Telozytes and their symphony with PRP

Telozytes and their symphony with PRP

The renaissance of skin regeneration: How telocytes and innovative injection techniques are revolutionizing PRP therapy

A look into the body's hidden communication network

Imagine we could zoom into a healing tissue area: a fine network of cells begins to work. Blood platelets flow in, stop the bleeding and release growth factors - like messenger substances that are both calls for help and blueprints (pmc.ncbi.nlm.nih.gov).

But who receives and distributes these signals? This is where telocytes come into play. These still relatively unknown cells act like silent conductors in the tissue orchestra. With their extremely thin, long extensions, they connect different cell types with each other and unobtrusively coordinate the healing process. It is as if cells are whispering to each other - and telocytes are the telephone lines through which the messages pass.

In this article, we delve deep into the fascinating world of telocytes and shed light on how they interact with platelet-rich plasma (PRP) to exert regenerative effects in the body.

Telocytes - mysterious networkers in tissue

Telocytes (also known as telocytes) are a cell population that has only been discovered in the last two decades (pubmed.ncbi.nlm.nih.gov | rri.ro). They were first described in 2005 - at that time still as "Cajal-like cells", due to their supposed similarity to Cajal's interstitial cells.

However, it soon became apparent that telocytes have their very own characteristics. They are cells with a tiny cell body and extremely long, thin cell extensions, the telopods. These telopods can extend over hundreds of micrometers and have a typical pearl-like appearance (rri.ro | pubmed.ncbi.nlm.nih.gov).

As a result, telocytes form an extensive communication network in the stroma of various organs. Telocytes are found almost everywhere in the body: they have been discovered in at least 25 organs - from the heart and liver to the lungs, skin, eyes and even bone marrow.

Laurentius Popescu, the discoverer of these cells, reported that telocytes are present in all wall layers of the heart muscle (myocardium), for example (pubmed.ncbi.nlm.nih.gov). In the skin, they are preferentially located in the dermis, often in the vicinity of hair follicles, glands, nerve fibers and capillaries, where they form a widely ramified network. Telocytes are therefore to a certain extent everywhere where communication in the tissue is important - at interfaces between vessels, nerves, immune cells and stem cells. The diverse functions of these cells are interesting. Telocytes are regarded as intercellular communicators and "mediators" in tissue architecture. Research results indicate that they take on several roles at the same time: They transmit signals from cell to cell, "care for" and control stem cells in their environment, provide structural support to tissue and influence the immune system by modulating inflammatory responses(pubmed.ncbi.nlm.nih.gov).

With their telopods, they contact neighboring cells - from muscle and epithelial cells to endothelial cells of blood vessels and immune cells such as mast cells or lymphocytes - and thus form a three-dimensional communication network. This network can be made impressively visible using modern microscopy techniques.

Image(image is for illustrative purposes; generated with AI): Transmission electron micrograph of a capillary vessel (center, cross-section) in the skin. It is surrounded by telocytes (TC) and their long extensions, the telopods (Tp), which enclose the vessel like a net. Telocytes are in close contact with the vessel wall, including smooth muscle cells of the vessel wall (SMC) and endothelial cells (End), as well as with surrounding immune cells - here, for example, a lymphocyte (L) and a macrophage (Mfg). These complex cell contacts illustrate the role of telocytes as mediators between cells: They "spin around" capillaries and connect different cell types, which could be important for coordinated tissue repair. (pmc.ncbi.nlm.nih.gov | pmc.ncbi.nlm.nih.gov)

Telocytes and PRP platelet-rich plasma

Telocytes are also suspected of triggering regenerative processes. Observations show that telocytes multiply in the event of tissue damage: If, for example, part of the liver is removed from test animals, the number of telocytes there increases significantly in the weeks of subsequent regeneration (rri.ro). Telocytes were also found to increase in healing skin wounds and other repairing tissues. Conversely, it has been found that telocytes are depleted in certain chronic diseases - for example in fibrotic changes such as scleroderma or in neurodegenerative diseases such as multiple sclerosis (rri.ro).

