Shared from the 12/20/2015 Connecticut Post eEdition

HEALTH

Treating patients with ‘stem cell lite’

Treatment from a person’s own blood

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Dr. Michael Redler administers platelet-rich plasma therapy to a patient.

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Information on PRP

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Some key questions and answers about platelet-rich plasma therapy.

What is platelet-rich plasma? Blood consists of a liquid (called plasma) with three solid components — red cells, white cells and platelets. Platelets are mainly known for their importance in causing clotting, but they also contain hundreds of proteins called growth factors that can aid in healing injuries. PRP is plasma with a higher concentration of platelets than is typically found in the blood. It’s developed by drawing blood from a patient and using a centrifuge to increase platelet concentration.

How does PRP work? It’s not clear exactly how PRP works, but studies have shown that the increased concentration of growth factors in PRP can possibly speed up the healing process. PRP can be injected directly into the injured area, or it can be applied to torn tissues during surgery.

What conditions are treated with PRP? Many kinds, including chronic tendon injuries, acute ligament and muscle injuries, knee arthritis, and fractures. There has been some success in using it treat hair loss, particularly in women, as well.

Does it work? Yes and no. More research needs to be done on the effectiveness of using PRP. Results vary depending on multiple factors, including the severity of the injury and the overall health of the patient. Source: American Academy of Orthopaedic Surgeons

After 30 years as a welder, Raymond Miller’s body was starting to give out.

His right elbow had been hurting him for years and the pain had gotten so bad, the 57-year-old Stratford resident couldn’t even bend the joint enough to reach up and touch his right ear.

“I think it was just a matter of wear and tear after 30 years,” of physical labor, Miller said.

Wanting some relief, he went to see orthopedist Dr. Michael Redler, who diagnosed him with tennis elbow and a torn tendon. Redler suggested a intriguing solution to Miller’s problem — injecting the patient with a concentrated version of his own blood.

Doctors are using platelet-rich plasma therapy, a kind of “stem cell lite,” to repair everything from arthritic knees to tennis elbow and, most recently — hair loss.

“Basically, what we’re doing is concentrating or supercharging the patient’s own healing ability,” said Redler, an attending physician with St. Vincent’s Medical Center in Bridgeport and head team physician at Sacred Heart University in Fairfield.

The procedure involves drawing blood from a patient and spinning it in a centrifuge to increase the concentration of platelets, an element of the blood mainly associated with clotting.

Platelets also include “growth factors” — proteins that can potentially help the body mend itself. For those who use the method, it’s a low-impact alternative to treatments such as cortisone shots or surgery.

Experts caution that the procedure is still somewhat unproven and there are questions as to exactly how the therapy works. Also, it’s not always covered by insurance, which is a significant problem given that the procedure can cost anywhere from $500 to $5,000.

But for those who have been helped by the procedure, including Miller, it’s something akin to a miracle.

Since his treatments, the pain in his elbow is pretty much gone, and his range of movement is back to normal. “I am doing wonderful right now,” he said.

A brief history

Platelets are one of three solid components of the blood, which also includes white cells and red cells. As its name suggestions, platelet-rich plasma, or PRP is plasma (the liquid part of blood) with a higher concentration of platelets — about five to 10 times the usual level.

PRP is usually delivered in one of two ways — by being injected directly into an injury site, or by being administered to the injured area during surgery.

When the PRP is activated “it releases about 1,500 different proteins,” known as growth factors, said Dr. Rocco Monto, spokesman for the American Academy of Orthopaedic Surgeons. “I almost think of it as ‘stem cells lite,’ ” he said.

PRP therapy was first developed in the 1970s and first used in an open heart surgery in 1987. In the 1990s, using the supercharged blood became more popular, particularly in disciplines such as dentistry and oral surgery, Monto said.

Its use in orthopedics goes back to the early 2000s. It’s frequently used in sports medicine, and a wide range of athletes, including Kobe Bryant, Tiger Woods and tennis star Rafael Nadal, have reportedly had the procedure.

