Plasmolifting, PRP and Other Methods of Regenerative Therapy Based on Autologous Blood Plasma.

By Renat Akhmerov

This book is an invitation to rethink paradigms for understanding mechanisms underlying the therapeutic effects of autologous blood plasma. As such, it introduces readers to the Plasmolifting method and its applications in various branches of medicine. The book offers not only the conceptual framework for implementation of this method and detailed treatment protocols but also a discussion of new forms and methods of autologous blood plasma administration. Moreover, it provides a detailed look at the autohemotherapy, the true predecessor and the prototype of autologous blood plasma therapy, and a comprehensive summary review of different types and preparation techniques of platelet concentrates that exist today. The book includes numerous clinical cases to illustrate the theoretical ideas.

• Language: English
• Publisher: Renat Akhmerov
• Release date: Sep 10, 2020
• ISBN: 9785903634460

Renat Akhmerov

Renat Akhmerov, D.Sc., Ph.D., plastic and maxillo-facial surgeon, serves as a Professor of Oral and Maxillofacial Surgery at New Vision University, Georgia. He devoted much of his career to the study and application of techniques for natural tissue repair and developed the Plasmolifting method based on the use of autologous blood plasma. He is author of more than 75 research papers.

Book preview

Plasmolifting, PRP and other methods of regenerative therapy based on autologous blood plasma

Renat Akhmerov

Moscow — Frankfurt

2020

Second edition, revised and supplemented

Plasmolifting, PRP and other methods of regenerative therapy based on autologous blood plasma

Copyright © 2020 Renat Akhmerov

All rights reserved.

ISBN 978-5-90363-446-0

All rights reserved, including the right to reproduce this book or any portion thereof in any form whatsoever, without prior written permission of the author, except in the case of brief quotations embodied in critical reviews and other noncommercial uses subject to copyright law.

Dedicated to my family, my wife Olesya and our sons Timur and Eldar Akhmerov

I would like to express my deepest gratitude to my associates and colleagues for their substantial contribution to the development of Plasmolifting, a new method of treatment with autologous blood plasma. Thanks to them, the selfless and challenging labour of doctors, scientists and methodologists turned into a smooth and exciting process of acquiring knowledge of the world of human capabilities. I very much appreciate all the scientists working or collaborating with me. You will find their names on these pages.

Particularly helpful to me during this time was our scientific editor, who managed to organize my thoughts and hypotheses and draw up a brief historical overview from a correct perspective.