This suggests that a lack of telocytes could be associated with impaired tissue healing. Telocytes therefore act as silent guardians of tissue integrity: if they are missing, the balance is upset. Recent findings from heart research are particularly exciting. The heart muscle has long been considered to be poorly regenerative - once destroyed, heart muscle cells hardly regenerate. But telocytes could be a game changer here. In animal experiments, attempts have already been made to introduce telocytes into the damaged heart tissue after a heart attack. The results are promising: transplanted cardiac telocytes reduced the size of the infarcted area, promoted the formation of new blood vessels and significantly improved heart function (frontiersin.org).

Researchers say that telocytes could possibly be part of cell therapies for the heart in the future(pubmed.ncbi.nlm.nih.gov/34681601).

The idea is that telocytes act as supporters and communicators that repair the damaged tissue together with stem cells - a double team of "construction managers" (telocytes) and "construction workers" (stem cells), so to speak. Such approaches are still experimental, but they underline the immense regenerative potential of telocytes.

Differentiation of fibroblasts

An important aspect for the understanding of telocytes is their clear differentiation from fibroblasts, with which they have often been confused in the past. In contrast to fibroblasts, telocytes show higher expression of genes associated with cell adhesion, cytoskeletal changes and mitochondrial transit, such as Ctgf, Tgln, Sprr1a and Myl9 (Zheng et al., 2013).

Proteomic analyses have shown that telocytes express more myosin-14 and periplakin than fibroblasts, suggesting their specific role in mechanical perception and mechanochemical conversion. In addition, telocytes differ from fibroblasts by a more flexible and adaptable cytoskeleton and a more active involvement in remodeling of the extracellular matrix.

Functionally, telocytes predominantly occupy regions with loose extracellular matrix and show a threefold higher ability to spread on certain matrix proteins than fibroblasts. They adhere better to fibronectin, worse to laminin and intermediate to collagen matrix (Niculite et al., 2014). These adhesion preferences have a considerable influence on the organization of the stroma and partly explain the complex arrangement of telocytes in the tissue.

PRP - concentrated healing powers from your own blood

While telocytes act as mediators behind the scenes, platelet-rich plasma (PRP) provides the tools and material for regeneration, so to speak.

PRP is a concentrate of platelets from the patient's own blood. Experiments with such autologous platelet concentrates have been going on for over 40 years (mdpi.com/2073-4409), and PRP has now firmly established itself in regenerative medicine. But what makes PRP so special?

The key lies in the platelets themselves. Platelets are miniaturized powerhouses: They normally circulate inactively in the blood and are suddenly activated in the event of injury. When tissue is injured, platelets are among the first cells on site; they accumulate in the wound area and release a variety of biologically active substances from their granules

(pmc.ncbi.nlm.nih.gov/articles/PMC11353115).

These include growth factors, cytokines, inflammation-modulating messenger substances and also factors that stimulate the formation of new blood vessels and extracellular matrix formation.

PRP can therefore be thought of as a concentrate of these healing substances - liquid gold for wound healing, obtained from the patient's own blood.

The production of PRP is comparatively simple, but effective. A small amount of venous blood is taken from the patient and centrifuged in special tubes to separate the platelets. Modern PRP kits, such as the VI PRP-PRO tube from prpmed.de, enable the collection of around 4-4.5 ml of highly concentrated PRP in a 9 ml collection tube.

It is important to use an anticoagulant (usually sodium citrate) and often a separating gel in the tube to separate the erythrocytes cleanly from the thrombocytes.

In the end, a plasma is obtained from the patient's own blood that contains a multiple increase in the concentration of platelets - and thus of all the healing factors that they release.

But what do these factors actually do? Here is a brief overview of important growth factors in PRP and their functions:

  • PDGF (Platelet-Derived Growth Factor): Promotes the proliferation of cells (e.g. fibroblasts) and angiogenesis (formation of new blood vessels).
  • TGF-β (Transforming Growth Factor Beta): Regulates scar formation and inflammatory reactions, supports the production of extracellular matrix.
  • VEGF (Vascular Endothelial Growth Factor): A key factor for the formation of new blood vessels, important for the supply of blood to regenerating tissue.
  • EGF (Epidermal Growth Factor): Stimulates cell migration and division, especially of epithelial cells, promotes wound epithelialization (new skin formation).
  • IGF (Insulin-like Growth Factor): Supports the differentiation and survival of cells, e.g. muscle and cartilage cells, and has an anabolic effect on tissue.