A fix for baldness

Doctors are finding other uses for PRP, including preventing hair loss.

Although this use is relatively new, some dermatologists have had some success in injecting PRP into the scalp, with the hope that the platelets will stimulate growth.

“Researchers are just beginning to study this therapy as a treatment for hair loss,” a statement on the American Academy of Dermatology’s website reads. “The early findings show promise, but more studies are needed to know whether this is a safe and effective treatment for (female pattern hair loss).”

Dermatologists welcome another possible treatment for those with thinning hair, particularly women, said Nicole Rogers, assistant clinical professor of dermatology at Tulane University in New Orleans.

“It offers sort of a nice alternative,” said Rogers, also a fellow with the Academy of Dermatology. For women in particular, she said, the options are pretty much limited to the nonprescription drug monoxidil. Still, Rogers said, “the data on PRP is somewhat limited.”

Because it’s still an emerging practice, some doctors have reservations about using PRP therapy, particularly for cosmetic purposes like treating hair loss.

Trumbull dermatologist Dr. Robert Patrignelli he hasn’t used PRP with his patients, mainly because there isn’t enough scientific evidence showing that it works. Many studies of the practice are small, he said, but results have been promising and PRP is something he can see himself offering at some point.

“It’s sort of going the direction that it can help a lot of different conditions,” Patrignelli said.

An expanding field

As far the treatment’s orthopedic use, some organizations have reservations about that as well.

“Treatment with platelet-rich plasma holds great promise,” reads a statement on the American Academy of Orthopaedic Surgeons website. “Currently, however, the research studies to back up the claims in the media are lacking.”

Doctors, including Redler, agreed that PRP doesn’t work for everyone

— but it does work enough for them to consider it a valid alternative to other treatments, such as steroid injections.

“We’re trying to steer away from steroids and go to more natural solutions,” said Dr. Corinne VanBeek, an orthopedic surgeon with Stamford Hospital who has worked in PRP therapy. “The hope is that (PRP) will accelerate the healing of injuries.”

Because it’s still an emerging practice, some doctors have reservations about using PRP therapy, particularly for treating hair loss.

Trumbull dermatologist Dr. Robert Patrignelli he hasn’t used PRP with his patients because there isn’t enough scientific evidence showing that it works; but results have been promising and he might offer it at some point.

Locally, several doctors said they largely use PRP for treating patients with sports injuries.

Redler said he uses the technique nearly every week, mainly in his work with athletes — though he does see “civilian” patients like Miller as well. In the past, the injuries he treats with PRP would likely be addressed using a combination of methods, including anti-inflammatories, cortisone, physical therapy or surgery.

He’s used the treatment for a variety of ailments, including plantar fasciitis (a common form of foot pain), tendinitis, muscle tears and others. Patients typically receive three injections over the course of a few months. Miller’s treatments took place over about two months. The injections themselves were somewhat painful, he said. But he noticed an improvement almost immediately.

“After the first (injection), after two days or so, my elbow felt much better,” he said.

Others who have used the therapy include Dr. Patrick Kwok, an orthopedic surgeon with Fairfield-based Orthpaedic Specialty Group. One of the drawbacks of the therapy, Kwok said, is that, because it’s still somewhat experimental, it’s not always covered by insurance.

Monto said using PRP for orthopedic injuries, on average, costs about $500 to $1,000, but, depending on the methods used to concentrate the plasma, it can cost up to $5,000 or more. That’s a hefty price tag, particularly considering that PRP doesn’t always work.

“I would say that, after the three-month mark (following a procedure), if it hasn’t helped you, then the procedure has failed,” Kwok said.

But he said, in his experience, the procedure is usually successful.

“In my own private practice, I’ve seen a 75 percent success rate, where the patients doesn’t have to have surgery,” Kwok said.

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