Activation of PRP and Platelet Count
PRP in each group was divided into 3 pieces of 0.2 mL. Twenty microliters of 0.5% Triton X in saline was added to 1 of the 3 and 20 μL of 8.5% calcium glucuronate to another. Triton-X is a kind of detergent that destroys cell membrane and let α-granules discharge nonspecifically. Calcium glucuronate neutralizes the anticoagulant effect of ACD-A while it has no effect to heparin. Platelet count of the 4 groups was performed by using disposable counting chambers.
Measurement of PDGF-BB
The PRP solutions were stored at 22–29°C4 overnight for the delivery to a laboratory (Institute of Applied Technology for Innate Immunity, Kagawa, Japan). PDGF-BB was measured there using Human PDGF-BB immunoassay microplate (R&D systems). Ten microliters of the specimen was taken from each whole blood or PRP solution after mingling, diluted to 190 mL buffer and measured. The rest 190 μL of the samples were centrifuged at 10,000 rpm for 10 minutes, and the supernatants were also measured.
All data are shown in Table 1, and an illustration of the procedure for better understanding is shown in Figure 6. PDGF-BB in the whole blood was 867.7 pg/mL in subject A and 477.8 pg/mL in subject B. The supernatant after the first centrifugation (plasma) contained 1066.6 (ACD-A) and 889.7 (heparin) pg/mL in subject A and 627.9 (ACD-A) and 671.2 (heparin) pg/mL in subject B. The finally processed PRP solutions in subject A contained 30109.4 pg/mL (ACD-A, PGE1+), 12281.5 pg/mL (ACD-A, PGE1−), 9232.1 pg/mL (heparin, PGE1+), and 7341.9 pg/mL (heparin, PGE1−), whereas 21094.9 pg/mL (ACD-A, PGE1+), 7987.2 pg/mL (ACD-A, PGE1−), 6530.8 pg/mL (heparin, PGE1+), and 5104.6 pg/mL (heparin, PGE1−) in subject B. The PRP solutions added by Triton-X in subject A showed the values of 41517.0 pg/mL (ACD-A, PGE1+), 41599.3 pg/mL (ACD-A, PGE1−), 8920.6 pg/mL (heparin, PGE1+), and 7819.8 pg/mL (heparin, PGE1−), whereas 27041.8 pg/mL (ACD-A, PGE1+), 26493.3 pg/mL (ACD-A, PGE1−), 6816.9 pg/mL (heparin, PGE1+), and 5959.4 pg/mL (heparin, PGE1−) in subject B. The PRP solutions added by calcium glucuronate in subject A showed the values of 38535.1 pg/mL (ACD-A, PGE1+), 20972.8 pg/mL (ACD-A, PGE1−), 8681.2 pg/mL (heparin, PGE1+), and 6578.4 pg/mL (heparin, PGE1−), whereas 34732.2 pg/mL (ACD-A, PGE1+), 21437.2 pg/mL (ACD-A, PGE1−), 4702.2 pg/mL (heparin, PGE1+), and 3290.8 pg/mL (heparin, PGE1−) in subject B. The values increased by addition of Triton-X or calcium glucuronate in PRP solutions processed by ACD-A, whereas the values did not increase in heparin-treated ones (Fig. 7).
In comparison of raw PRP solutions and centrifuged supernatants, the values decreased after centrifuge in all ACD-A–treated PRP solutions, whereas the values increased in all heparin-treated ones (Fig. 8). The largest value in nonactivated PRP solutions was obtained in the ACD-A, PGE1+ in both subjects, and the largest value in calcium glucuronate–activated PRP solutions was also in the ACD-A, PGE1+.
Platelet count by counting chambers resulted in 6.4 × 106/μL in ACD-A, PGE1+, 6.4 × 106/μL in ACD-A, PGE1−, 6.4 × 106/μL in heparin, PGE1+, and 6.4 × 106/μL in heparin, PGE1− in subject A, whereas 4.0 × 106/μL in ACD-A, PGE1+, 4.2 × 106/μL in ACD-A, PGE1−, 5.2 × 106/μL in heparin, PGE1+, and 6.0 × 106/μL in heparin, PGE1− in subject B.
Our New Method of Preparing PRP Solution
Our new method of preparing PRP solution has 2 advantages. One is economy, and the other is safety. Preparation of PRP for 1 client for cosmetic purpose usually requires 12 disposable 5-mL syringes (8 for the whole blood and 4 for the second centrifuge), caps, one 3-way cock, and 1 extension tube, which costs about 7 USD totally. They are all medical disposables, and the blood or plasma never goes out of them. So the method is safe and ethical.
Selection of the Anticoagulant
From the data of PDGF-BB, it is obvious that ACD-A is more appropriate than heparin as an anticoagulant for PRP preparation. However, platelet count revealed that the numbers of platelets are almost the same between ACD-A-treated ones and heparin-treated ones. How should this controversial result be interpreted? The authors consider that heparin-treated platelets more easily discharge α-granules, which contains PDGF than ACD-A–treated ones. The data of the change before and after centrifuge of the last processed PRP (raw PRP and supernatant) show that the concentration of PDGF decreases in ACD-A while increases in heparin. It is the clear evidence that platelets are less instable in heparinized plasma against centrifugation.