These and numerous other mediators work together in synergistic cascades. They are present in PRP in high concentrations - exactly where you want them, namely directly in an injured or degeneratively altered area of the body.

Doctors inject PRP into poorly healing wounds, damaged tendons or joints (e.g. in osteoarthritis), for example, or use it in aesthetic medicine for skin rejuvenation.

The range of applications is wide: studies and clinical reports document successes in hair loss (alopecia), the treatment of acne scars, burns, chronic skin ulcers, muscle and cartilage injuries and in post-operative wound healing (mdpi.com/2073-4409).

PRP is popular because it is minimally invasive and autologous - that is, it comes from the patient's own blood, which minimizes the risk of immune reactions or infections. At the same time, it is comparatively easy and inexpensive to produce. In short, PRP provides the body with a concentrated boost of natural healing factors exactly where they are needed.

When telocytes meet PRP - synergy in regeneration

So what happens when these two players - telocytes and PRP - meet? Just imagine: The platelets have released their cornucopia of growth factors after an injury. But how do these signals find their target? This is where perhaps the most fascinating hypothesis in regenerative medicine unfolds: telocytes could act as amplifiers and distributors of PRP signals (mdpi.com/2073-4409).

Telocytes as control centers of tissue repair

Telocytes are strategically positioned to serve as control centers in the tissue. Their long telopods allow them to reach several cells at the same time and can establish far-reaching cell contacts.

Telopods have been observed enveloping capillaries, wrapping around glandular structures or tightly hugging nerve endings.

This physical networking allows the telocytes to transmit information effectively through the tissue. If a growth impulse is given somewhere - for example by PRP factors - telocytes can pick up this signal and pass it on to distant cells, comparable to an amplifier that distributes a radio call to many recipients. In addition, telocytes communicate not only via direct cell contact, but presumably also via secreted vesicles (exosomes).

Telocytes release small membrane-wrapped particles containing microRNA and proteins - quasi micro-messages that are taken up by neighboring cells and can switch on certain programs there. Studies suggest that telocytes play a role in angiogenesis via these exosomes, for example, by sending out growth-promoting signals such as Wnt proteins. All this supports the idea that telocytes are an active hub for regeneration signals.

Telocytes as control centers for tissue repair

PRP - initial spark and fuel for telocytes

The ingredients of PRP act on telocytes like an initial ignition. Interestingly, telocytes have receptors on their surface for many of the growth factors contained in PRP. For example, telocytes are known to express the receptor PDGFR-α - the docking point for PDGF, one of the most important platelet-derived growth factors. The same applies to other factors. This means that telocytes can "hear" the messages from the PRP and react to them. In fact, dermal telocytes have been shown to respond positively to the presence of PRP components.

PRP contains a "bouquet" of molecules - from PDGF and TGF-β to VEGF and SDF-1 and many more - that dock to telocytes and presumably activate them. You can imagine this as follows: The telocytes act as a kind of sensor in the tissue. When PRP arrives, the telocytes register the growth factors and ramp up their activities. They could release more signaling substances to stimulate surrounding stem cells to divide, recruit immune cells or coordinate the formation of new blood vessels. A recent scientific study has substantiated this idea: In a study on skin wound healing, the authors found evidence that telocytes are indeed the "missing link" that could explain the effectiveness of PRP.

PRP alone also works, of course - it promotes fibroblast activity, for example. But why are PRP treatments so exceptionally effective in some cases? The hypothesis: telocytes mediate between the PRP factors and the effector cells (such as fibroblasts, endothelial cells, epithelial cells) and thus orchestrate a more efficient repair. Without telocytes, the growth factors would perhaps have a less targeted effect. Telocytes are the "interpreters", so to speak, that translate the chemical signals of the PRP into "understandable" terms for the tissue and direct them to the right place.

PRP - Initial spark and fuel for telocytes

Cooperation in the service of regeneration - examples

What could this Telocyt-PRP cooperation look like in concrete terms? Let's take skin wound healing as an example. In the event of a skin injury, the activated thrombocytes from the PRP release growth factors which, among other things, stimulate fibroblasts to form collagen and endothelial cells to form capillary sprouts. Telocytes, which are present in large numbers in the dermis, could help in two ways: Firstly, they themselves promote angiogenesis - it is known that dermal telocytes can co-initiate new microvessels.

