

    The upper part of the red blood cell layer contains the so-called leukocyte layer, because white blood cells are also lighter than red blood cells. They found out that this leukocyte layer also contains a certain amount of platelets. And the developers of the method thought: 

    - If we want to get concentrated PRP, then why do we need to lose this precious amount of cells.

    It turned out that if you drop the main erythrocyte mass, and, leaving a small amount of erythrocytes with leukocytes and platelets, spin it a second time in a centrifuge, then the number of platelets in the plasma increases even more.

    - What will happen if you activate the process of clotting in plasma? Will it increase the concentration of growth factors and cytokines in PRP?

    To solve this problem, experiments were carried out with the addition of calcium ions or autologous thrombin (different methods suggest different ways of activating plasma). It was decided to calculate the number of growth factors in plasma in case of activation of coagulation processes.

    It was found that the level of some growth factors increases almost 140 times.

    There were also attempts to activate the poor plasma, because there is also a part of platelets there. It turned out that when the poor plasma is activated, the number of growth factors in the plasma also increases several times.

     

     

     

    How do growth factors affect cell proliferation?

    In an in vitro experiment, human skin stem cells and fibroblasts were treated with growth factors from enriched plasma. The data obtained showed that the proliferation of stem cells and fibroblasts was markedly increased in the presence of active PRP.

     

    conclusions

    1. When centrifuged, the number of platelets is much higher than in whole blood.

    How much more depends on the technique used to make the plasma.

    2. Plasma activation leads to an increase in the quantitative content of growth factors in it.

    3. The addition of growth factors from PRP in vitro enhanced the proliferation of stem cells and fibroblasts.

     

    PRP application

    Recently, in medicine, in addition to the surgical direction, PRP began to be used in: ophthalmology, dentistry and veterinary medicine. In addition, there was such a direction as the treatment of pain with high concentrations of PRP. The PRP method began to be used in aesthetic medicine as well.

     

    World manufacturers of PRP cooking sets:

    We will briefly introduce the countries that are manufacturers of disposable kits (whales) for preparing active plasma.

    - Italia

    - South Korea 

    - Israel

    - Japan

    - South Africa

    - Hong Kong

    - USA - manufactures separate kits for human treatment and special kits for veterinary medicine

    - Indonesia

    - France.

     

    PRP in trichology

    What can we expect from PRP - therapy in the treatment of alopecia? Our Italian colleagues have used PRP in patients diagnosed with AHA, with varying degrees of Hamilton-Norwood. At their institute, they were engaged in autotransplantation of hair and a couple of years ago they became interested in PRP - therapy. They had more than 80 patients under observation who underwent this procedure and about 60 of them had a follow-up observation for 2 years, which showed that in most cases there was no regression (as with the use of minoxidil).

    The Americans have shown the experience of treating PRP patients diagnosed with alopecia areata. They got positive experiences. After PRP-therapy, overgrowth of the foci of alopecia occurred within a year.

    The method of combining transplant and PRP was also used. Since the anterior marginal hairline of the frontal part is very poorly amenable to external therapy, it is proposed to do hair autotransplantation here, and to do PRP therapy on the parietal region, where there is hair thinning. The effectiveness of the method satisfies both the doctor and the patient. With this method, the patient significantly saves his finances.

    However, 25% of patients after applying PRP did not see the result "in the mirror" (only macro photography was used to assess the effectiveness). The remaining 75% of patients had a clinically positive result. In my opinion, if they had done trichoscopy and trichogram, and not just macro photography, perhaps these 25% of patients would have found some changes that are not visible “in the mirror”. 

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