Platelet Rich Plasma-Can you get a Better Result through Higher Platelet Concentration?

by Chris Centeno, MD /

Receive a Regenexx® Patient Info Packet by email and learn why it's a superior regenerative solution.

I’ve blogged before on the problems with bedside machine made PRP-namely too much blood contamination. Another issue is platelet concentration. Some PRP machine makers tout their ability to get platelet concentrations as high as 11X over baseline, while others say that too many platelets that can cause cells to be inhibited. Since the goal of all PRP is to stimulate the damaged area’s natural cells toward repair, inhibited cells could be a bad thing. I have placed a graph by Kevy et al below and added a bar on top so you can easily see the platelet concentration over baseline (assumes a normal platelet count is 300 exp 3/microliter). Note that as the platelet concentration gets to about 5X (about 5 times as many platelets per volume as the average person has in their blood), the proliferation effect on these cells maxes out (the height of the bar is about at it’s highest). So based on this data put out by Harvest (a machine maker), it would seem that it’s just not worth concentrating platelets beyond 5X (which is curiously right about where their machine concentrates). When I first saw this slide in a lecture, I was confused, as the cell type they were trying to stimulate was “Human Umbilical Vein Endothelial Cells”. Huh? When PRP is used to treat orthopedic injuries, we never try to get cells lining the blood vessels of a baby’s umbilical cord to grow! As a result, I concluded that this experiment had little “generalizability” to how most physicians use PRP. In addition, knowing that the Harvest machine (like many others) has a serious blood contamination problem and knowing how excessive blood in mesenchymal stem cell culture can cause problems for the stem cells, I wondered what would happen if we ran the right experiment rather than the wrong one.

kevy prp concentration cell inhibition graph

The first change needed for the “right” experiment was to replace the baby vein cells with adult mesenchymal stem cells (the type most responsible for orthopedic tissue repair and already located in all of these tissues). The second modification was to get rid of the bloody machine made PRP and use our SCP procedure (which has no blood contamination, since it’s custom made for each patient rather than mass manufactured in a machine). Finally, we needed to see how the stem cells responded when stimulated by platelets from different age groups, as the amount of growth factors in platelets declines with age. The graph below is the result of that “right” experiment rerun by our advanced Colorado lab. Note that for all patient groups (patients in their 30’s, 40’s, and 50’s), a higher concentration of bloodless platelet rich plasma stimulates more orthopedic stem cell growth. This is all the way up to 20X! In addition, look at the differences in the amount of stimulation between 5, 10, 15, and 20X for the “50’s” patients. Concentrating in this age group makes a huge difference. Why? I suspect we’re seeing what we have seen before in other data sets that we’ve run-that there’s a saturation point. This means that when you’re young, you have a lot of growth factors in your platelets, so at some point concentrating them too much gets beyond a limit where your cells just cant respond anymore. As an example, if you add a little sugar to your drink, it’s a little sweet. However, you can also get to a point where adding more sugar on top of a lot of sugar isn’t going to make the drink much sweeter. In addition, remember that for growth factors there are two parts of the equation. On the one side you have the amount of growth factors coming from platelets, while on the other there are receptors that these growth factors stimulate on the damaged tissue or local stem cells. The body frequently adjusts the number of receptors on cells up or down based on what’s available to trigger those receptors. Having less growth factors circulating around them, older stem cells may express more receptors for these platelet growth factors on their surfaces. Having more receptors means they can respond better to less stimulus coming from older and growth factor depleted platelets. Flooding those older cells with lots of platelet growth factors may therefore give an even better proliferation response, as there are more receptors for the GFs to stimulate. Keeping with our sugary drink analogy, many people who eat very little sugar find that eating food that is usually sweetened is “too sweet”. The reason is the same, if you eat less sugar, your body builds more sugar receptors, so what most people would think of as “normal” you think is “too sweet”. The upshot? Concentrating bloodless and custom made PRP to high levels in older patients is likely well worth the effort. While the best bedside machines producing mass manufactured PRP can only get to about 11X over baseline, we can concentrate platelets in our lab to 20X (as can any of our network sites). So if you’re middle aged, you may want to take advantage of this additional concentration to maximally stimulate your stem cells for repair!

bloodless platelet rich plasma

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.