Secondly, they are in contact with fibroblasts and could transmit the "commands" for collagen production to them more quickly. Telocytes could therefore accelerate the wound healing phase by activating the right cells at the right time. In the aforementioned study, telocytes were examined more closely in skin biopsies after PRP administration - with the result that telocytes appeared morphologically activated and were closely localized to newly formed vessels and in the repair tissue.

Telocyt-PRP cooperation

This supports the assumption that telocytes and PRP have a synergistic effect together. Similar synergies are being discussed in other tissues. In heart regeneration, for example, PRP - which is rich in angiogenic factors such as VEGF - together with telocytes could contribute to the formation of a new capillary network in the damaged heart muscle after an infarction. Telocytes, which "dock" to the blood vessels in the heart, would direct the formation of new blood vessels and at the same time support the heart muscle cells through their stem cell nurturing function.

In joints with cartilage damage (where PRP is used for osteoarthritis, for example), there are indications that telocytes occur in the joint capsule and cartilage tissue and can support regenerative processes there - although direct studies on this are still pending. And in the liver - an organ that can regenerate remarkably well - telocytes have already been identified as a possible "clock generator" for this regeneration.

If this is combined with the stimulating effects of PRP (such as HGF and other liver regenerative factors), it could one day even be possible to treat liver damage using telocyte-PRP therapy (purely hypothetically speaking). Importantly, all of these scenarios are based on current research and suggest a synergy, but are not yet established clinical practice. It's a bit like having two pieces of a puzzle - telocytes and PRP - that could fit together. Initial images show that the jigsaw could provide a coherent overall picture of improved regeneration, but much remains to be explored before we can say with certainty.

Telocytes as the "missing link" in PRP-mediated tissue regeneration

The classic explanation for the effectiveness of PRP focuses mainly on the direct stimulation of fibroblasts by growth factors. However, this view may fall short and does not take into account the complex cellular interactions in the tissue.

An innovative hypothesis to explain PRP efficacy postulates that telocytes may act as a "missing link" between the growth factors contained in PRP and the effector cells in the tissue. This hypothesis is based on several observations:

  1. Spatial colocalization: telocytes are strategically positioned in tissues to serve as "sensors" for incoming signals and relay them to surrounding cells. They are in constant spatial relationships with vascular structures, immune cells and stem cell niches.
  2. Receptor expression: Telocytes express receptors for many of the growth factors contained in PRP and can therefore respond directly to them. They show positive expression for PDGFR-α/β, VEGFR, EGFR and other receptors that interact with PRP factors.
  3. Signal transduction: Through their long-range telopods, telocytes can transmit signals over large distances in the tissue and thus orchestrate a coordinated tissue response. This network structure enables efficient signal amplification and transduction.
  4. Paracrine secretion: Activated telocytes can themselves secrete bioactive molecules that act synergistically with PRP factors and promote tissue regeneration. Their secretome includes growth factors, cytokines, microRNAs and extracellular vesicles.
Telocytes as the "missing link" in PRP-mediated tissue regeneration

Scientific evidence for the telocyte-PRP interaction

A landmark study by Manole et al. (2024) entitled "Skin Telocytes Could Fundament the Cellular Mechanisms of Wound Healing in Platelet-Rich Plasma Administration" provides compelling evidence for the role of telocytes in PRP-mediated wound healing. The authors examined skin biopsies after PRP treatment and found morphologically activated telocytes that were closely associated with newly formed vessels and repair tissue.

The study shows that telocytes exhibit the following changes after PRP exposure:

  • Increased metabolic activity with increased expression of mitochondrial markers
  • Increased expression of angiogenesis-promoting factors such as VEGF and bFGF
  • Intensified communication with fibroblasts and stem cells through increased gap junctions
  • Coordinated recruitment of immune cells to the wound site through chemokine secretion

These observations support the hypothesis that telocytes act as "interpreters", translating the chemical signals of the PRP into "understandable" terms for the tissue and directing them to the right place.

