REVIVAL PRP® for Veterinary Medicine
WHAT IS REVIVAL PRP®?
REVIVAL PRP® is an Advanced Separator Gel-based, easy to use, sterile system that is used to prepare PRP in a safe and effective manner to accelerate the body’s own natural healing process.
PRP is used in various medical applications including tissue enhancement, tissue and cell regeneration, rejuvenation, reconstruction and for general healing and repair.
PRP is indicated for the following conditions:
COMMON CONDITIONS IN CANINE, FELINE AND EQUINE SPECIES
As an animal ages or engages in various activities, they are at risk for developing various degenerative joint diseases (DJD), tendinopathies and/or suffering from injuries that may develop into chronic wounds. Some common conditions that they may suffer from are:
Dogs are typically non-responsive to traditional treatments such as rest and NSAIDs, and additional reported treatment options such as rehabilitation therapy and surgery may not always be successful.
Following resolution of lameness, there is a lifelong increased susceptibility to re-injury due to the reduced strength of fibrotic scar tissue compared to the original tendon (Ho et al 2015).
Lacerations are when an animal’s skin has been cut or torn open. Some lacerations will have clean, smooth edges or they may have jagged edges. Some lacerations will affect multiple layers of tissue depending on what caused the actual laceration. Puncture wounds or bite wounds occur when an object or tooth pierces the skin and leaves a small hole in the surface.
The hole will most likely affect multiple layers of tissue and is most susceptible to bacterial infections. Puncture wounds can easily become abscessed, creating a bigger medical emergency for your client’s pet.
It appears that the SDFT matures early, after which time it has limited ability to adapt to stress and undergoes progressive degeneration (Dowling et al 2000). Tendinopathy of the superficial digital flexor tendon (SDFT) is a common injury in Thoroughbred racehorses and other horse breeds and is regarded as a career limiting disease. Clinical injury is mostly strain induced and characterized by chronic degeneration after repetitive microtrauma in sport horses.
Tendinopathy may also be caused by a single external percutaneous trauma, such as a kick (Geburek et al 2016)
Degenerative Joint Disease (DJD) refers to arthritis or osteoarthritis, which is the result of the gradual deterioration of the articular cartilage within one or more the joints. This smooth resilient cartilage degenerates, becoming brittle over time. With severe DJD, the degenerated cartilage may actually split away from the bone and become loose within the joint. DJD can follow a number of joint diseases, including infection, and may develop after bone or joint injury or surgery.
Obese animals are more likely to develop DJD, as a direct result of the mechanical stress that excess weight puts on the joints. Although DJD is not usually an inflammatory disease, mild inflammation plays a part in causing clinical signs. When the cartilage cells become damaged, they release substances that result in inflammation, causing pain and further damage to the cartilage. Thus, once DJD begins, it can become a vicious cycle. Most of the damage caused by DJD is irreversible.
WHAT IS PRP?
Platelet Rich Plasma (PRP) is a portion of the animal’s own blood plasma that is concentrated in platelets and growth factors. These are critical in triggering the body’s regenerative mechanisms.
The most basic method to prepare PRP is through centrifugation. The animal’s blood is drawn and centrifuged at a specific speed until it is separated into 3 layers: Platelet Poor Plasma (PPP), Buffy Coat/Platelet Rich Plasma (PRP) and red blood cells.
REVIVAL PRP’s Advanced Separator Gel sits in between the platelet-rich plasma and the red blood cells to ensure that the physician obtains a plasma preparation that is free from any red blood cells. Red blood cell contamination may provoke an inflammatory effect which can affect healing.
Depending on the application, calcium chloride is added to form a fibrin clot, which this then applied to the affected area
The platelets undergo degranulation to release Growth Factors (GFs) with healing properties. The plasma contains cytokines, thrombin, and other GFs with inherent biological and adhesive properties.
Growth Factors Present in Platelets and their Function
Transforming Growth Factor-beta
Basic Fibroblast Growth Factor
Platelet Derived Growth Factor
Epidermal Growth Factor
Vascular Endothelial Growth Factor
Connective Tissue Growth Factor
APPLICATIONS OF PRP IN DIFFERENT THERAPEUTIC AREAS
PRP has many different applications over a wide range of therapeutic areas such as Sports and Orthopedics, Dental, Cosmetic Surgery, Esthetics and Dermatology, General Surgery , Chronic Wounds, and Ophthalmology
Platelet Rich Plasma (PRP) is often used to treat a variety of chronic tendon, acute ligament and muscle injuries as well as other conditions such as arthritis and osteoporosis pain.
Athletes of all competition levels are early adopters of novel treatment methods. They are driven to find less invasive methods of injury management and faster means of returning to their sports.