In fact, the authors had considered that heparin is more proper than ACD-A. Because the latter has low pH (acidic) that causes less painful sensation when injected to the skin. As the low pH can be neutralized by sodium bicarbonate just before injection, the authors admit that ACD-A is superior to heparin as an anticoagulant for preparation of PRP. Moreover, Araki et al5 reported that the plasma finally added to the pellet can be replaced to normal saline and the concentration of PDGF increased 3 times more than original PRP. From the viewpoint of measures to the pain, it is a good idea.
Araki et al5 also reported that PRP processed by EDTA showed higher value of PDGF-BB than by ACD-A although the platelet counts were almost similar. So it is better to adopt EDTA in the laboratory experiments than ACD-A, whereas ACD-A is still appropriate in daily practice in the country where no clinical medication of EDTA is available. It is because there is an ethical problem to use EDTA under such a circumstance.
There are few reports of measurement of growth factors in PRP.6,7 As the concentration of growth factor in PRP solution might not necessarily correlate with the platelet count, the efficacy of PRP treatment is not also ensured by platelet count.
Utility of Platelet Aggregation Inhibitor
Anticoagulants such as ACD-A or heparin never interrupt aggregation of platelets. This point of view has been overlooked in preparing PRP. Aggregated platelets stick to the wall of syringes and do not easily detach from them. As the primary aggregation of platelets is reversible, the platelets come off from the wall and float in the plasma again after several hours. But we cannot wait until then in the daily practice. So the authors suggest using platelet aggregation inhibitor (PGE1). The data also ensure it.
Rotation Speed and Time of Centrifugation
The first centrifugation is aimed to separate RBC from other segments of the whole blood. From this point of view, the rotation speed and time was thought to be easily selected. As RBC is red, visible, and heavy in specific gravity, the best condition must be the lowest and shortest speed and time at which RBC and plasma can be clearly separated visibly. Too much speed and time will let platelets also precipitate and should be avoided. There is a report about the efficiency of platelet yield at various speed of centrifugation.5 230–270g for 10 minutes is reported to be the most efficient for the first centrifugation. Our experiment adopted 704g for 3 minutes from the reason that the shorter the better at daily clinical practice.
From the viewpoint that the second centrifugation is aimed to separate platelets from plasma, the speed and time should be as high and as long as possible. The higher the speed and the longer the time is, the more platelets will precipitate. However, as the centrifuge is revealed to be stimulus for platelets to discharge PDGF, the best speed and time should be studied by measuring PDGF in plasma discharged from platelets. It is a future-related issue.
The Difference among Individuals of PDGF-BB Was Not Clarified in the Study
Further investigation in many individuals is expected. Various commercial kits for preparing PRP are available nowadays, and their main target seems to be cosmetic or rejuvenating field although there are still only a few reports3 about the efficacy for antiaging. On the other hand, there are also many exciting reports8 that PRP accelerates wound healing process. Using the method in the study, researchers could try much more experiments without consuming expensive commercial kits.
Our new method is useful and ethical in clinical practice. The use of ACD-A and PGE1 is recommended for preparing PRP with dense PDGF-BB.
1. Redaelli A, Romano D, Marcianó A. Face and neck revitalization with platelet-rich plasma (PRP): clinical outcome in a series of 23 consecutively treated patients. J Drugs Dermatol. 2010;9:466–472
2. Kim DH, Je YJ, Kim CD, et al. Can platelet-rich plasma be used for skin rejuvenation? Evaluation of effects of platelet-rich plasma on human dermal fibroblast. Ann Dermatol. 2011;23:424–431
3. Cho JM, Lee YH, Baek RM, et al. Effect of platelet-rich plasma on ultraviolet b-induced skin wrinkles in nude mice. J Plast Reconstr Aesthet Surg. 2011;64:e31–e39
4. Pietersz RN, Loos JA, Reesink HW. Survival in vivo of platelets stored for 48 hours in the buffycoat at 4 degrees C compared to platelet rich plasma stored at 22 degrees C. Blut. 1987;54:201–206
5. Araki J, Jona M, Eto H, et al. Optimized preparation method of platelet-concentrated plasma and noncoagulating platelet-derived factor concentrates: maximization of platelet concentration and removal of fibrinogen. Tissue Eng Part C Methods. 2012;18:176–185
6. Lee JW, Kwon OH, Kim TK, et al. Platelet-rich plasma: quantitative assessment of growth factor levels and comparative analysis of activated and inactivated groups. Arch Plast Surg. 2013;40:530–535
7. Giraldo CE, López C, Álvarez ME, et al. Effects of the breed, sex and age on cellular content and growth factor release from equine pure-platelet rich plasma and pure-platelet rich gel. BMC Vet Res. 2013;9:29
© 2014 American Society of Plastic Surgeons
8. Marck RE, Middelkoop E, Breederveld RS. Considerations on the use of platelet-rich plasma, specifically for burn treatment. J Burn Care Res.. 2014;35:219–227