The princess and the PRP

Regenerative expert, nurse Claudia McGloin answers all your burning questions

CLAUDIA MCGLOIN

Claudia McGloin is a registered nurse and holds dual registration in both the UK and Ireland. With over 27 years’ nursing experience, McGloin is the clinical director and nurse practitioner at The New You Clinic in Sligo. She is one of Ireland’s leading plateletrich plasma experts and has performed thousands of PRP treatments. She has shared her expertise on the international stage and in various publications.

A hot topic with platelet-rich plasma (PRP) over the years has been whether or not PRP should be activated prior to injection. Activation refers to stimulating the platelets to release their bioactive substances by introducing agents like calcium chloride or thrombin. Although some PRP kits contain activation agents, many do not, and the decision of whether to activate PRP before injection comes with both advantages and disadvantages.

Activating PRP before injection can enhance the release of crucial growth factors like platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β). These proteins play a critical role in wound healing, cell migration, and tissue regeneration. When PRP is activated, platelets degranulate and release these growth factors in higher concentrations, which can potentially amplify the regenerative effects on damaged tissues. This boost in growth factor release accelerates healing by enhancing processes like collagen synthesis, angiogenesis, and the formation of extracellular matrix components. For chronic or degenerative conditions, activating PRP before injection can lead to faster, more efficient tissue repair. Another benefit of activating PRP is the potential for faster healing and recovery. The immediate release of growth factors help to promote the healing process straight after injection. This is particularly useful in patients with tendon injuries, ligament sprains, and osteoarthritis. Research has shown that patients who receive activated PRP tend to experience quicker pain relief and improved functional recovery compared to those who receive non-activated PRP. The rapid release of growth factors can not only stimulate tissue regeneration but also help reduce inflammation more efficiently, leading to quicker recovery times and an expedited return to normal activities.

In addition, activation helps form a fibrin matrix, which provides a structural scaffold that supports cell attachment and promotes tissue regeneration. This fibrin network is particularly important in musculoskeletal injuries, where structural support is essential for healing. The enhanced formation of the extracellular matrix through activation could result in more effective and organised tissue repair, especially in soft tissues like tendons and ligaments, which typically heal more slowly. Activated PRP may also have synergistic effects when combined with other regenerative treatments, such as stem cell injections, hyaluronic acid, or corticosteroids, resulting in more sustained and effective healing for patients undergoing various regenerative treatments.

However, activating PRP prior to injection is not without its risks. One major concern is the potential for excessive inflammation. While inflammation is a necessary part of the healing process, it can be problematic if triggered too aggressively. The activation of PRP provokes an inflammatory response, which could worsen symptoms such as pain, swelling, and tissue damage. Nonactivated PRP, where the release of growth factors is more gradual, may be a safer choice for these patients, as it may help prevent an overactive inflammatory response. Another issue with activating PRP is the risk of fibrosis. The growth factors released by PRP stimulate tissue repair, but if activation is excessive, it can lead to overproduction of collagen, increasing the risk of scar tissue formation. In patients with chronic injuries, where the healing process is already impaired, this excess collagen can result in fibrosis, which could hinder normal tissue function. In these cases, using non-activated PRP, which allows for a more controlled and prolonged release of growth factors, may help reduce the likelihood of fibrosis and result in better functional healing. Once PRP is activated, the release of growth factors begins, and this process cannot be undone. Medical professionals need to act fast and inject straight away.

Ultimately, the decision of whether or not to activate PRP prior to injection depends on the clinical situation and the treatment goals. Medical professionals should carefully evaluate the patient’s injury type, inflammatory status, and overall health to determine the most appropriate course of action. As more research is being carried out guidelines for the optimal use will likely emerge, allowing for more refined treatment protocols tailored to individual patient needs.

If you have questions regarding any aspect of regenerative medicine – PRP, PPP, PRF, polynucleotides, exosomes – or questions relating to treatments, please get in touch, either by contacting Aesthetic Medicine magazine or emailing claudia@thenewyouclinic.ie.