Ligament, muscle and tendon tears are often slow to heal due to inadequate blood supply to these areas. Although PRP can be injected on any muscle or tendon, the following areas are the most common sites:
- Shoulder (rotator cuff)
- Elbow (Lateral or medial Epicondylitis; aka tennis or golfer’s elbow)
- Knee (patellar tendon; aka Jumper’s knee)
- Ankle (Achilles Tendon)
PRP can also be used during surgery to augment healing for ACL reconstruction and rotator cuff repair.
Connective tissues such as ligaments and tendons heal by filling in with scar tissue, which in turn, doesn’t support the pressure of large loads effectively and increases the risk of re-injury. Chronic tendon injuries are related to degeneration of the tendon tissue. Traditional forms of therapy do not necessarily improve the tendon’s ability to create new tissue and heal in the same way PRP does.
Platelets release bioactive proteins and growth factors which enhance tissue regeneration and healing. New tendon cells called tenocytes start to develop in the treated area. Cartilage cells called chondrocytes form when PRP is injected into damaged cartilage. There is also an increase in the number of growth factors in the treated area as well as a build-up of Type 1 collagen fibers, which constitute the base structure of tendon tissue. PRP has been demonstrated to shorten recovery time, decrease pain and improve performance in the injured area
- Many high-profile athletes are also taking advantage of the benefits that PRP offers:
- Kobe Bryant of the LA Lakers received more than three treatments on his knee in the past few years and was able to make a full comeback after serious injury
- Alex Rodrigues of the New York Yankees received multiple PRP treatments for both his left shoulder and right knee
- Peyton Manning (quarterback of the Denver Broncos) had several treatments to help repair ligaments, tissues and alleviate pain in his neck
- Tiger Woods received PRP treatments for his Achilles tendon and both knees after a knee surgery to repair injury.
(News coverage of PRP usage in athletes)
(Pittsburgh Steelers athletes use PRP as an innovative injury treatment)
Some common orthopedic indications for which PRP is used are listed below:
- Tendinopathies (refers to a degenerative condition of tendons characterized by the chronic loss of collagen, stability, strength and tissue integrity possibly caused by natural aging, injury, repetitive stress, and/or neural, vascular and hormonal inputs)
- Ligament Sprains
- Muscle Strains
- Joints (i.e. osteoarthritis; a chronic degenerative disease of hyaline cartilage)
PRP can be effective for many cases of osteoarthritis as repairing the damage has posed a great challenge due to its regenerative limitations. Platelets and other elements within the blood help tendons and ligaments heal by stimulating a repair and growth response that accelerates the process of developing new tissue. However, the tendons and ligaments do not receive a rich blood supply containing these factors which is why they often take a significant amount of time to heal. PRP stimulates healing of cartilage and reduces pain and disability by delivering these factors directly to the site of injury. Areas of treatment can include knee, hip, shoulder and ankle.
With age, the cartilage lining the joints can shrink and wear thin causing friction between the bones. Bone spurs and inflammation can gradually enlarge the joint leading to the pain and dysfunction of arthritis.
Damages to the cartilage have been treated by cortisone and HA injections, micro fracture, debridement and grafting procedures. The results obtained by these techniques are so far unsatisfactory and in most cases, result in the formation of fibrous connective tissue with minimal mechanical strength at the affected area.
Not only does PRP stimulate cellular activity and the process of regeneration and repair, it also improves bone and cartilage recovery, as well as reduce inflammation and pain which could potentially inhibit the deteriorating effects of age and slow the progression of arthritis.
The primary goal of PRP is to resolve pain through healing, therefore, it could prove to have lasting results. Initial improvement may be seen within a few weeks and gradually increase as healing progresses. Research studies and clinical practice have demonstrated PRP injections to be very effective at relieving pain and returning patients to their normal lives.
Ultrasound and MRI imaging have both shown definitive tissue repair after PRP therapy thereby confirming the healing process. The need for surgery can also be greatly reduced by treating injured tissues before the damage progresses to an irreversible condition.
Early results are promising that PRP placed in the preparation site of a dental implant will promote and accelerate osteointegration. This may be beneficial in the maxilla, in areas of previous failures, in type IV bone, in osteoporotic women, etc.
PRP combined with ultra-pulsed fractional CO2 laser had a synergistic effect on PRP therapy for facial rejuvination (Hui et al, 2007). Combined application:
- Effectively reduces facial wrinkles
- Significantly improves skin texture and elasticity
- Relieves coarse pores, pigmentation, and erythema caused by laser therapy.
Other clinical studies have demonstrated that PRP induces the proliferation of new fibroblasts within the first few hours. PRP treatment resulted in notable increased rates of fibroblast migration and also induces the synthesis of collagen fibres that are of higher density and quality.
