PRECIPITATION OF GROWTH-FACTOR-ENRICHED FIBRINOGEN
CONCENTRATE FROM PLATELET RICH PLASMA
TECHNICAL FIELD
This application relates to improved processes for recovery and concentration
of blood components. In particular, the invention relates to the production of growth-
factor-enriched fibrinogen concentrate from platelet-rich plasma.
BACKGROUND
The need exists for means quickly to concentrate and recover certain blood
proteins from whole blood, which also contains platelets and certain growth factors,
in a closed-process system for use by physicians to assist in closing wounds, to
achieve faster haemostasis, to seal air and fluid leakage, and to aid in faster healing
and for drug and biologic delivery.
Those skilled in the art know that when platelet-rich plasma is harvested from
a surgical patient intraoperatively and is combined with thrombin, usually in a seven-
to-one ratio, and deposited on a wound site, a platelet gel is formed within seconds
of application. The gel achieves faster haemostasis than do other conventional
haemostatic agents. The gel also seals air and fluid leakage due to its viscous
properties, and results in faster healing resulting from the presence of platelet
derived growth factors (PDGF). Such a gel contains only native levels of fibrinogen,
FXIII, FVIII, and PDGF. Thus, the adhesive, tensile and shear strength of the clot
formed by this gel is generally less than is desirable. Further, failure of haemostasis
or sealing can occur because of these low levels of desirable proteins, resulting in a
failure to achieve the desired outcome.
Harvesting platelet rich plasma from a patient in the intra-operative setting
requires a "blood processor," one of which is sold under the trademark "Cell Saver,"
but other devices manufactured by various companies are known. The Cell Saver
device requires a highly-skilled, sometimes certified, operator to set-up and operate
the device. Operation (which can take 30 to 60 minutes) requires large-bore venous
or arterial access and processing of up to several liters of biood to obtain and
sequester sufficient platelets and plasma volume. The patient's haemodynamic and
cardiac status must be stable to allow processing of such large volumes.
An automated system for obtaining autologous fibrinogen has been described
in United States Patent 5,707,331 (Wells et al.), the disclosure of which is
incorporated herein by reference. According to that system, a relatively small
volume (e.g., 50ml) of whole blood is placed in a first chamber of a two-chamber
disposable container. A fibrinogen-precipitating agent is placed in the second
chamber. The container is then placed in a centrifuge, and the whole blood is
centrifuged to separate the plasma to produce platelet-poor plasma. The platelet-
poor plasma, thus obtained is then decanted into the second chamber where it is
mixed with the precipitating agent (e.g., PEG or ammonium sulfate). The plasma
and precipitating agent are then centrifuged to obtain a pellet of fibrinogen for
combination with thrombin to make a fibrin sealant.
DESCRIPTION OF THE PREFERRED EMBODIMENT
An important factor for processes that recover fibrinogen, such as the one
described in the mentioned United States Patent 5,707,331 , is the percentage of the
fibrinogen in the whole blood that is recovered in the pellet. Applicant has
discovered that this factor, the "fibrinogen yield," is unexpectedly greater when the
plasma from which fibrinogen is precipitated contains increased levels of platelets.
Thus, according to the process of the invention, a known fibrinogen precipitating
agent is added to platelet-rich plasma to obtain increased yields of fibrinogen.
The fibrinogen yield obtained with prior art methods is generally about 50%,
whereas the fibrinogen yield obtained in accordance with the methods of the
invention is about 72%, which represents a 44% increase in recovered fibrinogen.
In the preferred embodiments, the platelet-rich plasma from which fibrinogen
is precipitated contains at least 50K platelets per mm3 and preferably about
200K/mm3.
The disclosed invention produces FVIII and concentrated (up to 10+ fold
increase) proteins, preferably fibrinogen, FXIII, and recovered platelets (and
resultant increase in human growth factors) from relatively small aliquots (20cc-
150cc) of anti-coagulated whole blood in a short time (approx. 20 minutes). The
increased coagulation protein concentration of the disclosed invention over the
current Cell Saver methods results in a clinically more effective (greater tensile and
shear strength) clot. A clinically effective dose is produced from a smaller volume
(20cc-150 cc) of the patient's blood obtained by simple phlebotomy known in the art
versus the Cell Saver method (several liters).
