Temperature-controlled PRP in modern medicine: basics, advantages, and applications

Temperature-controlled PRP in modern medicine: basics, advantages, and applications

Temperature-controlled PRP (t-PRP): How cold and heat are revolutionizing autologous blood therapy

Imagine if you could activate the natural healing powers of blood at the touch of a button - not with additional chemicals, but simply by using temperature. This is exactly what temperature-controlled PRP (t-PRP), an innovative variant of the well-known PRP (platelet-rich plasma), promises. In this blog post, we delve into the world of t-PRP and shed light on what lies behind it. You can look forward to a lively mix of medical expertise and a vivid story that shows why t-PRP is so exciting for many specialties - from aesthetics and hair medicine to urology and gynecology.

What is PRP - and what does "temperature-controlled" mean?

Imagine if you could activate the natural healing powers of blood at the touch of a button - not with additional chemicals, but simply by using temperature. This is exactly what temperature-controlled PRP (t-PRP), an innovative variant of the well-known PRP (platelet-rich plasma), promises. In this blog post, we delve into the world of t-PRP and shed light on what lies behind it. You can look forward to a lively mix of medical expertise and a vivid story that shows why t-PRP is so exciting for many specialties - from aesthetics and hair medicine to urology and gynecology.

Temperature-controlled PRP (t-PRP) now goes one step further. As the name suggests, temperature plays a decisive role here. With t-PRP, the blood is processed in a cooled state (approx. 4 °C) and then activated by heating it to body temperature (37 °C) (pubmed.ncbi.nlm.nih.gov).

What does this mean in concrete terms? Instead of adding additional substances to activate the platelets, t-PRP uses the effect of the temperature change. Without a drop of additive, the platelets begin to clot and release their growth factors as soon as they change from cold to warm (pubmed.ncbi.nlm.nih.gov). The result: a PRP preparation that becomes an active healing power in a completely natural way - virtually only through cold and heat.

Classic PRP activation vs. t-PRP: What is the difference?

In classic PRP therapy, an artificial trigger is often required to induce the platelets to release their active substances. Typically, calcium chloride (CaCl₂) or thrombin (a coagulation enzyme) are used to trigger the coagulation cascadeen.wikipedia.org. Calcium chloride, for example, neutralizes a previously added anticoagulant (citrate) and causes the platelets to "explode " - they suddenly release their growth factors and a fibrin-rich gel is formed. Thrombin (formerly partly obtained from bovine blood, which could lead to allergies) has a similar effect: it activates coagulation directly. All this usually happens immediately before the application: The PRP is mixed and must then be injected or applied quickly before it coagulates completely.

With temperature-controlled PRP, this chemical wake-up call is not necessary. Here, the platelets are processed "asleep" - thanks to cooling, the blood does not initially clot. Only when the concentrated plasma is ready is it gently awakened by heating. You can visualize this like a stream that freezes over in winter (the platelets remain still), only to flow again in spring when the snow melts (the platelets become active). t-PRP therefore does not require any additional coagulants: activation occurs purely through a change in temperature(pubmed.ncbi.nlm.nih.gov). An amazingly simple difference with a big effect, as we will see in a moment.

Advantages of temperature-controlled activation

But why all this effort with a cool box and heating cabinet? t-PRP actually offers some tangible advantages over classically activated PRP:

