PRP and Amniotic fluid are both used in the treatment procedures of regenerative medicine which are becoming quite popular during the recent times. However, the underlying process imparting the healing properties is still poorly understood. The research so far suggests that the trophic factors present in significant concentrations in these fluids cause progenitor cells (parent cells) to proliferate and bring about the process of regeneration and healing. [1] [2] These cells are usually dormant or ‘asleep’, the presence of growth factors in PRP and Amnion derived fluid causes their growth and multiplication thus stimulating healing mechanisms.
Platelet-Rich Plasma (PRP):
PRP is growth factor rich fluid derived from the patient’s own blood. After the blood is withdrawn, it is spun into a centrifuge to extract a desired fraction which is then activated prior to the use by adding thrombin and calcium that facilitates the release of desirable growth factors necessary for healing [3]. Multiple different types of procedures are used to extract and activate PRP, the fraction of growth factors may vary in different samples even if they are acquired from the same patient [4]. Also, because the blood should be freshly withdrawn and processed prior to the procedure, the overall output is decreased in a clinical setting.
PRP is currently being used in a number of clinical therapies. It brings about its positive effects by the suppression of inflammatory process, promotion of angiogenesis (formation of new blood vessels), and anti-apoptotic (inhibiting cell death) functions [5]. In clinical settings, it is effectively being used for a wide array of clinical conditions including surgical wounds, diabetics wounds, muscular and skeletal injuries [6] [7] [8]. Other than these, it is also used in a variety of aesthetic procedures promoting healing and imparting a younger look. It has been reported to bring about positive effects without any noticeable side effects experienced by the patient.
However, there are certain limitations for the use of PRP, the most important being the lack of consistency in every next sample which affects the clinical results achieved after each session. Also, the concentration of growth factors decreases with the age of the patient making the sample less useful.
Amniotic Fluid/Amnion-Derived Fluid:
Amniotic fluid is derived from the innermost layer of placenta called the amnion. The amniotic layer is mechanically separated from the placenta once it is acquired from a donor. It is then further processed to isolated the cells which are then cultured in the lab. As these cells grow, they produce similar growth factors as those produced in the uterus during pregnancy. The fluid thus derived is collected and used for the treatment of a number of clinical conditions similar to PRP. Similar to PRP, amniotic fluid inhibits inflammation and promotes growth [9]. However, unlike PRP, amnion derived fluid is available as ready to use product which does not require any further processing prior to the treatment. Both PRP as well as amnion derived fluid have a low potential to trigger any allergic reactions which renders them both safe treatment options [10].
The Pros and Cons:
The differences and the pros and cons of both PRP and Amnion derived fluid should be considered to find out the best treatment option for a clinical condition.
Compared to PRP, the growth factor profile of amnion derived fluid is pretty consistent and does not vary from patient to patient or more accurately, sample to sample. Also, because amniotic fluid is available as a ready-made off the shelf product, the patient does not have to be available throughout the procedure which saves time for both the patient and the medical practitioner. Unlike, PRP the quality of sample does not vary depending upon the technique used or the patient the blood is derived from making the clinical results more consistent than the PRP. Other than these patient oriented benefits, several advantages exist for practitioners and clinicians such as reduced need for installing specified equipment for the production of activated and effective PRP fluid.
Despite these setbacks, PRP still stands as the king of regenerative medicine and its advantageous effects cannot be denied. It is also cost-effective and the source is readily available i-e the patient himself. To find out the best treatment for yourself, there are a number of factors that need to considered starting from the clinical condition you need it for, moving on to the accessibility and your budget. It is hard to rule out the single best treatment in regenerative medicine as the positive results have been shown by both the treatment procedures.
The combined use of PRP and amniotic fluid is also being considered to achieve amplified results. However, further studies are required to confirm its efficacy.
References:
[1] Hofer, Heidi R, Tuan RS (2016) Secreted trophic factors of mesenchymal stem cells support neurovascular and musculoskeletal therapies. Stem Cell Research and Therapy 7: 131.
[2] Vokurka J (2016) Concentrations of growth factors in platelet-rich plasma and platelet-rich fibrin in a rabbit model. Veterinarni Medicina 61: 567-570.
[3] Eppley, Barry L, Woodell JE, Higgins J (2004) Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plastic and Reconstructive Surgery 114: 1502-1508.
[4] Eppley, Barry L, Woodell JE, Higgins J (2004) Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plastic and Reconstructive Surgery 114: 1502-1508.
[5] Eppley, Barry L, Woodell JE, Higgins J (2004) Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plastic and Reconstructive Surgery 114: 1502-1508.
[6] Picard, Frederic (2015) The growing evidence for the use of platelet-rich plasma on diabetic chronic wounds: A review and a proposal for a new standard care. Wound Repair and Regeneration 23: 638-643.
[7] Sampson, Steven, Gerhardt M, Mandelbaum B (2008) Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Current Reviews in Musculoskeletal Medicine 1: 165-174.
[8] Taylor, Drew W (2011) A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clinical Journal of Sport Medicine 21: 344-352.
[9] Sartore, Saverio (2005) Amniotic mesenchymal cells autotransplanted in a porcine model of cardiac ischemia do not differentiate to cardiogenic phenotypes. European Journal of Cardio-Thoracic Surgery 28: 677-684.
[10] Vokurka J (2016) Concentrations of growth factors in platelet-rich plasma and platelet-rich fibrin in a rabbit model. Veterinarni Medicina 61: 567-570.