Table of Contents

List of abbreviations

INTRODUCTION

Part I. HISTORY AND THEORY

Chapter 1. ORIGINS OF THE PLASMOLIFTING METHOD

Chapter 2. AUTOLOGOUS BLOOD PLASMA THERAPY

Chapter 3. PATHOGENETIC MECHANISMS OF ACTION OF AUTOLOGOUS BLOOD PLASMA

3.1. The first step: the vascular wall response

3.2. The second step: platelet adhesion

3.3. The third step: activation and degranulation of platelets

3.4. Growth factors and mechanisms underlying their effects on tissues

3.5. Proliferation inhibitors and their effect on tissue cells

Chapter 4. CONCEPTUAL FRAMEWORK FOR THE IMPLEMENTATION OF PLASMOLIFTING METHOD

Part II. REALITY AND PRACTICE

Chapter 5. MODERN FORMS OF AUTOLOGOUS BLOOD PLASMA APPLICATION. BASIC EQUIPMENT AND SUPPLIES FOR PLASMOLIFTING THERAPY

Chapter 6. AUTOLOGOUS NATIVE BLOOD PLASMA OBTAINED BY PLASMOLIFTING METHOD

6.1. Applications in Cosmetic Dermatology and Aesthetic Medicine

6.2. Applications in Dentistry

6.3. Applications in Orthopedics, Traumatology and Sports Medicine

6.4. Applications in Gynecology

6.5. Applications in Urology

6.6. Applications in Treatment of Burn Wounds and Chronic Non-Healing Wounds

6.7. Applications in Veterinary Medicine

Chapter 7. GELTHERAPY: PLASMOGEL OBTAINED BY PLASMOLIFTING METHOD

7.1. Applications in Dentistry and Cosmetic Dermatology

Chapter 8. PLASMOLIFTING POWDER: PLASMA-POWDER OBTAINED BY PLASMOLIFTING TECHNOLOGY

8.1. Applications in Otorhinolaryngology, Dentistry and Surgery

Chapter 9. STUDY OF THE PHYSICOCHEMICAL PROPERTIES OF HEAT TREATED AND DRIED BLOOD PLASMA OBTAINED WITH PLASMOLIFTING TECHNOLOGY

9.1. Purpose of the Study

9.2. Materials and Methods

9.3. Study Results

About the Author

List of abbreviations

ABP — autologous blood plasma

APHP — autologous blood plasma with a high platelet content

FH — femoral head

HJ — hip joint

MRI — magnetic resonance imaging

PDGF — platelet-derived growth factor

PRF — platelets reach fibrin

PRP — platelet rich plasma

TGF — transforming growth factor

US — ultrasound

VEGF — vascular endothelial growth factor

INTRODUCTION

Dear Reader! Five years have passed since the book Plasmolifting as a method of regenerative therapy based on autologous blood plasma first appeared.

In that book, my colleagues and I tried to group together all the most relevant and latest data and findings that could reflect the main ideas and key details concerning both autologous blood plasma therapy in general and the Plasmolifting method in particular. However, just a few months after the publication of the book, it became apparent that this information and the underlying knowledge were rapidly losing its relevance. While continuing to actively conduct research and seeing discoveries and developments of colleagues with great interest, I noted that scientific data volumes started skyrocketing, inevitably necessitating a rethinking of the mechanisms of action of autologous plasma and approaches to its use. In this context, any generalizations and recommendations quickly become irrelevant and obsolete.

Having evaluated the overall situation and the trend of events, I concluded that it was unwise to continue work on subsequent monographs and guidelines devoted to this topic, and decided to focus on collecting the most insightful and conclusive scientific publications. So, on the site dedicated to the Plasmolifting method, a constantly updated specialized library appeared.

Studying the results of research conducted by scientists around the world, and comparing their hypotheses and theories, I could not help but notice that, despite the existence of many techniques for autologous blood plasma obtaining (PRP, PPP, PRF, L-PRP, etc.), there is neither standard classification of its preparations nor a consensus on what blood elements (platelets, white blood cells, red blood cells, etc.) and in what combination provide the therapeutic effectiveness of these techniques. Summarizing practical material also seemed a remote possibility, as the speed and quality of biological response of different body tissues and organs vary significantly and, therefore, the rules that work, for instance, in neurology, turn out to be inapplicable in aesthetic medicine or urology.

To find answers to my questions, I plunged deeply into new research and clinical practice. My hard four-year work bore fruit: new articles, inventions, and patents appeared. Moreover, new forms and methods of autologous blood plasma administration have been developed (thermogel, plasma powder, frozen suppositories, leukocyte-platelet gel), which make it easy to deliver blood plasma to anywhere in the body. But I consider the greatest accomplishment of these years the rules, premises, and postulates that I formulated for the use of autologous blood plasma in the process of studying it.

What is the novelty of these postulates? First of all, unlike the proponents of Robert Marx’s PRP theory, I am not inclined to regard blood plasma as an officinal preparation and, therefore, a quantitative assessment of the elements of plasma obtained after centrifugation seems to be a wrong-headed approach. Not for one moment wishing to deny the revolutionary character of the PRP method nor to belittle the importance of the contributions of other scientists to the development of this therapy area, I still consider false the idea that the concentrations of blood plasma components correlate with the treatment outcomes. Of course, the rearrangement of blood cells is essential, but only when considering plasma as tissue or even as a separate organ. In fact, all the rules underlying the Plasmolifting method are those for tissue auto-transplantation. And there is no place for the principles of pharmacology. The notion that the use of autologous blood plasma in medicine is similar to the transplantation of autologous tissues led to a further evolution of scientific thought.