Scientific evidence for the interaction between telocytes and PRP

Molecular mechanisms of telocyte activation by PRP

At the molecular level, the activation of telocytes by PRP factors could occur via the following signaling pathways:

  • PDGF-PDGFR axis: binding of PDGF to PDGFR on telocytes activates intracellular tyrosine kinases, leading to phosphorylation of downstream effectors such as PI3K/Akt and MAPK. These signaling pathways promote telocyte survival, migration and proliferation.
  • TGF-β-Smad signaling pathway: TGF-β from PRP binds to TGF-β receptors on telocytes and activates Smad-dependent and -independent signaling pathways that regulate the expression of genes involved in extracellular matrix remodeling and angiogenesis.
  • Ca²⁺-dependent signaling: PRP factors can trigger intracellular Ca²⁺ signaling in telocytes, which in turn regulate vesicle release and cytoskeletal contraction.
  • Exosome-mediated communication: PRP exosomes can be taken up by telocytes and modulate their function by transferring microRNAs and other regulatory molecules.

The integration of these signaling pathways enables telocytes to act as central coordinators of PRP-induced tissue regeneration.

Molecular mechanisms of telocyte activation by PRP

Clinical examples of Telocyt-PRP cooperation

Skin wound healing

Telocytes play a dual role in skin wound healing:

  1. Angiogenesis promotion: dermal telocytes can initiate and coordinate the formation of new microvessels, which is essential for the supply of oxygen and nutrients to the wound area. They express VEGF and other angiogenic factors and are in close contact with endothelial cells.
  2. Fibroblast activation: Telocytes are in direct contact with fibroblasts and can transmit the "commands" for collagen production more quickly, which leads to an accelerated wound healing phase. They modulate fibroblast activity through paracrine factors and direct cell-cell contacts.

In a clinical study on the treatment of chronic ulcers with PRP, it was observed that patients with higher telocyte density in the wound edge showed better healing rates. Histologic analysis of wound biopsies before and after PRP treatment showed a significant increase in telocyte number and activity, which correlated with clinical improvement.

Treatment protocol for chronic wounds:

  • PRP concentration: 4-6 times baseline concentration
  • Application frequency: Weekly for 3-4 weeks
  • Application method: Intralesional injection and topical application
  • Activation: Calcium chloride (10%)
  • Post-treatment: Moist wound dressing, compression therapy for venous ulcers
Skin wound healing

Heart regeneration after myocardial infarction

In cardiac tissue, telocytes form an extensive three-dimensional network that is important for the electrical coupling and structural integrity of the myocardium. After an infarction, PRP could help to activate cardiac telocytes, which in turn:

  • Promote the formation of new capillary networks in the damaged myocardium
  • Support the differentiation of cardiac stem cells
  • Improve the electrical integration of regenerated cardiomyocytes
  • Modulate scar formation and improve tissue elasticity

In experimental models of myocardial infarction, intramyocardial injection of PRP led to a significant improvement in left ventricular function, reduced infarct size and increased capillary density. Immunohistochemical analyses showed an increased number and activity of telocytes in the border zone between healthy and infarcted myocardium, indicating their involvement in tissue regeneration.

Experimental protocol for myocardial infarction:

  • PRP concentration: 5-7 times baseline concentration
  • Application: Intramyocardial injection at 5-10 sites at the border of the infarct
  • Timing: Ideally within 72 hours after infarction
  • Volume: 0.2-0.5 ml per injection site

Heart regeneration after myocardial infarction

Cartilage regeneration in osteoarthritis

The interaction between PRP and telocytes could also play an important role in cartilage damage, as occurs in osteoarthritis. Telocytes have been detected in articular cartilage, where they could coordinate regenerative processes by stimulating chondrocytes to produce extracellular matrix:

  • Stimulating chondrocytes to produce extracellular matrix
  • Promoting the differentiation of mesenchymal stem cells into chondrocytes
  • Modulating inflammatory processes and thus slowing down cartilage degradation
  • Improve synovial fluid through secretion of hyaluronic acid and lubricin

Clinical studies on intra-articular PRP injections for knee osteoarthritis have shown significant improvements in pain, function and quality of life. Histologic analysis of synovial biopsies after PRP treatment showed an increased number of CD34+ telocytes in the synovial membrane, which was associated with reduced expression of proinflammatory cytokines and increased expression of chondroprotectants.