The preferred method utilizes the dedicated centrifuge and disposable
container described in United States Patent 5,707,331 to process anti-coagulated
whole blood drawn from a patient (or directed blood donor). In accordance with the
invention, the process described there is modified to provide platelet-rich plasma by
appropriate control of the centrifuge speed and the length of time the blood is
subjected to centrifugation.
Anticoagulated blood retrieved from a mammal by simple phlebotomy
techniques is dispensed into a first chamber of a 2-chamber disposable, and an
appropriate volume of a precipitating agent, for example PEG or saturated
ammonium sulfate, is placed in the second chamber. The ammonium sulfate can be
25% to 100% ammonium sulfate, and is preferably about 95% ammonium sulfate.
The disposable is loaded into the dedicated centrifuge as described in United States
Patent 5,707,331 , and the process in that patent initiated. The centrifuge is
programmed to effect the following steps automatically:
1. Red cells are separated from whole blood in the centrifuge at a spin rate that
produces platelet-rich plasma (PRP). The spin rate is known as a "soft spin"
and preferably one that produces about 580G. The centrifuge is then
stopped, and the PRP is decanted from the first chamber to the second,
where it is mixed with the precipitating agent. This soft spin has been found
to produce plasma having a platelet concentration of from about 50K/mm3 to
about 450K/mm3.
2. After mixing is complete, the centrifuge re-starts and the precipitated proteins,
along with the platelets, are concentrated by a "hard spin," preferably one that
produces about 3500G.
3. Following step 2 above, the platelet-poor and fibrinogen-poor plasma and
residual precipitating agent are decanted from the second chamber back to
the first, leaving a relatively-dry, growth-factor-enriched protein/platelet pellet.
The use of a precipitating agent, such as PEG or ammonium sulfate, with
PRP has been found to provide greater protein (preferably fibrinogen)
recovery than obtained with techniques using a precipitating agent with
platelet poor plasma (PPP).
4. A suitable diluent volume, preferably a citrate buffer, is added to re-dissolve
and recover the protein/platelet pellet to allow transport by, for example,
syringe.
5. When the recovered, concentrated protein, containing increased levels of
human growth factors, is combined with thrombin and deposited on a wound
site, a platelet gel is formed within seconds of application. The gel achieves
faster haemostasis than when other conventional haemostatic agents are
used. It can also seal air and fluid leakage due to its viscous properties, and
results in faster healing from the presence of enriched platelet derived growth
factors (PDGF). The gel's properties include FVIII and increased levels of
fibrinogen, FXIII, and greater than native levels of human growth factors.
These increased levels result in a clot with more desirable adhesive, tensile
and shear strength. Because of these' higher levels of desirable proteins, the
risk of premature failure of the clot is reduced and the likelihood of achieving
the desired outcome is increased.
Example 1.
Fifty milliliters of whole blood were placed in the first chamber of a container
for use in an automated centrifuge, and 15 milliliters of 30% polyethylene glycol
(MW1000) were placed in the second chamber. The container was then subjected
to a soft spin of about 580G for three minutes. The platelet-rich plasma thus
obtained (23-25ml) was then decanted to the second chamber and mixed with the
PEG. The container was then subjected to hard centrifugation and the supernatant
was decanting back to the first chamber. The result was a fibrinogen pellet
representing a fibrinogen yield of approximately 70%, a four-to-ten fold increase in
TGF-B-1 and a thirty-fold increase in PDGF-AB.
Example 2.
Fifty milliliters of whole blood were placed in the first chamber of a container
for use in an automated centrifuge, and 7ml of saturated ammonium sulfate was
placed in the second chamber. The container was then subjected to a soft spin of
about 580G for three minutes and 23-25 milliliters of platelet-rich plasma were
decanted to the second chamber. After mixing with the platelet-rich plasma with the
ammonium sulfate, the container was subjected to a hard spin to obtain a fibrinogen
pellet, and the supernatant decanted to the first chamber. The fibrinogen yield of the
pellet was about 72% a four-to-ten fold increase in TGF-B-1 and a thirty-fold
increase in PDGF-AB.
Modifications within the scope of the appended claims will be apparent to
those of skill in the art.