  • No additives, fewer risks: As no foreign substances such as calcium chloride or animal thrombin are added, t-PRP is a 100% autologous product - it consists only of the patient's own material(pubmed.ncbi.nlm.nih.gov). This minimizes the risk of incompatibilities or immune reactions. It also saves the costs and organizational effort for these additives.
  • Higher platelet concentration: Studies show that t-PRP can achieve a higher concentration of platelets than conventional PRP. In one study, t-PRP achieved around 6.6 times the original platelet count in the blood, while conventionally processed PRP achieved around 4 times (pubmed.ncbi.nlm.nih.gov). More platelets potentially also mean more growth factors - in other words, a stronger "healing elixir".
  • Physiological environment: By dispensing with citrate and the like, the pH value and the biochemical environment of the plasma remain virtually unchanged and physiologicalpubmed.ncbi.nlm.nih.gov. The treated tissue is therefore not irritated by excess calcium or an abrupt pH change, for example. You could say: t-PRP is closer to nature.
  • Natural fibrin scaffold and slow release of active ingredient: A fascinating advantage is the way in which t-PRP coagulates. As coagulation is not forced abruptly, a dense, natural fibrin network is formed - you can imagine it as a finely spun scaffold. The platelets and their growth factors remain better embedded in it (pubmed.ncbi.nlm.nih.gov). As a result, the valuable growth factors are released more slowly and over a longer period of time instead of being released in one go (pubmed.ncbi.nlm.nih.gov). This prolonged drug release profile can result in longer-lasting tissue stimulation. To put it simply: t-PRP has a more lasting effect, whereas classically activated PRP tends to ignite a quick, short-lived fire.
  • Clearer plasma, less "ballast": Due to the two-stage, cooled centrifugation, t-PRP shows a very clear plasma with minimal contamination by red blood cells (pubmed.ncbi.nlm.nih.gov). Excess leukocytes (white blood cells) are also largely removed (pubmed.ncbi.nlm.nih.gov). The result is a pure PRP, which can be important as too many red blood cells or pro-inflammatory leukocytes in the PRP could potentially trigger undesirable effects (such as increased inflammation).

In summary, t-PRP provides a highly concentrated, pure and "patient" active plasma that works without artificial aids. But what does the science say? Let's take a look at whether these theoretical benefits have been confirmed in studies.

Scientific background and study situation

As always in medicine, trust is good, data is better. Fortunately, the first promising studies on t-PRP are already available. A groundbreaking report comes from Du and colleagues (2018), who described t-PRP in detail for the first time -->pubmed.ncbi.nlm.nih.gov. They show that t-PRP contains more platelets in the laboratory and forms a more stable fibrin scaffold after activation than conventionally activated PRP -->pubmed.ncbi.nlm.nih.gov |pubmed.ncbi.nlm.nih.gov. Particularly interesting: The release of important growth factors such as VEGF, PDGF or TGF-β was slowed down over hours to days instead of fizzling out within minutes pmc.ncbi.nlm.nih.gov| pmc.ncbi.nlm.nih.gov.

There are also in vivo results: In the aforementioned experiment, t-PRP was able to significantly accelerate wound healing in mice --> pubmed.ncbi.nlm.nih.gov. Wounds treated with t-PRP healed faster and with better tissue regeneration than comparative wounds. This suggests that t-PRP's prolonged drug release actually has a practical benefit - the tissue gets a longer-lasting "growth factor shower", so to speak.

Further studies support the idea: a temperature-induced PRP gel has been successfully used to create a growth factor depot, for example in novel microneedle patches for hair growth stimulation --> pmc.ncbi.nlm.nih.gov. The researchers report that the thermally activated PRP scaffold is particularly biocompatible and promotes angiogenesis (formation of new blood vessels) - important factors for regeneration and hair growth -->pmc.ncbi.nlm.nih.gov.

Even though t-PRP is still relatively new, two things are clearly emerging in the scientific literature: Firstly, initial data confirm the promised benefits (more platelets, slower release, good effect on healing). Secondly, t-PRP is being tested in a wide variety of areas, which leads us to the next point - the applications.

Areas of application: Where are PRP and t-PRP used?

PRP has experienced a real boom in recent years and is used across a wide range of disciplines. From aesthetic anti-ageing and hair loss treatments to supporting wound healing - the range is enormous. It is important to note that t-PRP is still in the early stages of clinical use, but the idea behind it can in principle be applied in all the areas mentioned. Let's take a look at the most important specialist areas:

Aesthetic medicine and dermatology: the fountain of youth from autologous blood

PRP application in aesthetics - PRP can be injected directly into the skin in aesthetic medicine, for example on the back of the hand, to improve skin quality and counteract signs of ageing. The body's own growth factors stimulate collagen formation and promote firmer, fresher skin.

