I wrote the research protocol for the project, applied for ethics approval and submitted amendment to the ethics committee when the need arose.
My research project was on the role of autologous derived platelet rich plasma in treating chronic diabetic foot ulcers.
I was awarded a £12,000 grant from the innovative research grant scheme of the Barts and The London Hospital Trust NHS. The research project led to the award of M.D (research) degree at the Queen Mary University of London. The research had two component; the clinical pilot study and the laboratory component.
The laboratory part of the study focused on characterizing Platelet rich plasma (PRP/PPP) and platelet poor plasma and the biological effects of the PRP/PPP were assessed on human derived epidermal keratinocyte and dermal fibroblast, endothelial cells. Growth factors of particular interest (PDGF, TGT, FGF, VEGF, IGF, EGF, TSP-1 and PF-4) were comparatively analysed from PRP and PPP through the use of Enzyme linked imunoabsorbent (ELISA) technique. Furthermore, the results from the experimental model of cell proliferation, chemotactic and angiogenesis assay on human derived keratinocyte, fibroblast and endothelia cell following treatment with platelet rich/poor plasma gel showed a consistent positive mitogenic and angiogenic effect which was observed to be dose dependent.
In addition, wound biopsy taken at day 0, 8, week 4 and week 8 were analysed through immuno-histochemistry. Biopsies obtained from the ulcers during treatment were assessed for the expression of keratin proteins (Ki67 &K1&10, K5), Collagen (I, III, VII), cell surface protein (CD31 & 44), beta-1 intergrin through imunoperioxide staining technique. In summary, we have demonstrated that Autologus derived platelet may play a vital role in accelerating the process of wound healing as shown by the positive biological effect on all in vitro assays. However, the same effect was not producible in the pilot study; complete wound re-epithelisation was achieved in only 3 patients.
The clinical part of the pilot study entailed treating chronic diabetic foot ulcers with Autologus platelet gel. Seven diabetic patients were recruited into the study. The ulcers were debrided and treated with platelet rich plasma. Computerised planimetry and photographical documentation were used as an objective means to assess the rate of wound re-epithelisation and coverage over a 16 weeks period.
We concluded that a number of potentially therapeutic growth factors were detected from PRP in significant levels. The direct application of PRP to wound is believed to deliver growth factors to wounds and allows wound to mimic normal physiological wound healing and tissue reparation process. However, there are confounding factors that preclude direct translational application of PRP in the clinical setting. Preliminary results from the laboratory study have been presented as oral and poster presentation at national and international meetings.