Platelet rich plasma contains the bioactive proteins which act as the catalyst for accelerating the wound healing process. With the increased level of growth factors present in PRP, the tissue maturation phase is accelerated and the overall healing process is significantly improved in terms of post-operative pain, swelling, infection and establishment of tissue texture, colour and contour. PRP’s cohesive nature and its hemostatic properties also allow for minimal bleeding.
Growth factors found in PRP permit accelerated tissue regeneration. It can be used to treat corneal lesions and dystrophy, superficial punctuate keratitis, severe dry eye-related ocular surface disorders, ocular GvHD, recurrent erosion syndrome, neurotrophic keratopathy, keratopathy with loss of epithelial-stromal tissue resulting from chemical or physical traumas, sicca syndrome and/or Sjögren’s syndrome.
It also provides nutritional factors necessary to maintain cellular feasibility in the epithelial repair process while reducing the risk of contamination and infection.
Administration of a single intra-articular injection of autologous PRP resulted in significant improvements in dogs suffering from OA involving a single joint
(Click here to download full article)
The purpose of this trial was to determine the efficacy of a single IA injection of an autologous platelet concentrate for treatment of osteoarthritis in dogs. Dogs were randomly assigned to a treatment or control group. Dogs in the treatment group were then sedated, and a blood sample (55 mL) was obtained. PRP was then injected intra-articularly within 30 minutes. Control dogs were sedated and given an intra-articular injection of saline (0.9% NaCl) solution. Assessments were repeated 12 weeks after injection of platelets or saline solution.
For control dogs, lameness scores, pain scores, and PVF at week 12 were not significantly different from pre-treatment values. In contrast, for dogs that received platelet injections, lameness scores (55% decrease in median score), pain scores (53% decrease in median score), and PVF (12% increase in mean PVF) were significantly improved after 12 weeks, compared with pre-treatment values
It was concluded that in dogs suffering from OA involving a single joint, administration of a single intra-articular injection of autologous platelets resulted in significant improvements 12 weeks later, as determined by subjective (ie, owner-assigned scores for severity of pain and lameness) and objective (ie, PVF) measures.
A single intralesional treatment with PRP contributes to an earlier reduction of lameness and to an advanced organization of repair tissue
(Click here to download full article)
The purpose of this trial was to evaluate the effect of a single treatment of equine superficial digital flexor tendon (SDFT) disease with PRP on clinical and ultrasonographic parameters
Using a placebo-controlled clinical trial design, 20 horses with naturally occurring tendinopathies of forelimb SDFTs were randomly assigned to the PRP-treated group (n = 10) or control group (n = 10) after clinical and ultrasonographic examination. The SDFTs received an intralesional treatment with autologous PRP or were injected with saline, respectively (day 0).
Compared to day 0, lameness decreased significantly by week 8 after treatment with PRP and by week 12 in the control group. Ultra-sonographically there was no difference in the summarized cross-sectional area between the groups at any time point.
Ultrasound tissue characterization showed that echo types representing disorganized matrix decreased significantly throughout the observation period in the PRP-treated group.
Echo type II, representing discontinuous fascicles, not yet aligned into lines of stress was significantly higher 24 weeks after PRP treatment. 80% of the PRP treated horses reached their previous or a higher level of performance after 12 months compared to 50 % in the control group.
A single intralesional treatment with PRP up to 8 weeks after onset of clinical signs of tendinopathy contributes to an earlier reduction of lameness compared to saline treatment and to an advanced organization of repair tissue as the fibrillar matrix is getting organized into fascicles while remodelling continues.
Long-term, PRP treatment has the potential to increase the number of horses reaching their previous level of performance. Earlier treatment of tendinopathy with PRP should be considered to enhance these effects
PRP treated wounds showed more granulation formation and angiogenesis, faster epithelialization and collagen deposition than control wounds.
(Click here to download full article)
This study was conducted to identify the effectiveness of platelet-rich plasma (PRP) and efficacy of intralesional injection as a method of application to acute cutaneous wounds in dogs
Autologous PRP was separated from anticoagulant treated whole blood in three dogs. Cutaneous wounds were created and then treated by intralesional injection of PRP in the experimental group, while they were treated with saline in the control group on days 0, 2 and 4. The healing process was evaluated by gross examination throughout the experimental period and histologic examination on day 7, 14 and 21.
In PRP treated wounds, the mean diameter was smaller and the wound closure rate was higher than in the control. Compared with control wounds, total granulation indexes of PRP-treated wounds were increased on days 7 (p = 0.040) and 14 (p = 0.031).
