PLATELET-RICH PLASMA AND STEM CELLS
Regenerative medicine is a relatively new branch of medicine which emerged with the 21st century, and pertains to the stem cells and their capacity to differentiate into other cells and tissues, thereby opening up great possibilities for the treatment of numerous diseases and injuries. In addition to the stem cells - Bone Marrow Stem Cells (BMSC) and Mesenchymal Stem Cells (MSC), the treatment of diseases and injuries of the osteoarticular system by regenerative medicine entails the use of Platelet-rich plasma (PRP).
Regenerative medicine is an invaluable option for the treatment of diseases and injuries in cases where many other treatment modalities fail to achieve the desired response.
Ličnim iskustvom koje je bazirano na preko 100 000 aplikacija plazme obogaćene trombocitima (PRP) personalizovanom metodom, u zavisnosti od simptomatologije pacijenta i kliničkog nalaza, dokazan je ogroman potencijal liječenja ovim terapijskim postupkom.
After two decades of treating patients’ injuries and diseases surgically in his orthopedic practice, Aleksandar Jakovljević MD PhD has been dealing with the methods of regenerative medicine since 2011 with impressive therapeutic results.
Personal experience based on over 80,000 applications of platelet-rich plasma (PRP) by a customized method, depending on the patient's symptoms and clinical findings, has proven the enormous potential of treatment with this therapeutic procedure.
The indications for the use of PRP are numerous, and one of the most common is degenerative knee changes in middle and old age, especially in women. Then, there are degenerative lesions or diseases and injuries of the shoulders, elbows, wrists, hands, spine, hips, ankles, feet, heels, muscles, tendons…
An important task is the treatment of athletes with injuries, as well as the overexertion syndromes. In the case of fresh injuries to muscles, tendons and joints, it is important to initiate the therapy as soon as possible, as it has been proven that methods of regenerative medicine yield the best results if applied within the first 24 hours after the injury.
Method of Performing the Procedure
The PRP procedure at our clinic involves blood sampling, followed by short-term processing (centrifugation), and application by injection into a painful or injured region. During the application, the patient may feel pain of lesser intensity, which may sometimes last for a couple of hours or a few days after the intervention, which is a normal reaction. Minor hemorrhage may occur at the application spot. The whole procedure takes 20-30 minutes. It is common for a patient to receive 3-5 doses of PRP 5 to 7 days apart.
U okviru našeg protokola, pristup svakom pacijentu je individualan, a količina krvi, broj doza i vremenski interval između doza se određuju u zavisnosti od indikacija i simptomatologije, na osnovu kliničke procjene ljekara.
Considering that the patient’s own blood is used, there are no allergic reactions.
The patients are advised not to take drugs which affect the platelet activity (aspirin, diclofenac, ibuprofen, ketonal, etc.) for a few days before application of the PRP.
The best results are achieved when the application of the PRP is combined with physical treatments.
Contraindications
PRP se ne primjenjuje kod pacijenata sa malignim bolestima na aktivnom liječenju hemioterapijom, infektivnim febrilnim stanjima, hematološkim oboljenjima, dok kod pacijenata koji koriste antikoagulanse ili kortikosteroide odluka o primjeni PRP se donosi individualno.
STEM CELLS
Stem cells are pluripotent cells with the capacity to self-renew, differentiate and proliferate. They have the ability to develop into any cell and thus build different tissues. They retain this ability throughout their lifetime, i.e., they form a reserve for damaged tissues and organs.
We must distinguish between 2 models of stem cell treatment. One option is allogeneic transplantation, in which the patient receives stem cells from an appropriate compatible donor - from a relative or from a person with whom he/she is not related. Another option is autologous transplantation in which the patient receives his own stem cells.
Stem cells are divided into embryonic stem cells (ESC) and adult stem cells (ASC).
Embryonic Stem Cells (ESC)
Embryonic stem cells represent cell cultures which form after conception. They develop from the epiblast tissue of the inner mass of blastocyst cells. Blastocyst is the early development of an embryo - approximately 4 to 5 days old fetus. Embryonic cells are pluripotent and theoretically may differentiate into cells derived from all three embryonic layers. Therefore, they may develop into any of more than 200 types of adult human body cells when they have sufficient stimulation for a specific cell type. They were first isolated from the inner layer of mouse embryo cells in 1981.
These cells are only available if the embryo is destroyed in the laboratory, which is completely unethical from a medical as well as from a legal point of view. Hence, although they seem ideal for the processes of regenerative medicine, there are a number of ethical and practical issues which significantly complicate and restrict their application.
Adult stem cells (ASC)
Adultne matične ćelije su postnatalne ćelije, tj. ćelije koje nakon rođenja ostaju u našem organizmu i učestvuju u procesima reparacije oštećenog tkiva. One stare kao i sam organizam, pa vremenom gube na vitalnosti. Izoluju se iz organizma nakon rođenja i imaju manji diferencijalni potencijal, ali puno više prednosti kada se govori o njihovoj primjeni u regenerativnoj medicini. Adultne matične ćelije se iz organizma dobijaju punkcijom koštane srži karličnih kostiju ili drugih dugih kostiju ili masnog tkiva. Dijele se na matične ćelije koštane srži – Bone Marrow Stem cells (BMSC) i matične ćelije masnog tkiva – Adipose mesenchymal stem cells (AMSC).
Bone marrow stem cells are obtained (BMSC) by penetrating the bone with appropriate equipment, also known as trepanning, then harvesting the bone marrow and processing it according to the protocol. The most common bone marrow aspiration is performed on the pelvic bones or other long bones.
Obtaining stem cells from adipose tissue (AMSC) is performed by liposuction, and after obtaining the adipose tissue, stem cells are processed and prepared according to the protocol. Adipose tissue is obtained from the region of anterior abdominal wall. The procedure takes place in the operating room, by observing the principles of asepsis and antisepsis.
The presence of stem cells, as well as the cytokines and other chemical signals they secrete, enables fast and efficient tissue regeneration at the spot of application.