PRP has long been known in aesthetic medicine. The processed plasma is injected into the skin of the face, neck, décolleté or hands to stimulate skin regeneration. Studies show that PRP injections can improve skin texture and reduce fine lines -->pubmed.ncbi.nlm.nih.gov.

For example, a 2020 systematic review reported that PRP achieved safe and moderate improvements in skin aging, e.g. facial skin - especially in terms of skin hydration, finer pores and reduction of fine lines -->pubmed.ncbi.nlm.nih.gov. PRP is also used after laser treatments (e.g. fractionated CO₂ laser): it accelerates healing and reduces downtime, as the growth factors promote the repair processes of the lasered skin.

Of particular interest to aesthetic doctors: t-PRP could be used to optimize these effects. As t-PRP remains active for longer, it could theoretically "supply" the skin with growth factors for longer. One can imagine, for example, that an injected t-PRP gel acts like a small depot under the skin, from which regenerative signals are constantly sent out for hours after the treatment. This could lead to even better collagen regeneration in skin rejuvenation treatments. Although corresponding studies on humans are still pending, the principle is interesting. It is also important for aesthetic applications that t-PRP does not require any additives, which means less risk of swelling or irritation caused by excess calcium, for example.

PRP back of the hand

Hair medicine (trichology): Help with hair loss

Hair loss patients are often inundated with empty promises. This makes PRP all the more exciting as an evidence-based option against androgenetic alopecia (hormonal-hereditary hair loss). PRP is injected into the scalp to revitalize the dwindling hair follicles. Growth factors such as PDGF, VEGF and IGF-1 from the platelets can improve blood flow to the hair root, stimulate the cells of the hair follicles to divide and keep the hair root in the growth phase (anagen phase) pmc.ncbi.nlm.nih.gov |pmc.ncbi.nlm.nih.gov. Clinical studies support this effect: In one study, hair density increased from ~34 to ~50 hairs/cm² on average after PRP treatment ->dartmouthderm.com. Patients and doctors reported thicker, denser hair and reduced hair loss (pull test) without severe side effects ->dartmouthderm.com anddartmouthderm.com.

For hair medicine, t-PRP could be a real game changer. Especially for hair follicles, which have a long growth cycle, a slow, continuous release of growth factor would be ideal. It is hoped that t-PRP will stimulate the follicles over a longer period of time - perhaps as if a one-off treatment were turned into a week-long micro-therapy. Initial research, as mentioned, is even combining PRP gel with microneedling technology to create a kind of reservoir of active ingredients in the scalp ->pmc.ncbi.nlm.nih.gov.

Even though t-PRP is not yet standard in everyday hair consultations, it is worthwhile for trichologists to keep an eye on this concept. It could further increase the effectiveness of PRP for alopecia - without the need for additional medication.

t-prp in trichology

Orthopaedics and sports medicine: repairing joints and tendons

PRP has already gained a firm place in orthopaedics. PRP is injected to promote healing, particularly in cases of joint wear and tear (osteoarthritis) and tendon injuries (tennis elbow, Achilles tendon irritation, etc.). Studies show, for example, that PRP injections work at least as well as, and often better than, hyaluronic acid or placebo for knee osteoarthritis -> link.springer.com. Patients report pain relief and improved function after PRP treatment, especially when several injections are given weeks apart ->link.springer.com.

PRP appears to have an anti-inflammatory effect on the joint and support cartilage regeneration. In sports medicine, doctors use PRP to accelerate the healing of torn ligaments or muscle injuries - prominent athletes have popularized the procedure.