Curious to relate, business processes have played a crucial role in this evolution. Scientists often prove to be powerless against the cruel and ruthless marketplace laws, falling into difficult and painful situations because of them. The realization of scientific ideas is carried out by business professionals, who are far from always being choosy in the means of achieving their primary goal: obtaining benefits. Each type of activity has its goals and methods for achieving them; there is no debate. However, the laws of science often conflict with the harsh realities of the commercialization of scientific research results. With the advent of therapeutic procedures based on the use of autologous blood plasma, a crisis gradually arose in the corresponding sector of the healthcare services market. The competition between companies promoting or manufacturing medical devices for PRP became ever fiercer. Manufacturers and regulatory authorities, as well as doctors from different countries, have focused on the quality of medical devices and the legitimacy of their use in various fields of medicine. Ideas and methods were pushed into the background, and fights started around the main object of commercialization, i.e., blood collection tubes. The blood collection tube war was waged by manufacturing plants, distributors, professors and coaches, methodologists, public health officials, heads of medical institutions, and many others. The patient became the victim of this war — the very patient who should be the primary beneficiary!

But the crisis can be used to reach a new qualitative level. By the way, one of the principles of the Plasmolifting method says that autologous blood plasma injections induce natural pathophysiological responses characteristic of the bruise formation, which, in turn, creates stress, in other words, a crisis, for tissues and organs.

Today I have a lot to share with my colleagues, whom I invite to take advantage of the experience gained by my co-authors and me during a long journey, which began at the dawn of the 21st century and was titled the Plasmolifting method. I would like to conclude this introduction with the phrase that I have already used in my first book: blood plasma is an amazing substance that has not yet been fully understood, and which improves health and prolongs life.

Renat Akhmerov, D.Sc., Ph.D.

Plasmolifting Method Developer

Part I

HISTORY AND THEORY

Chapter 1

ORIGINS OF THE PLASMOLIFTING METHOD

Throughout human history, men have been interested in treatments with blood and its components. Many attributed magical properties to blood, considering it the elixir of youth, a font of strength, or a symbol of eternal life. For example, the ancient Roman surgeon and philosopher Galen believed that blood contained a life spirit, captured out of the air by the act of breathing and transported to the various organs and tissues of the body [1]. The Flemish alchemist Van Helmont went further by claiming that blood is a substance obtained from the dust of the macrocosm, i.e., the quintessence of all that exists, so that elements of all that existed were contained in blood. [2, 3] In this book, however, we shall turn our attention away from mythology and mystical concepts, nor will we dwell on the rituals borne out of such popular beliefs. Instead, we shall direct our gaze towards solid facts grounded in authoritative sources. In this chapter, we hope to follow this method to outline a decisive picture of the historical development of auto-hemotherapy, the true predecessor and the prototype of autologous blood plasma therapy.

Our historical account naturally begins with the question: when did blood begin to be used for medicinal purposes? The answer may never be known. There are reports that even the Inca successfully practiced human blood transfusion [4]. According to other sources, one could trace the first treatment with blood back to 47 A.D. [5]. However, other sources place the origin at least four centuries earlier, claiming that Hippocrates himself was an adept of such methods [6]. That is, following these sources, he not only performed and described venesection (a.k.a. bloodletting) procedures but also found blood to be effective in the treatment of skin ulcers.

