A Simulacrum (Imitation) of PRP: Criticism of the Purity of Terminology, Its Misconceptions, Marketing and Reality

Author: Prof. Akhmerov R.R., MD, Developer of PRP technologies and protocols, Plasmolifting, Die Princessin auf der Erbse, Plasmoactive.

The present article offers an analysis of a persistent pseudoscientific discourse that has developed around PRP and is generously fuelled by manufacturers of test tubes and syringes. Their main advertising argument is their test tubes produce an allegedly higher concentration of plasma platelets. This marketing ploy misleads both doctors and patients.

Doctors merely possessing basic (not to mention in-depth) specialized knowledge can easily figure things out. However, many of them either deliberately ignore the real situation, or choose to support the myth of "miraculous" test tubes in order to justify the inflated cost of procedure. As a result, patients receive fewer PRP procedures than required, and the expected effect is weaker or absent altogether.

The fundamental principle of PRP lies not in the brand of a test tube, but in the doctor’s competence and the number of procedures. Unfortunately, today the term PRP has become a simulacrum — a copy of something non-existing – thus replacing the scientific approach with commercial interests. Hence in this article I shall discuss how and why this happened, and most importantly, what to do about it. I would like to note right away that I have previously discussed this topic in detail in my book “Regenerative Medicine Based on the Use of Autologous Blood Plasma”.

I realize that many people find it unprofitable to tell the truth, thus accepting conclusions based on fundamental knowledge of physics, biochemistry, physiology, as well as laboratory diagnostics. Yet my goal is to provide reliable information to patients and to enable them to independently understand the essence of the talk and to receive a truly effective and qualified treatment that uses their own plasma.

The origin of the term PRP and its original meaning

The term PRP (Platelet-Rich Plasma, i.e. plasma rich in platelets, or thrombocytes) was introduced by R. Marx and his co-authors. They took as a starting point for their argument the idea that platelets play a key role in tissue regeneration, and obtaining a concentration of 1 million platelets per 1 µl leads to a more efficient tissue repair.

However, the evidence for this hypothesis is still limited to studies in maxillofacial surgery conducted on rabbits. There have been no large-scale clinical studies in other areas of medicine confirming the effectiveness of this particular concentration.

It is important to note that the authors themselves have never claimed that this method was universal. They only developed a two-stage centrifugation system that really allows to achieve a concentration of 1 million platelets per 1 µl, as well as a technology for converting a plasma clot into a gel state for surgical use.

This is the classical PRP in its original scientific interpretation. The classic works of R. Marx are openly available, in particular, I recommend reading this article by him: (link https://pubmed.ncbi.nlm.nih.gov/11813662/)

PRP: scientific discovery and its practical significance

The world should be grateful to R. Marx, a scientist whose research and discoveries laid the foundation for a simple and safe method of treating many diseases. Today we witness a scientific revolution: PRP therapy is widely used in medical practice.

The classic PRP is a gel clot with a platelet concentration of 1 million per 1 µl, developed for dentistry and maxillofacial surgery in the 1980s and 1990s. To obtain it, a two-stage centrifugation and a 80-120 ml blood sample are required. A production process is based on the same principles of producing blood components for hemotransfusion.

The easiest way to test the methodology is to:

• familiarize yourself with the basics of fluid physics and blood physiology;

• study the protocols for the production of platelet mass in blood centres;

• read my book "Regenerative medicine based on the use of autologous blood plasma", which contains links to the original research by R. Marx and his colleagues who emphasized the similarity of abbreviations PRP, PRF, A-PRF, I-PRF, PRGF, etc.;

• submit 1 ml of plasma for analysis in the laboratory and independently check the platelet content in a test tube or a syringe.

The remaining doubts can have but one explanation: it is the unwillingness to give up the possibility of selling expensive test tubes under the guise of a unique solution.

PRP: Practice, evolution, reality

I started studying plasma and its physical and chemical properties in 1997, working at the Department of Biochemistry at the Kazan State Medical University. I first encountered the clinical use of autologous plasma in 1999, and began to work with classical PRP in 2002.

PRP therapy is really great and effective, however its classical form is difficult to manufacture and expensive to use. Back in the day, the cost of the first centrifuges in Moscow reached 15,000 dollars, and the price of one tube was 80 dollars.

Moreover, classical PRP is applicable only in surgery since its gel form is designed to be injected directly into an operated wound.

In essence, the technique is in many ways similar to autohemotherapy and autoserotherapy, developed in Germany more than 160 years ago. These methods had been actively used all over the world before the advent of antibiotics and biologics, demonstrating the highest effectiveness.

My suggestion was to take a logical step towards historically proven methods — the mentioned autohemotherapy and autoserotherapy. The idea was to use PRP in an injectable form, obtained after just one stage of centrifugation. Today, this approach is used by all specialists working with PRP, without exception. The idea lay on the surface, and it is not surprising that many of my colleagues came up with it in their own turn.

However, the term PRP has remained in use as slang, despite the fact that after the first stage of centrifugation there can be neither triple nor quadruple increase in platelet concentration.

No tube or syringe is physically capable of isolating a platelet concentrate at the first stage of centrifugation. At this point, only plasma and cellular elements are separated from blood, but their concentration level shows no increase. The maximum concentration that can be obtained is close to the baseline level in the patient's peripheral blood.

Fact: in the lower layer of plasma that traditionally contains more platelets their concentration reaches 100,000 per 1 µl. This is 10 times less than stated in the classical definition of PRP.

Nevertheless, manufacturers of test tubes and syringes actively manipulate doctors and patients to believe something which is obviously not true.

Should you come across studies claiming a concentration of 1 million platelets per 1 µl, beware. This is either a direct manipulation, or a mathematical interpretation of data using marketing terms, like "a useful dose", "a PRP recovery rate", "vPRP", "RSI × vPRP" and others, with the aim to confuse readers.

To verify my statements, do the following:

• donate plasma from a PRP tube for analysis;

• ask the salesperson/physician: "How many platelets per 1 µl are in your test tube? Show me the results of analysis, please."

The results will be very convincing.

PRP is a working technique

Despite all existing misconceptions, autologous plasma in its natural, non-concentrated form is extremely effective. It has already supplanted or supplemented many traditional methods of treatment.

Simply pressing the plunger of a syringe to inject the plasma increases the concentration of platelets in the tissues several times. It is the injection form that makes the method accessible, convenient and effective. No complicated manipulations of platelets are required.

As a result, PRP therapy is really effective, safe and affordable. The industry is rapidly developing: new methods, improved protocols, and various forms of plasma continue to emerge. Scientific publications on this topic have already reached tens of thousands!

At the same time, the mechanism of plasma action itself has not been fully deciphered. I am sure, however, that sooner or later the mankind will understand the working mechanism of this unique substance. The success of PRP therapy depends on the doctor’s competence, the quality of instruments used (optimal tubes and syringes) and the individual biological resources of a patient.

Addressing the manufacturers of PRP tubes and syringes, I want to say: "Plasma, like everything else in the human body, is a creation of nature, not marketing. Do not try to improve the Creator's idea. I doubt that you will succeed. The task of science is not to interfere but to learn, to understand and to effectively use the laws of nature. This is the exact true path of medicine and science”.

January 31, 2025, Vienna