Autologous conditioned plasma

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Autologous conditioned plasma (ACP) is a platelet-rich plasma that is extracted from autologous blood using centrifugation. It can support regeneration in a variety of orthopedic conditions and surgical procedures

Description[edit]

In an increasing number of orthopedic treatments, for example in the case of tendon and ligament injuries, torn muscles and osteoarthritis, there is growing interest in autologous blood products. In this therapy approach, substances occurring naturally within the body known as growth factors promote healing.

Definition[edit]

Autologous Conditioned Plasma (ACP) is an autologous blood plasma ‒ occurring naturally within the body ‒ that is conditioned as part of a special production process, which means that it is largely separated from the other blood components (such as erythrocytes), and concentrated. ACP is a platelet-rich plasma (PRP). PRP is a general term for a type of plasma that contains an increased concentration of thrombocytes (in comparison with whole blood) and that is extracted from whole blood using a separation process. Main components of ACP include thrombocytes (platelets), and several growth factors that play an important role in the healing process. Unlike other platelet-rich plasma formulations, ACP is distinguished by a low concentration of white blood cells such as neutrophil granulocytes that can be detrimental to the healing process when present in high concentrations.[1][2]

Production[edit]

ACP is extracted from autologous blood. For this purpose, a small quantity of blood (10 - 15 ml) is drawn from a superficial vein (such as the antecubital in the same way as in the case of a blood test. In a second step, a centrifuge is used to separate the ACP from the other blood components. For this purpose, centrifugation only needs to be carried out for a short interval at low speed. In the next step, the ACP can be separated as a supernatant. Manufacturers such as Arthrex offer dedicated syringe systems for this purpose that can be used to take blood from the patient, condition it, and then inject it again into the region to be treated. In this respect, the blood product remains in the syringe system throughout the entire process, offering the maximum possible level of protection against contamination.

Application[edit]

ACP can be used to promote healing in the case of injuries to the musculoskeletal system, ligaments or tendons, but also in the case of muscle injuries or tendinitis. In laboratory tests, a significant increase in cell proliferation has been demonstrated in muscle, tendon and bone cells.[3] Furthermore, the effectiveness of ACP in different fields of application has been demonstrated in numerous clinical studies.[4][5]

Possible indications – acute[edit]

  • Injuries to ligaments such as the cruciate ligament or ankle ligaments
  • Fractures
  • Injuries to muscle fibers and the meniscus
  • Injuries to tendons such as the Achilles tendon or rotator cuff

Possible indications – chronic[edit]

  • ACP can also be used in applications other than orthopedics, for example in wound healing or cosmetic surgery
  • Osteoarthritis, cartilage damage
  • Plantar fasciitis
  • Tendinitis such as patellar tendinitis
  • Impingement syndrome
  • Tendinopathy, for example of the Achilles tendon or elbow.

Action[edit]

The healing of injured tissue involves a complex series of natural processes within the body. Growth factors play a key role in this respect, as they initiate and regulate these complex processes. Many of these growth factors are released by thrombocytes that are contained in the blood and activated in the event of injury. As injury or inflammation involves the destruction of tissue or cells, growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF), basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are released. These are involved in cellular processes that promote healing and are associated with tissue growth.[6][7][8][9] Accordingly, they initiate the proliferation and differentiation of a variety of cell types (such as osteoblasts and chondroblasts),[10] promote matrix formation through the production of collagen and proteoglycan, and stimulate angiogenesis. This is in contrast to the immune response that is regulated by leukocytes/neutrophils and involved in the reduction of damaged tissue, and that counteracts possible infection with free radicals (Reactive Oxygen Species, ROS), proteases and antimicrobial peptides. However, these have the biological potential to also damage healthy tissue.[11] By adding ACP at the treatment site, an increased concentration of thrombocytes (2 - 3 times higher than that of whole blood) is applied with neutrophils almost entirely absent. This supports the natural process of healing within the body, i.e. the formation of blood vessels, new cells and tissue, while inhibiting painful inflammation.[12]

References[edit]

  1. ^ Mazzocca, Augustus D.; Platelet-Rich Plasma Differs According to Preparation Method and Human Variability; J Bone Joint Surg Am. 2012; 94:308-16
  2. ^ Sundman, Emily A.; Growth Factor and Catabolic Cytokine Concentrations Are Influenced by the Cellular Composition of Platelet-Rich Plasma; Am J Sports Med PreView August 16, 2011
  3. ^ Mazzocca, Augustus D.; The Positive Effects of Different Platelet-Rich Plasma Methods on Human Muscle, Bone, and Tendon Cells; Am J Sports Med 2012; 40:1742-49
  4. ^ Cerza F, et al: Comparison Between HyaluronicAcid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis. The American Journal of Sports Medicine, online published on October 25, 2012
  5. ^ Deans VM, Miller A, Ramos J: A Prospective Series of Patients with Chronic Achilles Tendinopathy Treated with Autologous-conditioned Plasma Injections Combined with Exercise and Therapeutic Ultrasonography. The Journal of Foot and Ankle Surgery. 2012; 51(6): 706-710
  6. ^ Andia, Isabel; Basic Science: Molecular and Biological Aspects of Platelet-Rich Plasma Therapies; Oper Tech Orthop 2012; 22:3-9
  7. ^ Borzini P, Mazzucco L: Tissue Regeneration and in Loco Administration of Platelet Derivates: Clinical Outcomes, Heterogeneous Products, and Heterogeneity of Effector Mechanisms. Transfusion. 2005; 45: 1759-1767.
  8. ^ Edwards D, et al: Transforming Growth Factor Beta Modulates the Expression of Collagenase and Metalloproteinase Inhibitor. The EMBO Journal. 1987; 6(7): 1899-1904.
  9. ^ Lynch S, et al: Role of Platelet-derived Growth Factor in Wound Healing: Synergistic Effects with other Growth Factors. Proc. Natl. Acad. Sci. USA. 1987; 84: 7696-7700.
  10. ^ Graziani F, et al: The In Vitro Effect of Different PRP Concentrations on Osteoblasts and Fibroblasts. Clin Oral Implants Res. 2006; 17(2): 212-219.
  11. ^ Andia, Isabel; Basic Science: Molecular and Biological Aspects of Platelet-Rich Plasma Therapies; Oper Tech Orthop 2012; 22:3-9
  12. ^ Andia, Isabel; Basic Science: Molecular and Biological Aspects of Platelet-Rich Plasma Therapies; Oper Tech Orthop 2012; 22:3-9