Cartilage regeneration in osteoarthritis

Limitations and open questions

Despite the promising evidence for the role of telocytes in PRP-mediated tissue regeneration, there are still significant knowledge gaps and methodological challenges:

Methodological challenges

  1. Identification of telocytes: The clear identification of telocytes in tissue samples remains difficult as no single specific marker exists. The gold standard method is transmission electron microscopy, which is, however, time-consuming and not suitable for routine examinations.
  2. Heterogeneity of PRP preparations: Variability in PRP preparation protocols results in different concentrations of platelets, leukocytes and growth factors, which makes it difficult to compare clinical studies.
  3. In vivo visualization: The dynamic interaction between PRP and telocytes in vivo is difficult to visualize and quantify, limiting the understanding of the temporal and spatial aspects of this interaction.

Challenges and research needs in telocyte PRP regeneration

  1. Specificity of telocyte-PRP interaction: To what extent does the response of telocytes to PRP differ from that of other stromal cells, and which specific factors in PRP are responsible for telocyte activation?
  2. Tissue-specific differences: How does the role of telocytes in PRP-mediated regeneration vary between different tissues and organs?
  3. Age- and disease-related changes: How do age, chronic diseases and medications affect the number and function of telocytes and thus the response to PRP therapies?
  4. Optimal PRP composition: Which PRP formulation (leukocyte-rich vs. leukocyte-poor, activation method, concentration) is optimal for the stimulation of telocytes in different clinical scenarios?

Potential side effects and contraindications

Although PRP therapies are generally considered safe, potential risks and contraindications should be considered:

  1. Local reactions: Pain, swelling and redness at the injection site are common but usually self-limiting.
  2. Risk of infection: Despite autologous application, there is a small risk of infection, especially if handled improperly.
  3. Contraindications: Thrombocytopenia, platelet dysfunction, anticoagulant therapy, active infection, pregnancy/lactation and malignant diseases in the treatment area are considered relative or absolute contraindications.
  4. Adverse telocyte activation: Excessive or dysregulated activation of telocytes could theoretically lead to fibrosis or abnormal tissue remodeling, although this has not been clinically documented to date.

Implications for clinical practice

Understanding the telocyte-PRP interaction could lead to optimization of existing PRP protocols:

1. Timing of application: The application of PRP could be timed to coincide with times when telocytes are particularly active or numerous in the target tissue. For example, in chronic wounds, prior stimulation of telocytes by low-energy shock waves could improve the efficacy of PRP.

2. Combination therapies: Simultaneous stimulation or activation of telocytes by other methods could enhance the efficacy of PRP:

  • Low-energy shock waves for telocyte activation
  • Hyaluronic acid to improve telocyte migration
  • Stem cell therapies to synergize with telocyte-mediated regeneration

3.Patient selection: Identification of patients with optimal telocyte function could help to identify those who would benefit most from PRP treatments. Potential biomarkers could be CD34 levels in peripheral blood or specific microRNA profiles.

4.PRP formulation: Tailoring PRP composition to the specific needs of the target tissue and telocyte status could improve efficacy:

  • Leukocyte-rich PRP for inflammatory conditions with telocyte depletion
  • Leukocyte-poor PRP for degenerative conditions with preserved telocyte function
  • Specific activation methods for the targeted release of telocyte-stimulating factors

New therapeutic approaches

The finding that telocytes play a key role in PRP-mediated tissue regeneration opens up new therapeutic possibilities:

1.Telocyte-directed therapies: Development of methods for targeted stimulation or augmentation of telocytes in damaged tissue:

  • Pharmacologic modulators of telocyte function
  • Gene therapeutic approaches for the overexpression of telocyte-specific factors
  • Transplantation of cultured telocytes into damaged tissue

2. Biomarkers for therapy response: Identification of telocyte-associated biomarkers that can predict response to PRP therapies:

  • Circulating microRNAs as surrogate markers for telocyte activity
  • Imaging techniques to quantify telocyte density in the target tissue
  • Genetic polymorphisms that influence telocyte function

3.Tissue engineering: integration of telocytes into tissue engineering constructs to improve vascularization and functional integration:

  • Co-culture of telocytes with stem cells in 3D scaffolds
  • Bioprinting of telocyte-rich tissue structures
  • Development of biomaterials that promote telocyte function

Practical recommendations for clinicians

Based on the current state of knowledge, the following practical recommendations for clinicians can be derived:

  1. Standardization of PRP production: use validated systems with known platelet and leukocyte concentrations and documented clinical efficacy.
  2. Documentation of treatment parameters: Detailed recording of PRP concentration, activation method, injection volume and technique to optimize future treatments.
  3. Patient education: Realistic presentation of the expected results and the time course of the effect, based on the current understanding of biological processes.
  4. Aftercare and follow-up: Regular clinical and, if necessary, imaging follow-up to document the success of treatment and early detection of complications.

