Scientists have recognized platelet concentrates as ancillary to healing and tissue regeneration in wounds, soft tissues, and other musculoskeletal structures. The release of various growth factors gives them regenerative properties. Platelet-rich plasma (PRP) is also concentrated into platelet-rich fibrin (PRF) to further facilitate healing through integration of bone and soft tissue. The fibrin gradually releases growth factors and serves as a storage scaffold. Cellular elements such as platelets, neutrophils, and macrophages might benefit immune responses within the tissue through cytokines and growth factors.
Bacterial infection is a wound complication that interferes with healing and tissue regeneration. In a recent study, researchers in India explored PRP’s and PRF’s antimicrobial properties for wound healing by examining relevant research studies in animals and humans from 2000-2023. They determined 12 of 612 studies were eligible for inclusion in their review.
Review Questions
The authors asked several questions in their literature review:
- Can PRP and PRF exhibit antimicrobial properties?
Study results have shown PRP has varying levels of efficacy against MRSA, E. coli,
Klebsiella, Enterobacter spp., and a variety of other microbes. Immune proteins and peptides found within platelets are likely responsible for these concentrates’ antimicrobial properties. Discrepancies in efficacy against a variety of microbes might prevent PRP from being a uniform treatment option for all bacterial infections, especially with variations in PRP processing and concentration of cell components.
- What is the mechanism by which PRP exhibits antibacterial activity?
Platelets might provide antibody-dependent cytotoxicity of bacteria. Scientists speculate that white blood cells also provide an immune response to kill bacteria. However, some researchers theorize that leucocytes do not necessarily increase antibacterial action, while metalloproteases and other inflammatory components from leucocytes might intensify an inflammatory reaction.
- Is PRP bactericidal or bacteriostatic?
Reaching the MIC (minimum inhibitory concentration necessary to halt bacterial replication) depends on bacterial load, bacteria type, the concentrate dose of PRP administered, the wound environment, and the host’s overall health. Some suggest repeated PRP administration during wound healing is better than a single treatment.
- Do various agents provide a synergistic effect?
Adding conventional antibiotics can enhance PRP gel’s antibacterial properties. The platelets’ angiogenic properties amplify new blood vessels that help distribute antibiotics to the tissues and improve blood flow.
Final Thoughts
In conclusion, the authors recommended “careful consideration to the composition of PRP and PRF preparations to optimize antimicrobial effectiveness.” They also emphasized that PRP and PRF might be especially helpful in wound infections that have become resistant to traditional antimicrobial agents. The synergistic effect of PRP and PRF with antibiotics is particularly appealing for clinical application. One caveat the researchers noted is the need for standardized preparation of PRP and PRF to optimize effective and reliable treatment.
Reference
Karan CL, Jeyaraman M, Jeyaraman N, et al. Antimicrobial Effects of Platelet-Rich Plasma and Platelet-Rich Fibrin: A Scoping Review. Cureus Dec 2023; DOI: 10.7759/cureus.51360
