Leukocyte-Rich Platelet-Rich Plasma Has Better Stimulating Effects on Tenocyte Proliferation Compared With Leukocyte-Poor Platelet-Rich Plasma

Keng-Yi Lin; Poyu Chen; Alvin Chao-Yu Chen; Yi-Sheng Chan; Kin Fong Lei; Chih-Hao Chiu

doi:10.1177/23259671221084706

Leukocyte-Rich Platelet-Rich Plasma Has Better Stimulating Effects on Tenocyte Proliferation Compared With Leukocyte-Poor Platelet-Rich Plasma

Orthop J Sports Med. 2022 Mar 15;10(3):23259671221084706. doi: 10.1177/23259671221084706. eCollection 2022 Mar.

Authors

Keng-Yi Lin¹, Poyu Chen², Alvin Chao-Yu Chen^{3

4}, Yi-Sheng Chan^{3

4}, Kin Fong Lei⁵, Chih-Hao Chiu^{4

6

7}

Affiliations

¹ Department of Medicine, Chang Gung University, Taoyuan.
² Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan.
³ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou.
⁴ Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou.
⁵ Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan.
⁶ Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan.
⁷ Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan.

Abstract

Background: Rotator cuff (RC) tendinopathy is one of the most common causes of shoulder pain. Platelet-rich plasma (PRP) has been frequently used in clinical scenarios, but its efficacy remains inconsistent.

Purpose: To investigate the different responses of human tenocytes from torn RCs to leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) in a 2-chamber coculture device.

Study design: Controlled laboratory study.

Methods: PRP was prepared using different platelet and leukocyte concentrations according to 5 groups: (1) LR-PRP with 5000 platelets/µL, (2) LR-PRP with 10,000 platelets/µL, (3) LP-PRP with 5000 platelets/µL, (4) LP-PRP with 10,000 platelets/µL, and (5) control with only culture medium supplementation and without PRP stimulation. Platelet-derived growth factor-AB (PDGF-AB) and transforming growth factor-β1 (TGF-β1) were measured in LR-PRP and LP-PRP via enzyme-linked immunosorbent assay. Microscopy, water-soluble tetrazolium salt assay, and quantitative real-time polymerase chain reaction were used to investigate the morphology, proliferation, and gene expression of RC tenocytes exposed to different PRP formulations. Data were collected from at least 3 independent measurements. The results were analyzed via 1-way analysis of variance, followed by the post hoc Bonferroni test.

Results: The ratio of leukocytes to 5000 platelets/µL was 29.5 times higher in LR-PRP than in LP-PRP (P < .05). In the 5000 platelets/µL groups, the levels of TGF-β1 and PDGF-AB were both significantly higher in LR-PRP versus LP-PRP (TGF-β1: 367.0 ± 16.5 vs 308.6 ± 30.3 pg/mL, respectively [P = .043]; PDGF-AB: 172.1 ± 1.8 vs 94.1 ± 4.2 pg/mL, respectively [P < .001]). Compared with the control group, RC tenocyte proliferation was 1.42 ± 0.01 and 1.41 ± 0.03 times higher in the LR-PRP groups with 5000 platelets/µL and 10,000 platelets/µL, respectively (P < .05). The expression of tenocyte-related genes was higher in tenocytes cultured in LR-PRP.

Conclusion: Both the LR-PRP groups with 5000 platelets/µL and 10,000 platelets/µL induced more growth factor release and increased RC tenocyte proliferation than did the LP-PRP groups.

Clinical relevance: In RC repair, LR-PRP may be better than LP-PRP for increasing the proliferation of tenocytes.

Keywords: leukocyte; platelet-rich plasma; rotator cuff; tenocytes.