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Platelet-rich plasma for patent ductus arteriosus: an orthopaedic surgeon's perspective
Mehmet Ali Engür1, Defne Engür2
11 Clinic of Orthopaedics, Isparta State Hospital, Isparta, Turkey.
Insights
Platelet-rich plasma shows promise for treating patent ductus arteriosus by promoting vascular remodeling. This approach may improve ductal closure in preterms by addressing platelet dysfunction and supporting key molecular pathways.
Area of Science:
- Neonatal Physiology
- Vascular Biology
- Regenerative Medicine
Background:
- Current treatments for patent ductus arteriosus (PDA) rely on cyclooxygenase inhibition, with debated efficacy and safety.
- Optimal PDA management requires targeting vascular remodeling and molecular steps for anatomical closure.
- Premature infants often exhibit platelet dysfunction, hindering natural ductal closure.
Discussion:
- Platelet-rich plasma (PRP) injection presents a promising alternative for PDA, particularly in preterms with platelet dysfunction.
- PRP can induce intimal mount formation via hyaluronan synthase, compensating for defective milestones in preterm infants.
- It provides platelet-derived growth factor to enhance platelet aggregation and lumen occlusion.
Key Insights:
- PRP increases local vascular endothelial growth factor and transforming growth factor-β levels, crucial for ductal closure.
- These growth factors stimulate vascular smooth muscle cell migration, contributing significantly to ductal closure.
- Local application of PRP maximizes therapeutic effectiveness while minimizing systemic side effects.
Outlook:
- PRP's multifaceted action on vascular remodeling and cellular signaling presents a potential paradigm shift in PDA management.
- Further research into PRP's role in neonatal cardiovascular conditions is warranted.
- This approach could improve outcomes for premature infants with persistent ductus arteriosus.
Abstract:
Although closure of ductus arteriosus requires multiple intriguing cell signalling pathways, current treatment options merely act through cyclooxygenase inhibition. Expectedly, medical management of ductus arteriosus is quite far away from optimum and there is an ongoing debate on its efficiency and safety. The ideal therapeutic agent for patent ductus arteriosus should target vascular remodelling and support the arrested molecular steps that should completely eventuate during anatomical closure. Platelet-rich plasma injection, which has been used as a treatment alternative for many musculoskeletal conditions, can be a promising solution in this context by compensating the relative platelet dysfunction in preterms and providing a convenient microenvironment for proper cellular communication for ductal closure. First, by inducing hyaluronan synthase, platelet-rich plasma can induce mount formation in the intima, which is the significant defective milestone in preterms. Second, by providing platelet-derived growth factor, it can further stimulate platelet agregation and occlusion of the lumen. Finally, it can provide an increment in local vascular endothelial growth factor and transforming growth factor-β levels, which cannot be achieved because of insufficient intramural hypoxia. Migration of the vascular smooth muscles would further be triggered by transforming growth factor-β and vascular endothelial growth factor, aiding a major contribution to ductal closure. Above and beyond all other considerations, opportunity of local application would render maximum effectiveness and minimum side effects.