Temperature-controlled PRP could be of interest here, for example in the form of PRP gels or membranes. One could imagine applying t-PRP as a biological patch to an injured meniscus or a cartilage defect, where it would then gradually release its growth factors. The same applies to injections into joints: the anti-inflammatory microenvironment of a slow-release PRP could theoretically last longer. Previous PRP applications usually work with relatively rapid release - t-PRP would represent a new therapeutic approach here. Concrete clinical data is still lacking, but the foundation has been laid and research is underway.

t-prp in orthopaedics

Urology: Regeneration in sensitive areas

PRP therapies are also being tested in urology, for example for erectile dysfunction or Peyronie's disease (curvature of the penis due to scarring). The idea: PRP in the erectile tissue or scar tissue should improve blood circulation and promote tissue remodeling. Initial studies and reviews indicate that PRP injections can actually achieve improvements in function for mild to moderate erectile dysfunction - and are well tolerated -> pubmed.ncbi.nlm.nih.gov. In a meta-analysis of several randomized studies, PRP showed significant advantages over placebo, without severe side effects ->pubmed.ncbi.nlm.nih.gov

PRP is already being injected into the penis in practice. Of course, safety plays a major role here - and t-PRP scores highly because it is 100% autologous. No foreign material that could cause irritation in this sensitive area.

Theoretically, t-PRP could even stimulate the erectile tissue for longer (slow GF release), which may be beneficial for tissue regeneration in the penis. PRP is also being discussed for chronic prostatitis or as support after prostate surgery, although the data is still thin on the ground.

t-prp in orthopaedics

Gynecology: From intimate rejuvenation to the healing of stubborn findings

PRP injections in the genital area have recently attracted interest in gynecology. For example, PRP is being tested for genitourinary menopausal symptoms (vulvovaginal atrophy) and stress incontinence. Initial systematic reviews suggest that PRP - sometimes in combination with hyaluronic acid or laser treatment - delivers promising results: Improved lubrication, firmer vaginal skin and relief of symptoms such as dryness and pain ->pmc.ncbi.nlm.nih.gov and pmc.ncbi.nlm.nih.gov. In combination with autologous fat injections (lipofilling), for example, atrophic labia could be plumped up again and symptoms of lichen sclerosus alleviated -> pmc.ncbi.nlm.nih.gov.

However, it must be emphasized that the evidence for PRP alone in the gynecological field is still limited ->pmc.ncbi.nlm.nih.gov. Many reports use PRP as an add-on to other therapies.

Nevertheless, the regenerative effect of PRP - promotion of angiogenesis (vascularization), improvement of mucosal trophism - fits well with the needs of many patients, for example during the menopause. t-PRP could represent a next step here. One could imagine, for example, injections into the vaginal wall in which t-PRP releases growth factors over a longer period of time in order to build up the mucous membrane. This would be a hormone-free, potentially safe option for patients who cannot or do not wish to take oestrogens (e.g. after breast cancer). T-PRP could also promote wound healing in the healing of birth injuries or operations. Of course, all these applications are still experimental, but the ongoing studies already promise that PRP could be an "ace up the sleeve" in gynecology.

t-prp in orthopaedics

Possible risks and limitations of PRP therapy

Despite all the praise for PRP and t-PRP, it is important to stay grounded in the facts. No therapy is a miracle cure, and PRP also has its limitations. On the positive side, PRP is obtained from the body's own blood, so allergic reactions or serious side effects are extremely rare. Infections at the injection site or swelling can occur, but are unusual if the procedure is carried out correctly and under sterile conditions. Patients sometimes report temporary pain or a feeling of pressure at the treated area after PRP injections, but this usually subsides within a few days. Overall, PRP is considered safe - hardly any significant side effects have been recorded in studiespubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov.

The limitations of the method lie more in its effectiveness, which can vary depending on the indication and individual situation. Not every patient responds equally well to PRP. For example, PRP may achieve significant improvements in the early stages of osteoarthritis, whereas in very late stages (when the cartilage is practically completely gone) it is not expected to work miracles. Also for hair loss: PRP can slow down the progression and initiate regeneration, but cannot definitively "cure" genetic hair loss. Realistic information is important here so as not to raise false hopes.