Outlook and conclusion - the future of regenerative medicine?

The combination of telocytes and PRP opens up an exciting perspective in regenerative medicine. We are on the cusp of a paradigm shift here: until now, many therapies have focused on either providing cells (such as stem cell therapies) or administering growth factors (such as PRP or single recombinant factors). The idea of bringing a communication cell like the telocyte on board adds a third dimension - namely the optimization of cellular communication. Instead of just providing building blocks and blueprints, we now also pay attention to the construction manager who coordinates the construction work. The research results to date give us hope: in preclinical studies on animals, telocyte transplants, especially in combination with stem cells or PRP, have achieved astonishing improvements.

If we succeed in translating these effects into clinical applications, we could one day see personalized regeneration therapies in which patients are administered not only concentrated growth factors (PRP), but also telocytes or their products. It would be conceivable, for example, to isolate telocytes from the patient's own tissue, multiply them and deliver them together with PRP to an injured area in order to tailor the healing process. Thinking even further: perhaps one day the exosomes secreted by telocytes could be processed as a drug to deliver the exact communication signals required for regeneration - without the need for cell transplants. Of course, it is important to remain realistic. Telocytes are not yet fully understood. There is a lack of standard protocols for reliably isolating and cultivating them.

We also do not yet know whether too many telocytes could have undesirable effects - e.g. excessive scarring or uncontrolled cell growth. Ethical and regulatory issues also need to be clarified before telocyte-based therapies can be widely used in humans. Nevertheless, the fascination is palpable. Telocytes and PRP together embody the concept that healing depends not only on the "usual suspects" (such as fibroblasts, stem cells, growth factors), but on their subtle interplay. They show us how important the language of cells is. If we learn to use this language in a targeted way - whether through telocytes that serve as interpreters or through customized combinations of cellular signals - this could take medicine a big step forward. In the end, telocytes and PRP paint a hopeful picture: perhaps in the future we can treat injuries and degenerative diseases more holistically by providing not only replacement parts, but also the repair team and the project manager. Nature gives us a fascinating clue as to how regeneration can work - we just have to decode it. In any case, the synergy of telocytes and PRP is a story that is only just beginning, but is already having a strong suction effect on the curious medical community. It will be interesting to see what chapters research will write in the coming years.

