Gonalgie fémorotibiale du sportif

Biological Basis
Different Products
Benjamin Sainsous*, François Kelberine*,
Alexandra Malgoyre**
Antonia Alonso**, Xavier Bigard**
*Clinique PPR-P, Aix en Provence, France
** IRBA, SSA, Grenoble, France
SFTS, Grenoble, Octobre 2012
Disclosure
• No financial relationship with the companies
involved in this study
• Financial Support / IOC Medical Committee
Platelet - Rich Plasma
• Plasma with an amount of platelets largely
above serum base line (from x 3 to x 8)
• Volume, blood cells, activation, viscosity
(liquid, matrix),……
• Physiological balance of GF
Eppley (2004), Marx (2004), Anitua (2005), Sanchez (2007AJSM)
• Cost
PRPs look similar…
Commercial proposals……
• Arthrex (ACP-DS)
• Biomet (GPS)
• BTI (PRGF)
• Curasan
• Regenlab
• Plateltex
• Vivostat
•
•
•
•
Harvest Tech (SmartPRep)
Cascade (Fibrinet)
Medmetric (Magellan)
Nahita
•
•
•
•
•
•
Cytomedix
Friadent
Sequier
Choukroun’s PRF
Genesis
Ace
Material & Methods
• 6 volunteers for 7 techniques
• Each individual serves as control for baseline
• Withdraw citrated blood
• Strict guidelines / each company protocol
• Spinning
• Rolling to avoid agregates < activation
Material & Methods
Independant labs
• Cells count pre and post spinning
(SELARLAIX)
• GF after activation (Elisa kits)
(IRBA)
• Comparison PRP with
• Baseline & classic low spinning
Cells count
% age related to baseline +/- Standard Deviation
PLATELETS
Biomet
BTI
Control T
Regenlab
Arthrex
379,38%
184,78%
142,99%
142,27%
131,55%
+
+
+
+
+
54,4 Large range++
13,1
7,59
14,15
10,93
Vivostat
Plateltex
51,03% º+ 24,54 Large range++
numération Plaquettaire*1000/mm3
30,26% + 6,36
1200,00
Curasan
no cells (GF only)
* plasma T
$ toutes autres
*** $$$
methodes
§  sang total
1000,00
1 symbole <0.05
2 symbole<0.01
3 symboles <0.001
800,00
600,00
400,00
200,00
*
** $
0,00
EDTA
A Plasma T B
C
D
E
F
G
basa
l
Cells count
% age related to baseline +/- Standard Deviation
RED CELLS
only Biomet 12,27 % + 3,19
WHITE CELLS
a) Concentration
Biomet 489,31 % + 43,78
b) Presence
Regenlab 59,74% + 9,55
Vivostat 288,96% + 73,21
Cells count
WHITE CELLS
c) Few or Absence
Arthrex 7,95 % + 1,69
BTI 0,95% + 0,52
Plateltex 0,06% + 0,06
Curasan no cells (GF only)
*  plasma T
$ toutes autres methodes
§  sang total
numération leucocytaire/mm3
35000,00
*$§
p <0.001
30000,00
*$§
25000,00
20000,00
basal
PRP
15000,00
10000,00
5000,00
0,00
EDTA
A
plasma T B
C
D
E
F
G
Summary /Cells
• Amount of PLT above baseline 1,3 to 4
(sometime under)
• Reproducibility from irregular to unpredictable
• Platelets < Leukocytes : negative ratio
• Biomet (0,82) and Vivostat (0,38)
• Platelets > Leukocytes : positive ratio
• Regenlab (2,54), Arthrex (21,77)
• No Leukocytes :
BTI, Control, (Plateltex, Curasan)
Activation
• Critical, release GF from α-granules
(degranulation)
• Calcium Chloride Thrombin
• Performed for analysis / in vitro study
• Assess the amount of GF available independantly
of the kinetic of the release
PDGF, VEGF, TGFß1, FGF, IGF-1
• 100% release after 1 hour
Marx J MaxilloF surg 2004
Fufa J MaxilloF surg 2008
Growth Factors
PDGF,VEGF,TGFß1 are correlated with degranulation
corrélation VEGF
TGF
PDGF
ß1et
etetnumPq
numPq
numPq
1800,000
16000,000
80000,000
1600,000
14000,000
70000,000
R² = 0,65526
0,80612
R² = 0,67816
1400,000
12000,000
60000,000
1200,000
10000,000
50000,000
1000,000
TGF
VEGF
VEGF
VEGF
IGF
1
IGF 1
IGF 1
PDGF
PDGF
FGF
FGF
FGF
Linéaire (PDGF)
(VEGF)
Linéaire
Linéaire (TGF)
40000,000
8000,000
800,000
30000,000
6000,000
600,000
400,000
20000,000
4000,000
200,000
10000,000
2000,000
0,000
0,0000
-200,000
0
200
200
200
400
400
400
600
600
600
800
800
800
1000
1000
1000
1200
1200
1200
1400
1400
1400
1600
1600
1600
1800
1800
1800
Growth factors
FGF, IGF 1 are NOT correlated with degranulation
corrélation FGF & IGF1 et numPq
180,000
R² = 0,07431
160,000
140,000
120,000
IGF 1
FGF
100,000
Linéaire (IGF 1)
80,000
Linéaire (FGF)
60,000
40,000
R² = 0,00944
20,000
0,000
0
200
400
600
800
1000
1200
1400
1600
1800
Are they only circulating?
Amount of GF/Techniques
1) Biomet (but with all blood cells, leukocytes)
2) Arthrex, BTI, Standard centrifugation
3) Regenlab (leukocytes)
4) Plateltex, Vivostat = not PRP
5) Curasan=selective no IGF1, PDGF --, VEGF ++
• Not related to molecular weight
• Role of filter or wasching buffer?
Take home messages
• PRP preparations are not similar and some are not PRP
• Cost consideration
• Be critical to company initiatives ++
• The concentration is not so high (up to 4)
• Physiological balance of GF?
• IGF1, FGF are poorly present in platelets
• Leucocytes
• Are they beneficial or detrimental ?
• Timeframe of use