The upper granulation index of PRP-treated wounds on Day 7 was significantly higher (p = 0.006) than that of the control while on day 14, the lower granulation index of the PRP-treated group was higher (p = 0.000)
The number of vessels was highest on day 7 in both the control and PRP-treated wounds and decreased gradually over the experimental period. More vessels were observed in the PRP-treated wounds than the control wounds on day 7 (p=0.0000). On day 7, PRP-treated wounds also displayed more collagen fibers than control wounds. The collagen fibers in all of the PRP-treated groups became denser and more abundant than those in the control group on day 14.
At day 21, most of the midportions and all of the upper portions of the dermis in PRP-treated wounds showed tightly packed collagen fibers running parallel to each other and the epidermis relative to control wounds.
RESOURCES FOR PET OWNERS
Xediton Pharmaceuticals offers a variety of services and resources to pet owners
The following colleges and associations offer a tool on their websites that allow pet owners to locate a veterinarian in their area. Click the link below to locate a vet near you
|British Columbia||College of Veterinarians of British Columbia|
|Alberta||Alberta Veterinary Medical Association|
|Saskatchewan||Saskatchewan Veterinary Medical Association|
|Manitoba||Manitoba Veterinary Association|
|Ontario||College of Veterinarians of Ontario|
|Quebec||Ordre des Médicins Vétérinaires du Quebec|
|New Brunswick||New Brunswick Veterinary Medical Association|
|Newfoundland||Newfoundland and Labrador Veterinary Medical Association|
|Nova Scotia||Nova Scotia Veterinary Medical Association|
|Prince Edward Island||PEI Humane Society|
Click here to download full Prescribing Information for Revival PRP®
PRP Therapy for horses
Platelet-rich Plasma Therapy Explained
For cranial cruciate ligament ruptures (CCLR) in small animals, surgery has typically been the only option. Click here to learn about how PRP therapy is a potentially beneficial adjunct treatment to surgery. This article talks about both the clinical benefits as well as limitations of PRP use in small animals with CCLR.
For many canine injuries, platelet-rich plasma has shown promising results in optimizing the healing environment after an injury. Click here to read more.
Early treatment and rehabilitation techniques are key to successful platelet-rich plasma therapy. Click here to learn how injecting PRP into a lesion within a few days of injury can stop the progression and growth of a lesion and prevent scar tissue formation
With recent advances made in the field of regenerative medicine, platelet-rich plasma therapy is becoming a more widespread treatment option offering vastly improved healing. Click here to read how this approach works to create real tendon tissue instead of scar tissue.
Click here to download the Revival PRP® Patient Brochure
To learn more about Revival PRP®, please enter your name and email address below and click submit.
FREQUENTLY ASKED QUESTIONS
PRP is then injected or applied directly into the injured area causing the platelets and growth factors to activate. There is also recruitment of other healing proteins and factors to the area resulting in the healing and regeneration of tissue.
PRP is autologous and does not provoke an immune response and is therefore perceived to have a high margin of therapeutic safety (Textor 2014).
Since PRP is prepared from autologous blood, theoretically there are minimal risks for disease transmission or immunogenic reactions (Wang-Saegusa et al. 2011).
Adverse effects are rare, however, there is always a small risk of injection site morbidity, infection or injury to nerves or blood vessels. Scar tissue formation and calcification at the injection site have been reported as well (Dhillon et al. 2012).
It is also very rare that development of antibodies against clotting factors V and IX leading to life-threatening coagulopathies have been reported. However, to date there is no compelling evidence of any systemic effects of a local PRP injection (Dhillon et al. 2012).
Acting growth factors also attach to cell surfaces rather than to the nucleus, which minimizes the chance of tumor formation using a negative feedback control (Ko 2010).
Pet owners can see a significant improvement in symptoms and function in as little as two to three weeks. It reduces pain, increases mobility and increases flexibility as the treatment works to heal the injured or dysfunctional area. This may eliminate the need for more aggressive treatments such as long-term medication or surgery.
• Ligament sprains or tears
• Hip dysplasia
• Elbow dysplasia
• Muscle tears
• Chronic wounds
Equine PRP preparations will require more blood (about 20ml) to yield approximately 12-14ml of plasma.
• REVIVAL PRP® has an advanced separator gel technology which allows for separation of the red and white blood cells so that only the plasma rich in healing platelets and proteins will be injected into the animal. The unique properties of the gel trap pro-inflammatory granulocytes below the gel. These granulocytes do not help regeneration and may contribute to a catabolic effect, so it is an ideal system when a veterinarian recommends it for your animal’s joint injury.
• REVIVAL PRP® is a sterile and closed system, ensuring that your vet obtains a clean PRP preparation each time.