Literature and further studies

  1. Aleksandrovych V, et al. (2022). Telocytes: immune function and involvement in inflammatory processes. Int J Mol Sci, 23(3), 1651.
  2. Chaitow L. (2017). Telocytes: Connective tissue repair and communication cells. J Bodyw Mov Ther, 21(2), 231-233.
  3. Cismaşiu VB, Popescu LM. (2015). Telocytes transfer extracellular vesicles loaded with microRNAs to stem cells. J Cell Mol Med, 19(2), 351-358.
  4. Cretoiu D, et al (2019). Telocytes and their extracellular vesicles-Evidence and hypotheses. Int J Mol Sci, 20(5), 1183.
  5. Cretoiu SM, et al (2022). Telocytes and Other Interstitial Cells 2.0: From Structure to Function. Int J Mol Sci, 23(1), 558.
  6. Edelstein L, Smythies J. (2014). The role of telocytes in morphogenetic bioelectrical signaling: once more unto the breach. Front Mol Neurosci, 7, 41.
  7. Manetti M, et al (2019). Telocytes in regenerative medicine. J Cell Mol Med, 23(3), 1610-1618.
  8. Manole CG, et al (2024). Skin Telocytes Could Fundament the Cellular Mechanisms of Wound Healing in Platelet-Rich Plasma Administration. Cells, 13(16), 1321.
  9. Niculite CM, et al. (2014). Telocyte heterogeneity: From cellular morphology to functional evidence. Semin Cell Dev Biol, 35, 85-97.
  10. Popescu LM, et al. (2005). Interstitial cells of Cajal in pancreas. J Cell Mol Med, 9(1), 169-190.
  11. Popescu LM, Faussone-Pellegrini MS. (2010). TELOCYTES - a case of serendipity: the winding way from Interstitial Cells of Cajal (ICC), via Interstitial Cajal-Like Cells (ICLC) to TELOCYTES. J Cell Mol Med, 14(4), 729-740.
  12. Radu BM, et al (2017). Calcium signaling in interstitial cells: focus on telocytes. Int J Mol Sci, 18(2), 397.
  13. Rosa I, et al. (2019). Telocytes constitute a widespread interstitial meshwork in the lamina propria and underlying striated muscle of human tongue. Sci Rep, 9(1), 5858.
  14. Sanches BDA, et al. (2024). Telocytes of the male reproductive system: dynamic tissue organizers. Front Cell Dev Biol, 12, 1444156.
  15. Smythies J, Edelstein L. (2014). Telocytes, exosomes, gap junctions and the cytoskeleton: the makings of a primitive nervous system? Front Cell Neurosci, 7, 278.
  16. Vannucchi MG, et al. (2020). The Telocytes: Ten Years after Their Introduction in the Scientific Literature. An Update on Their Morphology, Distribution, and Potential Roles in the Gut. Int J Mol Sci, 21(12), 4478.
  17. Yang J, et al (2021). Telocytes damage in endometriosis-affected rat models: potential impact on infertility. J Cell Mol Med, 25(6), 2886-2897.
  18. Zheng Y, et al. (2013). Protein profiling of human lung telocytes and microvascular endothelial cells using iTRAQ quantitative proteomics. J Cell Mol Med, 18(6), 1035-1059.
  19. Manole CG et al. (2024) - "Skin Telocytes Could Fundament the Cellular Mechanisms of Wound Healing in Platelet-Rich Plasma Administration." Cells, 13(16):1321. DOI:10.3390/cells13161321 mdpi.com/2073-4409 This study highlights the role of telocytes in the skin and hypothesizes that telocytes may be the missing mediator for PRP-induced wound healing.
  20. Klein M. et al. (2021) - "Cardiac Telocytes 16 Years on - What Have We Learned So Far, and How Close Are We to Routine Application of the Knowledge in Cardiovascular Regenerative Medicine?" Int J Mol Sci, 22(20):10942. DOI:10.3390/ijms222010942 | pubmed.ncbi.nlm.nih.gov/34681601. A review article summarizing the discovery of cardiac telocytes and their impact on cardiovascular regeneration, including initial telocyte transplantation trials in myocardial infarction.
  21. Zheng Y. et al. (2014) - "Intramyocardial transplantation of cardiac telocytes decreases myocardial infarction and improves post-infarcted cardiac function in rats." J Cell Mol Med, 18(5):780-9. DOI:10.1111/jcmm.12259 | frontiersin.org. This experimental paper reports that transplantation of telocytes into an infarct-damaged rat heart promotes healing (infarct area smaller, cardiac function better), indicating the potential therapeutic application of telocytes.

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Centrifuge

DUO PRF/PRP centrifuge - Class IIa medical device for PRP and PRF therapies

DERMOAROMA
100401
€1,679.83
Certified Class IIa medical device – specifically designed for PRF and PRP therapies. Maximum speed of 4500 RPM and RCF up to 2490 x g for precise and safe blood preparation. Quiet operation at only 56 dB – ideal for use in quiet clinic or practice environments. User-friendly controls with pre-set programs and easy parameter adjustments. Highest...
PRP tubes | PRP-Pro | PU 10 pcs. PRP tubes | PRP-Pro | PU 10 pcs. 2
immediately available
PRP

PRP tubes | Vi PRP-PRO | with Anticoagulant PU 10 pieces

PRPMED Professional Cosmetic Treatments
100101
€110.08
VI PRP-PRO | PRP Tubes – The Revolution in Plasma Treatment The VI PRP-PRO glass tube offers a modern solution for producing platelet-rich plasma (PRP) and ensures additional stability and reliability in treatments with a wall thickness of 2.4 mm. Developed with innovative technology and EC-certified (0425-MED-004180-00), it guarantees the highest level...

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