Another point is the variability: PRP is not the same as PRP. Differences in the preparation (single vs. double centrifugation, with or without leukocytes), in the platelet count and in the type of application make studies sometimes difficult to compare ->link.springer.com. Of course, this also applies to t-PRP: this method requires precise temperature control and, if necessary, special equipment (such as a refrigerated centrifuge). Not every practice has such equipment available. In addition, t-PRP must first be transferred to everyday clinical practice - laboratory success does not automatically mean that it works just as well in practice. Further clinical studies with patients are needed to determine optimal protocols (How long to cool? How long to heat? Inject immediately or leave to act as a gel?

From a legal point of view, it is important to ensure that PRP does not make any promises of healing that are not scientifically proven. In Germany, advertising for medical procedures is subject to strict rules (Therapeutic Products Advertising Act). We are therefore deliberately careful in our wording: PRP"can" support healing processes, studies"show indications" of effectiveness - but no promises are made that something is guaranteed to be cured or improved. This language should also be used with patients in order to be on the safe side legally. Fortunately, reputable PRP providers are aware of this and advertise with study results rather than promises of miracles.

The bottom line is that when used correctly, the benefits far outweigh the minimal risks. However, PRP - whether temperature-controlled or conventional - should always be used responsibly and evidence-based, ideally as part of a holistic treatment concept.

Materials and devices required for temperature-controlled PRP (t-PRP)

PRP tubes: Special PRP tubes made of glass are required to collect autologous blood and separate the platelet-rich plasma.

The use of tubes is recommended for t-PRP without Anticoagulants and without separating gel, as this method deliberately avoids the use of additives.

High-quality glass tubes generally provide a higher platelet yield than plastic tubes and are inert to the blood. Standard tubes hold approx. 9-15 ml of blood. (Example: PRP/CGF tubes without anticoagulant for the collection of platelet-rich plasma.)

Centrifuge: For the production of PRP, a Practice centrifuge with adjustable speed and time is essential. For t-PRP, the centrifuge should ideally have a Cooling function to keep the blood at approx. 4 °C during centrifugation -> ouci.dntb.gov.ua. Only a few PRP centrifuges have temperature control, but this is important as friction generates heat at high speeds. Uncontrolled heating of the sample can lead to premature platelet activation and impair cell vitality. A suitable PRP centrifuge (preferably with cooling) therefore ensures that sufficient platelets are concentrated without damaging them through heat.

Cooling options: The t-PRP procedure requires hypothermic conditions of about 4 °C during blood preparationouci.dntb.gov.ua. It is best to use a refrigerated centrifuge that works constantly at 4 °C. Alternatively, the tubes and blood should be pre-cooled and stored in a refrigerator or on ice between centrifugation steps. It is customary in research to cool centrifuges or samples as a precaution to compensate for friction-induced heating. This prevents the blood from clotting during processing or platelets from being lost before activation.

Heating methods: Once the PRP has been successfully isolated using the cold process, the platelets are activated using a controlled heating performed at body temperature (~37 °C) ouci.dntb.gov.ua. Through this Rewarming the platelets are activated without the addition of reagents and form a natural fibrin scaffold, which releases the growth factors. An incubator (heating cabinet) or a water bath set to 37 °C is suitable for this step to ensure uniform heating of the PRP. It is important to control the temperature precisely so that the activation is reproducible and the plasma quality is maintained. (In the original paper on t-PRP, the PRP was explicitly coagulated by heating it to 37 °Couci.dntb.gov.ua.)

Optional accessories: In addition, various aids can facilitate the collection and handling of t-PRP:

  • Blood collection set: A vacuum-assisted blood collection system (e.g. butterfly cannula with holder) enables the blood to be collected directly into the PRP tubes. This simplifies and speeds up blood collection considerably.

  • PRP adapters and transfer systems: Special Luer lock adapters or cannula systems help to draw up the collected plasma sterilely into syringes after centrifugation, without air contact. Such closed transfer systems minimize the risk of contamination during decanting.

