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P406-P465-Sports Medicine/Arthroscopy Posters
Tuesday, Mar 19, 2013, 8:00 AM - 6:00 PM
Posters occur Tuesday through Saturday.
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McCormick Place, Academy Hall B
Systemic Performance-Enhancing Effects of Platelet-Rich Plasma (PRP) Injection
+Basic Science/Biologics (Sports Med/Arthro)
Injuries; Viscosupplement; Outcomes; Research / Clinical; Research / Basic
Alex H. Harris
, PhD, MS
Hyeon Joo Kim
Jason L. Dragoo
INTRODUCTION: The World Anti-Doping Agency (WADA) banned platelet-rich plasma (PRP) in competitive athletes in 2010 due to concerns that it may increase performance-enhancing growth factors. The ban on PRP was removed in 2011 due to limited evidence for a systemic effect of PRP, but the growth factors within PRP remain prohibited.
METHODS: To assess the effect of local PRP injection on systemic growth factors with suspected or known performance-enhancing effects, we measured serum hGH, IGF-1, IGFBP-3, bFGF, VEGF and PDGF-BB in 25 patients before (baseline), and 0.25, 3, 24, 48, 72 and 96 hours after PRP injection. Eating and exercise were prohibited the morning before testing. Growth factors were quantified by ELISA and the change relative to each individual’s own baseline was calculated, and analyzed by paired 2-tailed T-tests.
RESULTS: Nineteen males and six females with a mean age of 28.5 years (±11.3) underwent one intratendinous PRP injection with a mean volume of 3.7 mL (±1.3). Relative to serum, PRP contained significantly more bFGF (226 vs. 5 pg/mL), VEGF (1,426 vs. 236 pg/mL) and PDGF-BB (26,285 vs. 392 pg/mL), but IGF-1 and hGH were not elevated within PRP. Serum hGH increased by a mean of 16.0x at 0.25h and by 12.7x at 24h after PRP, but these results were not significant due to large variance. IGF-1 increased significantly by 1.08x at 24h (95% CI 1.009-1.148) and by 1.07x at 48h (1.002-1.143). bFGF increased significantly by 1.6x at 72h (1.02-2.20) and by 2.3x at 96h (1.07-3.50). VEGF increased significantly by 1.5x at 3h (1.14-1.94), 1.4x at 24h (1.17-1.66), 1.3x at 48h (1.12-1.52), 1.5x at 72h (1.15-1.84), and 1.4x at 96h (1.19-1.65). The product of IGFBP-3 x IGF-1 increased significantly by 1.35x at 96h (1.14-1.55).
DISCUSSION AND CONCLUSION: Serum IGF-1, VEGF and bFGF levels are significantly elevated following PRP injection, supporting a possible performance-enhancing effect of PRP. An indirect marker for hGH doping, the product of IGFBP-3 x IGF-1, also significantly increased after PRP. Importantly, the concentration of IGF-1 was lower in PRP relative to serum at baseline, so the observed increase in serum IGF-1 after PRP treatment is probably not due to the dose contained within PRP itself, but rather due to activating the hGH-IGF-1 axis. This is also supported by the observation that although [PDGF-BB] is 67x greater in PRP than in serum at baseline, PRP injection does not significantly alter circulating PDGF-BB. The increases in circulating IGF-1, bFGF and VEGF at specific times could be used in combination as a “molecular signature” to detect athletes recently treated with PRP. Testing for recent PRP treatment could deter athletes from intentionally using PRP as a doping vehicle, and may also be helpful to distinguish athletes treated with medically appropriate PRP therapy from those using exogenous hGH. IGF-1, VEGF and bFGF are elevated in PRP-treated patients, and are all explicitly banned in competitive sport by WADA.
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