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. 2024 Nov 19:16:467-479.
doi: 10.2147/CCIDE.S488206. eCollection 2024.

Platelet-Rich Fibrin (PRF) Analyzed for Cytokine Profiles - A Misguided Hope for Osteogenesis in Jawbone Defects? Research and Clinical Observational Study

Johann Lechner  1 , Volker vonBaehr  2 , Cornelia Doebis  3 , Florian Notter  4 , Fabian Schick  4
Affiliations

Platelet-Rich Fibrin (PRF) Analyzed for Cytokine Profiles - A Misguided Hope for Osteogenesis in Jawbone Defects? Research and Clinical Observational Study

Johann Lechner et al. Clin Cosmet Investig Dent. .

Abstract

Background: Platelet-rich fibrin (PRF) blood concentrates are used in oral implantology and defect surgery to promote osteoneogenesis in Bone Marrow Defects in Jawbone (BMDJ), according to the morphology of fatty-degenerative osteonecrosis also called FDOJ.

Question: Can the benefit of PRF on alveolar osteoneogenesis be confirmed by cytokine analysis?.

Methods: The cytokine expressions of the PRF samples in 26 patients undergoing BMDJ/FDOJ surgery in the same session were analysed for seven cytokines (RANTES/CCL5; FGF-2; IL-1RA; Il-6; IL-8; MCP-1; TNF-a) by multiplex (Luminex). The FDOJ samples of these 26 BMDJ/FDOJ patients were analysed for the RANTES/CCL5 expression only.

Results: Cytokine expression in PRF is compared to reference values for healthy medullary bone of the jaw and BMDJ/FDOJ and shows that the cytokine expressions of the PRF samples do not compensate or counteract prima vista for the cytokine dysregulations present in the BMDJ/FDOJ areas.

Discussion: To define the aid of cytokines studied in PRF in the restoration of the immunological dysregulation in areas of BMDJ/FDOJ, literature is reviewed comparing RANTES/CCL5, IL-1ra, TNF-α and MCP-1/CCL2 expression in PRF and BMDJ/FDOJ. Immunoregulatory properties of PRF in alveolar bone restoration are evaluated.

Summary: PRF was mistakenly thought to be a cure for bone healing, which is here shown to be incorrect. Enoral Ultrasound Sonography of bone density is available for the clinical measurement of individually developed osteoneogenesis by PRF.

Conclusion: The multiplex analysis of PRF shows a dynamic and cytokine-based interaction with osteoneogenesis that is not yet fully clarified.

Keywords: bone marrow defects of the jaw; cytokines; enoral transalveolar ultrasonograph; multiplex analysis; osteoneogenesis; platelet-rich fibrin.

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Conflict of interest statement

Drs Johann Lechner reports a patent Europäisches Patent 3720382 PCT/EP2018/084199 issued to Dr. Johann Lechner. The authors report no other conflicts of interest in this work..

Figures

None
Graphical abstract
Figure 1
Figure 1
Legend: Columns in red (MV) show the mean value of the respective cytokine in 128 BMDJ/FDOJ samples; columns in blue (Norm) show the mean value of each cytokine in 19 healthy jaw bone samples. The distribution of the multiplex analyses of 128 BMDJ/FDOJ samples shows marked singular overexpression of R/C, mild overexpression of IL-1ra (red arrows) and highly downregulated TNF-α and IL-6 expression (blue arrows). (*) Indicate medium values of cytokine expressions in BMDJ/FDOJ samples. The inset image shows one of the characteristic samples of fatty-degenerative osteonecrosis of the jaw (FDOJ) which was evaluated using a cytokine panel analysis.
Figure 2
Figure 2
Graphical statistics of. Figure 1: MV FDOJ = 128 show the mean value of the respective cytokine in 128 BMDJ/FDOJ samples; Norm = 19 show the mean value of each cytokine in 19 healthy jaw bone samples.
Figure 3
Figure 3
From left to right: PRF clot frozen transport to laboratory for Multiplex analysis (Luminex) for a seven cytokine panel (RANTES/CCL5, FGF-2, IL1-RA, Il-6, IL-8, MCP-1, and TNF-α: See Figure 2).
Figure 4
Figure 4
Areas of BMDJ/FDOJ. The left panel shows a hollow cavity in areas 38–39 after curettage of a softened, spongy bone marrow defect of the jaw (BMDJ). The right panel shows a clump of tissue displaying fatty degeneration of bone marrow (FDOJ) with the typical yellowish coloring characteristic of this fatty transformation.
Figure 5
Figure 5
Distribution of cytokine expression of PRF samples from 26 patients as determined by multiplex analysis of the following cytokines in pg/mL: R/C, FGF-2, IL1-RA, IL-6, IL-8, MCP-1 and TNF-α.
Figure 6
Figure 6
Graphical statistics to Figure 5: Left picture: Results of RANTES/CCL5 expression in 26 PRF samples (MV = 9.212,19 pg/mL; StDev = ±7.352,03 pg/mL). Right picture: Results of RANTES/CCL5 expression in 26 BMDJ/FDOJ samples of same patients as PRF (MV = 2.766,88 pg/mL; StDev = ±3.399,78 pg/mL).
Figure 7
Figure 7
Comparison of cytokine expression patterns observed in the 7-cytokine panel for 19 samples of healthy medullary bone of the jaw (green columns), for 128 BMDJ/FDOJ samples where we added the new R/C of 26 actually debrided BMDJ/FDOJ samples (red columns), and 26 PRF samples (blue columns).
Figure 8
Figure 8
Hypothetical mechanism of aim of PRF (yellow columns), ie, balancing the pathological cytokine profile of BMDJ/FDOJ by upregulating TH-1 acute cytokines IL-6, MCP-1 and TNF-α, (red arrows), and downregulating TH-2 cytokines, (blue arrows).
See this image and copyright information in PMC

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