PRP and Bio-Active Regenerative Fluid
Platelet-Rich Plasma (PRP) and Amnion-derived fluid are both regenerative medicine treatments that are widely used to treat various orthopedic and wound care conditions. Current understanding of regenerative medicine treatments is that the major therapeutic benefits come not from stem cells, but from the action of growth factors contained in significant concentrations which signal, among many things, the patient’s own progenitor cells to begin proliferation and healing, to reduce chronic inflammation and promote regrowth of new tissue.
PRP is a growth factor-rich treatment derived from a patient’s own blood draw. A patient’s blood is spun down using centrifugation, platelets are extracted and further processed to release desirable growth factors.
Because there are multiple ways to extract PRP from a patient’s blood draw, several different ways to activate it, and different technicians performing the steps, the growth factor profile for a given sample can vary, even when the samples come from the same patient. This translates to a lack of consistency in clinical outcomes and therapeutic potential. Additionally, the concentrations of a number of growth factors have been found to decrease as patient age increases. Furthermore, higher concentrations of these growth factors were found in female subjects than in male subjects when harvesting PRP from older patients.
PRP also requires processing steps which must be performed on freshly isolated blood, therefore the patient must be retained while their treatment is being prepared and processed from their own blood draw. This adds time to the procedure and decreases overall throughput in a clinical setting.
Amnion-derived fluid is a conditioned media that is created during the growth and culture of cells extracted from the amnion, the innermost layer of the amniotic membrane. These cells are then collected via centrifugation. As the cells grow in culture, they release a milieu of growth factors and cytokines that mimic the previous in utero environment. The conditioned growth media they inhabit, also known as amnion-derived fluid, is then collected and used as a treatment for a similar range of clinical conditions as PRP.
The mechanism of healing for amnion-derived fluid is also believed not to be cell-based, similar to PRP, and again lies in the growth factor signaling of endogenous resident cells. Amnion-derived fluid is delivered as a ready-to-use, off-the-shelf product which does not require processing time in the clinic.
Both treatments operate on the principle of growth factor-mediated therapeutic action, rather than the previous understanding that cells themselves are the healing mechanism. Both treatments are effective for diabetic wounds, surgical wounds, and musculoskeletal injuries as well as osteoarthritis. Though similar in how they work, there exist several differences between PRP and amnion-derived fluid that are relevant to discuss when considering their use for therapeutic effectiveness or clinical efficiency.
First, because of the nature of cell culture and product manufacturing, the growth factor profile of amnion-derived fluid is more consistent, and is not as severely affected by donor-based biological variability as PRP due to the ability to quality control the product both during cell culture and in evaluating the end product. Additionally, the separate processing of amnion-derived fluid reduces chair time for the patient and processing time for the practitioner, without requiring the practitioner to purchase processing equipment, which increases throughput for the medical facility.
It is important to remember, however, that the quality and quantity of growth factors and cytokines available in the two treatments will be markedly different. Amnion-derived fluid is cultured to develop maximum quantity, and PRP is not. In addition, PRP treatment makes available the stem cell growth factors and cytokines of an older person. Amnion-derived fluid provides those that could grow a baby in 9 months. Which would you rather use?