The picture becomes clearer in more recent history. In Europe, interest in blood transfusion became widespread only after the English physiologist William Harvey published Estudo anatômico do movimento do coração e do sangue nos animais [Anatomical study of the movement of the heart and blood in animals] in 1628. In that treatise, Harvey first formulated his theory of blood circulation and provided supporting empirical evidence [7, 8]. In the same year, the Italian doctor Giovanni Colle, inspired by Harvey’s explanations, performed the first blood transfusion in animals [9]. Less than three decades later, in 1667, the personal physician of King Louis XIV, Jean-Baptiste Denys, transfused animals’ blood into three patients. The first two received small amounts of sheep’s blood, apparently being able to withstand any allergic reaction due to the small amount of blood transfused. The third patient, having received calf’s blood, died, leading to Denys’s arrest. [10, 11]. Despite Denys’s subsequent acquittal and the fact that the fatality was due to arsenic poisoning rather than the transfusion, the procedure was banned in France and subsequently in England and Italy [12]. Over a century passed until interest was revived in 1796 due to the efforts of Erasmus Darwin, the grandfather of Charles Darwin. Erasmus Darwin ardently insisted on the effectiveness of blood transfusion for the treatment of various diseases [10]. Furthermore, the fact that there were few methods available to treat heavy bleeding and acute anemia induced physicians to turn to blood transfusion as a possible resource. In 1819, the London obstetrician James Blundell [13], realizing that blood from animals of different species were incompatible, successfully carried out the first documented first human-to-human blood transfusion. The replacement of animal blood with human blood did not lead to a reduction in the alarmingly high mortality rate. Therefore, a proposal was put forward to use a physiological saline solution instead of blood [14]. The resulting procedures offered no noticeable side effects and did not lead to the dangerous coagulation which occurred with the earlier practice. Nonetheless, interest in, as well as further research into, the therapeutic potential of blood continued unabated.

The consequences of blood transfusion remained unpredictable until the beginning of the 20th century, when the Vienna bacteriologist Karl Landsteiner [15], and later his colleagues Adriano Sturli and Alfred Von Decastello [16], discovered the four blood groups in 1902. This revelation finally provided the answer to the puzzle, and thereby issued in a revolution in surgical techniques. Surgery soon rid itself of the high risk of massive and fatal bleeding.

However, hindsight may be misleading, and it remains uncertain whether this discovery was responsible for the conviction of researchers at that time that a patient’s own blood could turn out to be not only the safest but also the most effective therapeutic agent for that patient. Be that as it may, a half-century later, the German surgeon Max Schede advanced a method, now called Schede’s clot, for treating bone necrosis with autologous blood [17]. Some sources place the beginnings of auto-hemotherapy back to 1898 when the American doctors Carl E. Elfström and Axel V. Grafström used patients’ own blood in order to treat croupous pneumonia [18].

We digress for a moment to note that tracing the origins of the term auto-hemotherapy can be somewhat confusing. In the late nineteenth and early twentieth centuries, the term auto-hemotherapy as such did not exist. Until the term came into its own, all procedures to inject the patient with either autologous blood or in fact any other biological fluids were subsumed under the terms serum therapy or auto-serotherapy. At that time, two main types of therapy were known involving the extraction of the pathogen from the body and its reinjection into tissues to trigger an appropriate reaction. These were auto-serotherapy and autogenic vaccines, both widely described in the literature as effective methods of treating a number of common pathological conditions [19–62].

The origins of traditional serum therapy followed the publication of works of Kitasato Shibasaburo and Emil von Behring in the 1890s [63, 64]. This therapy proved successful, although some reviewers proposed that any beneficial effect associated with it was in reality due to autogenous vaccine therapy [4]. The traditional serotherapy of Kitasato and Von Behring involved the intravenous administration of the immunized serum and the presumptive transfer of passive immunity to the patient. The subsequent auto-hemotherapy procedure consisted of simple reinjections of the patient’s own blood, either intramuscular or subcutaneous, partially repeated it. The popularity of reinjections of autologous blood serum increased significantly since the publication of the works of Bodo Spiethoff in 1913 [65, 66].

