Review
Platelet-derived bio-products: Classification update, applications, concerns and new perspectives

https://doi.org/10.1016/j.transci.2019.102716Get rights and content

Abstract

Platelet derived bio-products in the form of platelet rich plasma, plasma rich in growth factors, or plasma-free platelet releasates, are being studied worldwide with the aim of proving their efficacy in tissue regeneration within many different clinical areas, such as traumatology, maxillofacial surgery, ophthalmology, dermatology and otorhinolaryngology, amongst others. The current lack of consensus in the preparation method and application form, or in the quality assessment of each bio-product, precludes adequate interpretation of the relevance of reported clinical outcomes, and, while many in clinicians are very positive about them, many are sceptic. Relevant aspects of these products are considered to propose a classification nomenclature which would aid a comprehensive comparison of clinical outcomes of bio-products of the same characteristics. Finally, the uses of platelet-derived bio-products in in vitro culture (for cell therapy purposes) as a substitute of animal-origin sera, and other future perspectives of applications of platelet-derived bio-products are discussed.

Section snippets

Background: an overview of platelet biology and key functional aspects

Platelets are circulating anucleate blood components (2−4 μm in diameter) and key players in maintaining hemostasis [1]. Platelets have a limited life-span in the circulation (around 7–12 days), and therefore, the right balance between platelet production (approximately 1011 platelets daily) and clearance must be tightly regulated [2]. In addition to their key role in hemostasis, many other functions have been attributed to platelets, such as immunomodulation or lymph and blood vessel

Not quite yet platelet rich plasma: fibrin and platelet-rich fibrin

Among the fibrinogen-based biomaterials, fibrin sealant (also called fibrin glue) is amongst the best-known. This product mimics the last step of the coagulation cascade through the activation of fibrinogen by the biologically active alpha thrombin, leading to the formation of a semisolid fibrin clot. Its network architecture provides the required scaffold to support tissues or materials, while retaining its hemostatic and healing properties [12]. It is widely used as a biodegradable tissue

Clinical uses of platelet-derived bio-products and concerns: does it work?

The effect of PRP on tissue regeneration has been supported by in vitro and in vivo studies that suggest a positive impact on the proliferation, differentiation and migration of several cell types. Its clinical use initially developed in the areas of dental and maxillofacial surgery. PRP and platelet-based biomaterials were found to accelerate endosseous wound healing in oral surgery [[32], [33], [34]]. Using these products combined with autologous and allogeneic bone grafts provides better

Classification of PRP products

As clinical technology products in development, the above-mentioned blood-products are prone to high variability that leads to different product types and compositions, due to a lack of consensus in the preparation method/application form or product characteristics (purity, content, quality) with severe impact on their potential clinical efficacy [39]. For example, just reviewing the literature on the use of PRP as intra-articular injury therapy, only around 5 % of the reports specify the type

Platelet-derived factors in tissue engineering and advanced therapies

To date, the most widely used animal serum supplement in cell culture is fetal bovine serum (FBS), which stimulates cellular proliferation, differentiation and survival of many cell types [90]. However, whenever a therapeutic approach requires cell culture, the use of animal-derived biomaterials is associated with different types of risks that should be avoided in order to abide by good manufacture procedure (GMP) requisites. In particular, a major concern is the immunogenicity associated with

Future perspectives in platelet applications

The harnessing of the biological functions of platelets to develop novel therapeutic strategies has been widely explored in the last few years. In this section we will focus on the most important advances in the field, opening up new methodologies and applications of platelets and their derived bio-products.

Final remarks/conclusions

While there is a tremendous expansion of the use of platelet-derived bio-products for various purposes in the clinic, the clinicians in favour equal the sceptic ones. The use of different nomenclatures and the lack of information in reported works make it difficult not only to obtain data on effectiveness, but also on such an important aspect as safety. Most products, especially PRP products, are used (in some countries) in an autologous manner, which minimizes the risk of infectious disease

Funding

LG is supported by a Ramón y Cajal Fellowship (RYC-2013-12587, Ministerio de Economía y Competitividad – Spain) and an I+D Excellence Research Project (SAF2017-85489-P, Ministerio de Ciencia, Innovación y Universidades – Spain – and Fondos FEDER). AAH is supported by a postdoctoral ISPA 2018 intramural fellowship.

Declaration of Competing Interest

The authors declare no conflict of interest.

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