PRP Platelet Rich Plasma use in Singapore

Following increased PRP use in Europe & the United States, physicians in Singapore are beginning to use PRP( Platelet Rich Plasma) to treat various musculoskeletal & sports injuries. The are establishing themselves as pioneers in biologics. Below is a recent press release which highlights the global use of platelet rich plasma therapy.

SingaporeMedicine is a multi-agency government-industry partnership committed to strengthening Singapore's position as Asia's leading medical hub and international health care destination. Hopefully they will record data & publish their results to further promote the efficacy of PRP.

http://www.prcompass.com/Medical_Pharmaceuticals/Singapore_First_in_Southeast_Asia_to_Use_Novel_Treatment_for_Sports_and_Musculoskeletal_Injuries/

Botox use getting more attention for healing rather than cosmetic use

Recently Botox has been getting more press about it's applications for conditions other than vanity. Botox temporarily weakens muscle and blocks "substance p" which in turn blocks pain. Unlike many other meds, botox has very little side effect & lasts for months. As a result there is increased use across the board in medicine including migraines, neck and low back pain, and buttock pain (piriformis syndrome). Research is being conducted on prostate enlargement (BPH) and overactive bladder. Also patients with tight limbs from strokes or brain injuries receive this treatment to improve function.

The NY Times recently published an article on botox seeing increased use for medical conditions.
http://www.nytimes.com/2009/04/12/business/12botox.html?hpw

Also I published a chapter on botox use for sciatica (buttock pain known as piriformis syndrome).
http://prpinjection.blogspot.com/search?q=piriformis

Stem cell therapy for soldiers in battle?

Military medics often struggle to get donated blood to soldiers in battle, which can take weeks to deliver. Also hospitals in the US have seen a sharp drop in donated blood resulting from risks associated with hepatitis and other disease. This supply shortage has increased the cost of transfused blood to hospitals which are already suffering in a recession.

Researchers at the Defense Advanced Research Projects Agency (DARPA) were recently awarded a large grant to implement technology developed from John Hopkins University using nanofibers to mimic marrow to produce blood and stem cells. Theoretically this would decrease the need for transfusions and decrease the costs associated with them.

This work may contribute the the global understanding & usage of stem cells to help save lives and cure disease. Clearly in our lifetime we will see more and more stories on stem cells and growth factors unlocking some of the chains of disease.
http://www.popularmechanics.com/science/health_medicine/4296060.html

Barack Obama Pledges to reverse Bush Administration Policy on Stem Cell Research

With the election of a new president, there will certainly be change. Recently in the Washington Post & CBS news, it was reported that Barack Obama intends to reverse the Bush policy on stem cell research. It is believed amongst the scientific community that stem cells offer abundant potential for challenging conditions including parkinson's disease and osteoarthritis among others. However, adult rather than embryonic stem cells are available with current technology and have little controversy associated with their use. The only problem is that harvesting them requires inserting a metal rod into the bone marrow to extract it. Hopefully, soon we will be able to draw adult stem cells from peripheral blood (drawing blood from the arm & processing stem cells). Clearly the orthobiologic field is growing, and we will learn more about the promise of stem cells in the near future whether adult or embryonic cells are utilized.

http://www.cbsnews.com/stories/2008/11/09/politics/washingtonpost/main4586410.shtml

New FDA Approved Study with Adult Bone Marrow Stem Cells in Vascular Disease

Using One's own adult stem cells taken from bone marrow, researchers are studying the effects of potentially preventing amputation in ischemic (poor blood supply)limbs. Doctors do a minimally invasive procedure obtaining stem cells, then much like PRP or platelet rich plasma they increase the concentration and then inject it. Doctors are injecting multiple sights just beneath the tissue in the blood flow deprived extremity. We look forward to following this study & the results that follow.

http://www.biomet.com/patients/clinical_recruitment_padstudy.cfm

Adult Stem Cells for Arthritis?

Perhaps the next frontier beyond PRP is Stem Cells. While the topic is the subject of much controversy politically, technology now allows us to utilize adult stem cells opposed to embryonic cells to treat disease.

Stem Cells are the birthplace of platelets rich in healing properties, which can potentially program cells to regenerate tissue & cartilage. Currently stem cells can be retrieved via embryo (controversial in US), umbilical cord, bone marrow, peripheral blood, & in the near future adipose (fat) cells via liposuction.

Peripheral blood, or simply drawing blood from a patient's arm is the least invasive & most promising method. Patients require a shot or medication to release stem cells from the marrow to the blood stream. It can then be processed & used for injection. In the future patients may have the option to store unused stem cells for future use as well.

Stem cells are being used in the US mostly for cancer patients to assist in recovery from the ill effects of chemotherapy. A few practitioners are using them orthopaedically with reportedly good results in arthritis. Internationally there are centers where patients seek alternative treatment to serious diseases like spinal cord injury, multiple sclerosis, and ALS.


There is an adult stem cell organization which lists numerous articles & personal stories.

www.adultstemcelleducation.com

New Platelet Rich Plasma (PRP) review article for tendon injuries and arthritis

In a Jan/Feb 08 issue of Practical Pain Management, the authors describe PRP use in tendon injuries, spine conditions, as well as hip & knee arthritis. The article emphasizes a need for agreed upon nomenclature.

An interesting concept addressed is whether a gel matrix is needed for the platelets to adhere to the target site. Because of their structure tendons & ligaments may not require the gel, however it is not known if adding calcium chloride with thrombin to the PRP is needed in joint spaces like knee & hip arthritis. Further data needs to compare the usage with gel versus without.

The article showed x-rays post prp injection with subtle smoothing of a previously arthritic femoral head (hip bone). It is not clearly known how PRP acts on arthritis, however a particular growth factor found in PRP, TGF-B has been linked to cartilage growth (chondrogenesis). Furthermore, another study showed that PRP influences hyauloronic acid production which balances cell proliferation (angiogenesis). Also, the authors suggested a possible role in serotonin decreasing pain. Lastly, utilizing "stem cells" (the birth place of platelets and their precursors)may offer the most ultimate potential.

http://www.ppmjournal.com/abstract.asp?articleid=P0801F01

http://prpinjection.blogspot.com/2007/11/new-article-on-osteoarthritis-and.html

Bone Marrow Aspirate, Using Adult Stem Cells To Treat Osteoarthritis

Platelet Rich Plasma provides a potent delivery of the body's healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult "mesenchymal stem cells" from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it's ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is: http://www.autologousadultstemcells.org/blogs.html