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Possible use of platelet gel in ulcerative-erosive oral lesions

Alessio Gambino1*
  • 1 University of Turin, Department of Surgical Sciences, Italy

Platelet-rich plasma (PRP) has been proposed for different applications in the medical field and in maxillofacial surgery thanks to its many growth factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), and keratinocyte growth factor (KGF). In this context, Platelet gel (PG) from peripheral blood is currently used to improve tissue healing in orthopedic, oral maxillofacial and dermatologic surgery (Marx, 2001). The PG for non-transfusion use consists of a suspension of plasma plates to the concentration of 0.8-1.2 mL. It is obtained by autologous / allogenic / umbilical cord blood and plates after activation released in the gel growth factors able to stimulate the replication of mesenchymal and endothelial cells (Pietrzak and Eppley, 2005). The failure of standard therapies especially for autoimmune mucocutaneous chronic diseases and the lack of prevention activity in wound healing have triggered the interest in developing drugs/interventions based on specific biological mechanisms. One approach is the use of autologous PG and growth factors inside it (Carlson and Roach, 2002). Despite the excellent results and the numerous publications about the effects of PG in oral surgical procedures, the scientific literature is not so abundant as regards oral mucous diseases. However, there are case series or case report from which we can get some information about the possible use of PG in oral ulcer/erosive lesions. In the study of Caramella et al. the use of PG has been developed a mucoadhesive PRP gel for the treatment of oral mucositis or GHvD (Caramella et al., 2013). Besides technological characterization, the formulations have been preliminarily screened with an ELISA assay, a cell proliferation test and an in vitro wound healing test. Some formulations have been used in early clinical trials. This could be a simple and economic option to cure oral mucosa damages otherwise very difficult to treat. Regarding Oral Lichen planus (OLP), a case report describes the use of autologous PRP in a patient with erosive OLP no responding to conventional therapies (Merigo et al., 2018). Another recent case series confirms this result (Lore et al., 2018). The wound healing properties of PRP encouraged us to evaluate its usefulness in treatment of non- healing oral Pemphigus Vulgaris (PV) lesions. In a study of Medhat El-Komy et al., seven patients with chronic oral PV, resistant to conventional therapy, were treated with weekly to monthly intralesional injections of autologous PRP (MH et al., 2015). All recruits reported improvement in pain and mastication and 6 of 7 patients had an improvement in pemphigus disease area index scores with PRP treatment. The patients, however, showed variable response to the PRP treatment. This can be due to PRP being of autologous origin; its content may vary from patient to patient. In another split-mouth study of the same authors, it was compared intralesional injection of steroids (triamcinolone acetonide) and autologous PRP treatment of oral erosions of PV. Seven out of the nine patients (78%) showed no significant difference in clinical improvement between autologous PRP and steroid in the treatment of oral PV erosions (El-Komy et al., 2018). Recent findings on multiple biological properties of human umbilical cord blood (CB) and its high level of viral safety prompted us to investigate the characteristics of its PLTs and the possibility to produce PLT gel from cord blood (CBPG). The study of Parazzi et al. suggest that CBPG can be a preferable tool for tissue engineering applications where high levels of VEGF and PDGF may be desirable (Parazzi et al., 2010). Tadini et al. performed a pilot evaluation of the safety and effectiveness of CBPG for the treatment of skin lesions in three children with recessive Epidermolysis Bullosa (EB) (Tadini et al., 2015). EB is a rare group of genetically heterogeneous diseases, characterized by deficiencies in the adhesion of the connective tissue to the epithelium. Junctional EB and dystrophic EB are the most severe types. Common clinical manifestations are mechanical fragility of the skin and mucosae, with blister formation and abnormal wound healing, the severity of the lesions depending on the distinct type (Figures 1-3). The oral cavity is frequently involved, but, although bullae and erosions are common, there is only one published study of therapy, reporting that sucralfate suspension can reduce the development and duration of blisters and ulcers, reduce the associated pain, and improve indices of gingival inflammation (Fine et al., 2014). The oral mucosa in patients with EB can be affected with different lesions and degrees of severity, even if their patterns are still unclear (Fortuna et al., 2013). It has been shown that CBPG releases high levels of VEGF and PDGF, suggesting that CBPG might be useful where high levels of VEGF and PDGF may be desirable (e.g. mucosal and skin lesions). Photobiomodulation therapy (PBMT) has potential biostimulating effects, improving wound healing, and is a possible treatment for autoimmune oral erosive lesions, with a notable analgesic effect (Cafaro et al., 2012). Sindici et al. recently, performed a pilot evaluation of the efficacy and safety of a CBPG with PBMT for the treatment of EB oral mucosal lesions, with some promising results (Sindici et al., 2017a). In fact, this study was the first reported study showing the effectiveness of CBPG and PBMT in reducing intraoral discomfort from ulcerations in patients with EB, being effective also in the long-term. Another study of the same authors valuated the CBPG efficacy, with or without the use of PBMT, in the EB patients (Sindici et al., 2017b). Participants with two bilateral simultaneous symptomatic oral ulcerations were prospectively selected and divided in two groups: group one, treated with topical application of CBPG, and group two, treated with topical application of CBPG followed by PBMT for 15 minutes. A statistically significant difference was observed for reported pain and clinical size of lesions from the first day of treatment in both cases. A month later only two patients treated with CBPG developed new lesions near the treatment site, while no patients treated with CBPG and PBMT developed new lesions in the area. All patients continued to show other oral lesions at untreated sites. This study revealed that CPBG could be a safe and, possibly, a promising option for the treatment of EB oral lesions and that its use combined with laser biostimulation would bring greater benefit to the patient but further studies with greater numbers and longer follow-up are required to confirm this hypothesis and to investigate the incidence of the relapse. At the best of our knowledge the blood components of autologous origin have a proven utility in oral surgery, an easy availability and simple applicability but there are still controversies about their use in erosive lesions from autoimmune chronic diseases refractory to standard therapies. On the other hand, the CPBG avoid skin wounds for blood collection and their use in a population of patients with frequent ulcers / erosions in which it is not possible the use of PG as EB or PV patients could be a hint for future researches.

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References

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Keywords: Autologous platelet gel, PRP, Rare Autoimmune Oral Diseases, cord blood platelet gel, Epidermolysis Bullosa

Conference: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.

Presentation Type: oral presentation

Topic: Oral Diseases

Citation: Gambino A (2019). Possible use of platelet gel in ulcerative-erosive oral lesions. Front. Physiol. Conference Abstract: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine.. doi: 10.3389/conf.fphys.2019.27.00080

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Received: 28 Nov 2018; Published Online: 09 Dec 2019.

* Correspondence: Dr. Alessio Gambino, University of Turin, Department of Surgical Sciences, Turin, Piedmont, 10124, Italy, marcomascitti86@hotmail.it