  • Pipettes/holders: Sterile disposable pipettes can be used to precisely separate the plasma layer from the erythrocytes if no special adapter is available. Tube holders or stands are also helpful for holding PRP tubes securely upright during processing.

In addition, of course Disposable syringes and suitable injection needles needed to collect the finished PRP and inject it into the patient's target area.

All these tools and materials ensure that the production of temperature-controlled PRP takes place under sterile and optimal conditions, guaranteeing a high quality of PRP for treatment in aesthetics, trichology, gynecology or orthopedics.

Sources: The above recommendations are based on current specialist articles on t-PRPouci.dntb.gov.ua as well as manufacturer information from recognized PRP specialist dealers prpmed.de, to provide a practical and evidence-based equipment list for t-PRP production.

Conclusion

Temperature-controlled PRP (t-PRP) combines innovation and nature: by cooling and heating, the body's own healing power of the blood platelets is activated virtually via a temperature switch - without any external additives. Initial scientific findings indicate that t-PRP actually has more physiological and potent properties compared to conventional PRP treatmentpubmed.ncbi.nlm.nih.gov. In practice, this means potentially more effective treatments with fewer additives and side effects. From wrinkle treatment to cartilage therapy, from hair root lifting to intimate medicine - the potential areas of application are diverse and the medical community is eagerly awaiting further studies.

It is important not to regard PRP as a panacea, but as a valuable addition to established therapies. In the future, t-PRP in particular could help to further increase the effectiveness of PRP therapy by making optimum use of our body's natural mechanisms. It will be interesting to see what doors this temperature-controlled method will open. One thing is certain: the journey of the tiny droplet of blood, from test tube to cooling to healing injection, is a fascinating example of how high-tech and biology go hand in hand for the benefit of the patient.

Bibliography

  • Du et al. (2018) - A Novel and Convenient Method for the Preparation and Activation of PRP without Any Additives: Temperature Controlled PRP. . Biomed Res Int. 2018;2018:1761865. DOI: 10.1155/2018/1761865pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. . (Basic study on t-PRP, shows higher platelet concentration, no addition of CaCl₂ necessary, slow GF release and improved wound healing in the mouse model)

  • Maisel-Campbell et al. (2020) - A systematic review of the safety and effectiveness of platelet-rich plasma (PRP) for skin aging. . Arch Dermatol Res. 312(5):301-315pubmed.ncbi.nlm.nih.gov. . (Review: PRP injections are safe and lead to moderate improvement in skin ageing, especially skin texture and fine wrinkles)

  • Butt et al. (2019) - Efficacy of platelet-rich plasma in androgenetic alopecia patients. . J Cosmet Dermatol. 18(4):996-1001dartmouthderm.comdartmouthderm.com. . (Randomized study: PRP led to a significant increase in hair density and hair quality in men and women with hereditary hair loss, without serious side effects)

  • Otahal et al. (2023) - Platelet-rich plasma and blood products - new research aspects and clinical results in osteoarthritis of the knee. . Knee Journal. 2023link.springer.comlink.springer.com. . (Overview in German: PRP for knee osteoarthritis shows comparable to better results than hyaluronic acid, in particular multiple PRP injections led to pain reduction and functional improvement)

  • Matz et al. (2023) - Role of Platelet-Rich Plasma in Genitourinary Syndrome of Menopause. . Ther Clin Risk Manag. 19:505-520pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. . (Systematic review: PRP in combination with other therapies (hyaluronic acid, laser, lipofilling) shows promising improvements in vaginal atrophy and incontinence, but unclear evidence for PRP as monotherapy, further studies required)

  • Zaghloul et al. (2023) - Platelet-rich plasma injection for erectile dysfunction: a systematic review and meta-analysis of randomized trials. . Sex Med Rev. (ahead of print)pubmed.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. . (Meta-analysis: PRP injections into the corpus cavernosum significantly improve the IIEF score (erectile function) in mild-moderate erectile dysfunction, with good safety. However, more high-quality studies are needed)

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