One of the reasons I blog is to make sure that almost every possible question a patient could ask is covered by a detailed answer. This week a patient commented on one of my old YouTube videos on platelet lysate, not fully understanding how it was different than PRP and what it’s used to treat. Hence, here’s a new video (above) and a blog that better describes the differences between PRP and platelet lysate.
What Are Platelets? Why Are They Like a Barista?
Platelets are little fragments of cells that come from a huge cell in the bone marrow called a megakaryocyte. They help your blood clot, but they’re also responsible for orchestrating healing. They do this last part by releasing growth factors over about a week.
Growth factors are like espresso shots for the local repair cells. Or maybe better said, they’re like Starbucks’ espresso shots if you wrote something about the job to be done on the side of the cup. Take for example one of those growth factors called FGF for Fibroblast Growth Factor. If we stay with that Starbucks analogy and the goal is to heal a tendon injury, the platelet is the barista who calls out the name of a mesenchymal stem cell (MSC) and serves up a triple espresso shot in a cup with instructions on the side. The MSC then downs the espresso shot and reads the side of the cup which says “Make more tendon cells”. The MSC is now energized and quickly goes about recruiting his friends (other cells) to repair the tendon.
Platelet Rich Plasma
So if platelets can help repair injured tissue, why not concentrate platelets and deliver this to tissues that haven’t naturally healed? This is the goal of platelet-rich plasma, also called PRP. However, there are many different types of PRP, so let’s explore.
The first thing to know about PRP is that when doctors use it, they often sacrifice maximum customizability for their own convenience. Meaning, they purchase a simple machine that can automatically make only one type of PRP despite the fact that their patients would likely do better if the doctor could easily customize the PRP to the specific needs of the patient.
Take for example the matter of platelet concentration in PRP. We and many others have documented in middle-aged and older patients that higher platelet concentrations are likely better. For example, as we get older, the amount of growth factors in each platelet goes down. Because of that, the sensitivity of cells to platelet released growth factors goes up to compensate.
So if you’re treating a 22-year-old professional athlete or high school age patient, you really don’t need to concentrate PRP very much as their platelets are loaded with growth factors. In addition, their cells see high concentrations of growth factors every day, so they are easily stimulated to the point of saturation, meaning throwing more growth factors at them won’t stimulate them anymore. This is like the Starbucks addict who gets used to having 5 quad espresso shots per day. A single cup of coffee isn’t going to get him going. However, on the other end of that spectrum is a 55-year-old active guy or gal who wants to stay active as they age. Here the growth factors are far lower per platelet and their cells are far more sensitive to those growth factors. Hence, concentrating their platelets to high levels is key.
How do I know this is true? We researched it in our advanced lab and published the paper below on tendon repair, age, and platelet concentration (click on the image to read the full manuscript):
So while this research shows that a very high concentration of platelets works better to heal older tendons, the problem is that there are no bedside machines that can easily get to these levels on a reliable basis.
In addition, there are other ways PRP can be made that would be better for some patients than others. For example, recent research has demonstrated that for many circumstances, you don’t want red or white blood cells in your PRP. That’s called LP-PRP (Leukocyte Poor-PRP). However, in specific cases like treating a disc, Leukocyte-Rich (LR-PRP) may reduce the rare side effect rate of discitis. However, almost all machines doctors can buy only make one or the other. This why Regenexx providers have left the training wheels of little bedside machines behind and have graduated to a flexible lab platform. Let me explain.
The Flexible Lab Platform: A Ferrari vs a Tricycle
If the ability of the bedside machines 99% of doctors use is quite limited, then the opposite approach is a Flexible Lab Platform. This is what Regenexx providers use because it has unlimited flexibility. Need high dose PRP with very few red or white blood cells, no problem! Need a lower dose, yep we can do that. Need to add the white blood cells back in to fight infection? Got that covered too. Watch my video below to understand more about what that looks like for Regenexx providers and how it dramatically changes the way they can treat patients and expands what they can do to help:
What Is Platelet Lysate?
If you have a flexible lab platform, you can make platelet lysate. What is platelet lysate? First, watch the video at the top of the page.
Platelet lysate is from the Latin word “lysis” which means to break open. So it’s platelets that have been broken open by one or more means. Why do that? Platelets contain alpha granules, which are packets where their growth factors live. If you break open a platelet, those packets get dumped out with their load of growth factors all at once rather than slowly released over a week. Hence, with a platelet lysate (PL) you can get a bigger hit of growth factors all at once than you could if you used PRP. Sort of like an immediate release pill puts out more drug more quickly than a sustained release pill that releases drug over time.
Why Would You Use PRP vs Platelet Lysate?
PRP is good for treating mild arthritis in a joint or small tendon or ligament tears. PL on the other hand, in our decade-plus experience using it, really excels around nerves. For example, we use it extensively in the spine to treat irritated nerves due to disc bulges (epidural). We also use it quite a bit to treat nerve issues like carpal tunnel syndrome (and other areas). To see how PL is used there, watch my video below of a precise, ultrasound-guided, nerve hydrodissection:
To see how we use PL and PRP in the spine, watch this video:
We can use PL in other applications as well when it’s combined with adjuvants. For example, by itself, it’s anti-inflammatory whereas PRP can tend to stoke up more inflammation in the short-run. So we can use it with a low dose anti-inflammatory drug to get a big anti-inflammatory effect.
The upshot? I hope you now have a good sense of how PRP is different from PL. In addition, I hope you understand how critical it is that a doctor using platelet products can tailor those to specifically what you need. Regrettably, all too often in medicine, what’s better for the doctor is placed above what’s best for the patient. That’s not the case at Regenexx.