To confuse the history further, the terms serotherapy and serum therapy meant both intravascular and extravascular (i.e., intramuscular and subcutaneous) injections; eventually it was only the extravascular methodology that became known as auto-hemotherapy.

The question as to the difference between autogenous vaccine therapy and auto-serotherapy naturally arises. Autogenous vaccine therapy is based on the discovery of Louis Pasteur who found that injecting attenuated microbes could protect animals from future exposure to virulent ones, and on the experiences of Almroth Wright as he subsequently used this discovery to create autogenous anti-typhoid vaccine. As S. Hale Shakman mentioned in his book, autogenous vaccines allow better dosage control than does auto-hemotherapy. The down side was that the creation of a vaccine required much more time and resources, along with the risk of inadvertently excluding or altering the disease-causing agent. If such an agent is in one’s blood, auto-hemotherapy ensures its inclusion. Auto-hemotherapy in any case ensures the introduction of this microorganism into the tissue — provided that it is present in the blood. Wright has repeatedly criticized auto-serotherapy [4], arguing that it was only a variation on bacterial vaccines, and thus inheriting the vaccine’s success. Wright’s criticisms aside, one can conclude that auto-hemotherapy clearly cannot be classified as passive immunization since the blood is received from the patients themselves rather than other donors with appropriate immunity. Furthermore, the results of the Edward Rosenow’s bacteriological research indicate that the effects of auto-hemotherapy may be attributed, at least partially, to the presence of the corresponding antigen in the blood; that is, auto-hemotherapy can act as a therapeutic vaccine [67]. It is assumed that auto-serotherapy, autopyotherapy (that is, reinjection of autogenic serum and pus, resp.), and similar therapies, act on the same principle.

The fact that auto-hemotherapy is usually not considered a form of vaccine therapy seems to be largely due to the difference in their historical origins. As just explained, the former developed out of serum therapy, an intravenous injection of immune serum obtained from an immunized person, and is said to transmit passive immunization. The latter, however, attempts to directly immunize the patient, thus being termed active immunization. This difference leads to the conclusion that one and the same procedure cannot be both serotherapy and vaccine therapy [4].

After this digression, we return to the historical narrative. In 1901, before the works of Spiethoff appeared, Valentin Jez reported on the subcutaneous reinjection of autologous serum taken from a patient’s vein, in the regime of treatment of erysipelas [68]. It is also documented that in 1905 August Bier used it to treat pneumonia [69], not relying on results of previous uses of autologous blood. However, despite the documentation of these and other earlier results in autohemotherapy, the French dermatologist Paul Ravaut became known as the pioneer in this method. In an essay published in 1913, he describes auto-hemotherapy as an effective method of treating dermatoses [70]. Ravaut’s article appeared in a French journal only a few months after Spiethoff’s report on similar use of autologous serum that was published in a German journal [65]. Spiethoff attempted to show that the credit belonged to him, not Ravaut, by calling attention to his report of the introduction of not only autologous immune serum but also autologous blood. His insistence that his discovery predated Ravaut’s fell on deaf ears.

We turn, then, to Ravaut’s better-known methods and justifications. He used the term auto-hematotherapy to describe his simpler method of reinjection of autologous whole blood; his data pointed to a significantly lower risk of infection during auto-hematotherapy than through the use of autogenous serum or heterologous blood. He further concluded that it was advisable to administer whole blood with the rationale that all possible beneficial elements in the blood were thereby supplied to the body. He also postulated that reabsorption of blood introduced under the skin would induce the body to produce more antibodies.

Spiethoff was not alone in refusing to give priority of discovery of auto-hemotherapy to Paul Ravaut. For example, Wien et al. [5] wrote that auto-hemotherapy developed upon the basis of the research of many scientists. They cited the following researchers who had published results before Ravaut: Naswitis (who had published results of the use of frozen then thawed blood); Dold (who had successfully applied autologous blood for the treatment of eczema), and Fauvet (who had received favourable results