“The Efficacy of Recombinant Platelet-Derived Growth Factor on Beta-Tricalcium Phosphate to Regenerate Femoral Critical Sized Segmental Defects: Longitudinal In-vivo Micro-CT Study in a Rat Model” [Citation1] fits in among the recent numerous publications from orthopedic and dentistry journals that deal with biological treatment options for bone loss. As of today, the number of publications listed in the PubMed database dealing with the effectiveness of autogenous growth factors obtained from blood platelets in treating bone loss amounts to 256 positions. 148 of these publications deal with animal model research projects and 65 are clinical works comparing the results of groups of patients or short series thereof. The remaining 43 publications are laboratory analyses or meta-analyses of literature. Few of these articles, however, have high levels of evidence. PRP and the commercial bone-artificial materials provide undoubtedly a new quality of treatment in the arsenal of therapeutic methods for dealing with bone pathologies.
The authors of this work present a fine animal experimental model that has clinical implications. These are nonetheless still selective observations that do not necessarily steer our knowledge in the direction of determining recommendations for the use of biological treatments in practical clinical applications. The question of the safety of the application of locally increased concentration and its combination with many cell activity stimulators remains essential. Nearly all publications point to the safety of applying PRP, both in isolation and combined with other biologically active substances [Citation2–4]. We optimistically assume that they will conduct reparative changes of the damaged structures. We are still not able to identify which factors, in what relational capacity of concentration, and in which concrete clinical situations lead to the reconstruction of tissue loss without the risk of excessive hyperplasia or even cancerous transformations. The commercially-elaborated systems of PRP preparation differ among themselves to such an extent, that it is not clear which of them should be used in the preparation of the PRP for each individual medical condition. For this reason a standardized preparation method is indispensable.
The trend of looking for treatment options that bring together industrially-produced tissue substitutes and biological growth factors gives reason for concerned. We need to bear in mind that we cannot avoid such activities, especially given the existing and growing pressure from the manufacturers of tissue substitutes. Regenerative medicine does not yet have answers to the questions how and what chemical compounds or cellular ingredients are safe in their reconstructive actions. Therefore, I think that proceeding by putting together industrial substitutes of confirmed bio-neutrality with factors that do not have yet a proven or even a fully explored biological activity quality is premature.
Numerous publications exist that undermine the scientific value of research on the effectiveness of PRP in reconstructive treatments, due to their lack of methodological uniformity [Citation5, Citation6]. There are publications speaking to the unfavorable and unintended interactions of autogenous tissue reconstruction stimulators as well as to the variable influences of those same compounds depending on the concentration achieved in the locus of application [Citation7].
I contend that the research undertaken by the authors is right. Lacking data, especially information on the disadvantages obtained from laboratory research on animal models, we will surely not come closer to the safe and commonly-approved clinical research model. Mainstream scientific enquiry should be directed at fundamental research on the formulation of specific models catering to the identifiable, frequent, and, simultaneously diversified clinical practice needs. Hence, research must be designed well and thoroughly conducted in order to obtain credible results and thereby scientific evidence of the effectiveness of the proposed biological treatment methods, not only in orthopedics.
DECLARATION OF INTEREST
The author report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
REFERENCES
- Badwelan M, Alkindi M, Ramalingam S, Nooh N, Al Hezaimi K. The efficacy of recombinant platelet-derived growth factor on beta-tricalcium phosphate to regenerate femoral critical sized segmental defects: longitudinal in-vivo micro-CT study in a rat model. J Invest Surg. 2020;33(5):489–490.
- Zanon G, Combi F, Combi A, Perticarini L, Sammarchi L, Benazzo F. Platelet-rich plasma in the treatment of acute hamstring injuries in professional football players. Joints 2016;4(1):17–23. doi: 10.11138/jts/2016.4.1.017. eCollection 2016Jan-Mar.
- Smith OJ, Kanapathy M, Khajuria A, et al. Protocol for a systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing. Syst Rev. 2017;6(1):111. doi: 10.1186/s13643-017-0505-8.
- Fukawa T, Yamaguchi S, Akatsu Y, Yamamoto Y, Akagi R, Sasho T. Safety and efficacy of intra-articular injection of platelet-rich plasma in patients with ankle osteoarthritis. Foot Ankle Int. 2017;38(6):596–604. Epub 2017 Apr 11. doi:10.1177/1071100717700377.
- Vannini F, Di Matteo B, Filardo G. Platelet-rich plasma to treat ankle cartilage pathology - from translational potential to clinical evidence: a systematic review. J Exp Orthop. 2015;2(1):2. doi: 10.1186/s40634-015-0019-z. Epub 2015 Feb 12.
- Dai WL, Zhou AG, Zhang H, Zhang J. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy 2017;33(3):659–670.e1. Epub 2016 Dec 22. doi:10.1016/j.arthro.2016.09.024.
- Kuffler DP. Platelet-rich plasma promotes axon regeneration, wound healing, and pain reduction: fact or fiction. Mol Neurobiol. 2015;52(2):990–1014. doi: 0.1007/s12035-015-9251-x. Epub 2015 Jun 6. doi:10.1007/s12035-015-9251-x.