Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Response to the Commentary on: Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study

International Journal of Impotence Research volume 36, pages 299–300 (2024)Cite this article

Subjects

We thank our Turkish colleagues on commenting our study [1, 2]. They started off with an impeccable summary of our work then moved on explaining how several fibrotic mediators in Platelet-Rich Plasma (PRP) especially TGF-β can induce healing complications like scar tissue and fibrosis [2]. They mentioned that the supplementation of certain antibodies can counteract this effect and/or by applying PRP purification methods can prevent fibrosis. Furthermore, they stated that percutaneous needle tunneling’s (PNT’s) traumatic effect can activate certain macrophages that can contribute to fibrosis.

The aim of using PRP is to stimulate the normal healing process, as, in addition to their role in hemostasis, platelets are involved in the regulation of tissue repair. When performing PNT to break the fibrotic plaques in patients suffering from Peyronie’s disease (PD), PRP is used to stimulate healing without inducing new fibrotic tissue formation. Platelet granules contain various active substances (More than 300 according to Golebiewska et al.) and some of them are pro-inflammatory, as inflammation is part of the normal healing process [3]. However, in physiological healing, the inflammatory stage is transitory. The certified medical device used to prepare PRP in our study (RegenKit BCT-3, Regen Lab, Switzerland), allows the preparation of a standardized leukocyte poor PRP with virtually no red blood cells (RegenPRP) [4]. The effective depletion of those undesired blood cells in RegenPRP ensure avoidance of unregulated inflammatory reactions at the site of injection. The platelet concentration factor in RegenPRP is around 1.6 times the baseline value in whole blood. As the physiological platelet/plasma ratio is maintained, such PRP stimulates the healing in respect to physiological tissue homeostasis. In addition, platelets are fully functional in RegenPRP, hence the growth factors are released in an orchestrated manner in response to local signals and according to the different steps of the healing process [3]. This is not the case when frozen/thawed PRP or PRP clot releasate are used, as it was the case in the Li and Tsai studies mentioned in the comment [5, 6]. In such products, the growth factors from platelets, but also from the leukocytes when present in the PRP, are released in bulk, hence in high dose and without regulation. The PRP used by Culha et al. on an animal model of PD was not characterized [7]. Nevertheless, the device used for its preparation (GLO-PRP kit, GloFin, Finland) is known to produce a pro-inflammatory leukocyte-rich PRP with a very high platelet concentration factor (4–9x) [8]. The fibrosis induced by this type of PRP in this study is probably due to its cellular composition, as fibrosis is the result of uncontrolled inflammatory reactions [9]. Contrary to leukocyte rich PRP, leukocyte poor PRP induces the transition of pro-inflammatory M1 macrophages to anti-inflammatory M2 macrophages [10]. This physiological transition conducts to the granulation phase of the healing process. As for inflammation, the granulation phase should be regulated and transitory, in order to avoid excessive production of extracellular matrix proteins that could lead to fibrosis [11]. The transition to the remodeling phase leads to the resolution of the wound. On the contrary, a reversion from M2 to M1 macrophages is not desirable as this would lead to sustained inflammation and prevent healing [12].

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Data availability

Data is available within the published article.

References

  1. Zugail AS, Alshuaibi M, Lombion S, Beley S. Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study. Int J Impot Res. 2024;36;140–5. https://doi.org/10.1038/s41443-023-00744-y.

    Article  PubMed  Google Scholar 

  2. Şahin A, Gül M. Commentary on: Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study. Int J Impot Res. 2024;36;162–3. https://doi.org/10.1038/s41443-023-00806-1.

  3. Golebiewska EM, Poole AW. Platelet secretion: From haemostasis to wound healing and beyond. Blood Rev. 2015;29:153–62. https://pubmed.ncbi.nlm.nih.gov/25468720/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Gomri F, Vischer S, Turzi A, Berndt S. Swiss Medical Devices for Autologous Regenerative Medicine: From Innovation to Clinical Validation. Pharmaceutics. 2022;14:1617. https://pubmed.ncbi.nlm.nih.gov/36015243/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Li H, Hicks JJ, Wang L, Oyster N, Philippon MJ, Hurwitz S, et al. Customized platelet-rich plasma with transforming growth factor β1 neutralization antibody to reduce fibrosis in skeletal muscle. Biomaterial. 2016;87:147–56. https://pubmed.ncbi.nlm.nih.gov/26923362/.

    Article  CAS  Google Scholar 

  6. Tsai WC, Yu TY, Chang GJ, Chang HN, Lin LP, Lin MS, et al. Use of Platelet-Rich Plasma Plus Suramin, an Antifibrotic Agent, to Improve Muscle Healing After Injuries. Am J Sports Med. 2021;49:3102–12.

    Article  PubMed  Google Scholar 

  7. Culha MG, Erkan E, Cay T, Yücetaş U. The Effect of Platelet-Rich Plasma on Peyronie’s Disease in Rat Model. Urol Int. 2019;102:218–23.

    Article  PubMed  Google Scholar 

  8. Collins T, Alexander D, Barkatali B. Platelet-rich plasma: a narrative review. EFORT Open Rev. 2021;6:225–35. https://pubmed.ncbi.nlm.nih.gov/34040800/.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wynn TA. Cellular and molecular mechanisms of fibrosis. J Pathol. 2008;214:199–210. https://pubmed.ncbi.nlm.nih.gov/18161745/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nishio H, Saita Y, Kobayashi Y, Takaku T, Fukusato S, Uchino S, et al. Platelet-rich plasma promotes recruitment of macrophages in the process of tendon healing. Regen Ther. 2020;14:262–70. https://pubmed.ncbi.nlm.nih.gov/32455156/.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang X, Chen J, Xu J, Xie J, Harris DCH, Zheng G. The Role of Macrophages in Kidney Fibrosis. Front Physiol. 2021;12:705838. https://pubmed.ncbi.nlm.nih.gov/34421643/.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care. 2015;4:560–82. https://pubmed.ncbi.nlm.nih.gov/26339534/.

    Article  Google Scholar 

  13. Virag R, Sussman H, Lambion S, de Fourmestraux V. Evaluation of the benefit of using a combination of autologous platelet rich-plasma and hyaluronic acid for the treatment of Peyronie’s disease. Sexual Health Issues. 2017;1. https://www.oatext.com/evaluation-of-the-benefit-of-using-a-combination-of-autologous-platelet-rich-plasma-and-hyaluronic-acid-for-the-treatment-of-Peyronies-disease.php#Article_Info.

  14. Hersant B, Sidahmed-Mezi M, Picard F, Hermeziu O, Rodriguez AM, Ezzedine K, et al. Efficacy of Autologous Platelet Concentrates as Adjuvant Therapy to Surgical Excision in the Treatment of Keloid Scars Refractory to Conventional Treatments: A Pilot Prospective Study. Ann Plast Surg. 2018;81:170–5. https://pubmed.ncbi.nlm.nih.gov/29762444/.

    Article  CAS  PubMed  Google Scholar 

  15. Pirrello R, Verro B, Grasso G, Ruscitti P, Cordova A, Giacomelli R, et al. Hyaluronic acid and platelet-rich plasma, a new therapeutic alternative for scleroderma patients: a prospective open-label study. Arthritis Res Ther. 2019;21:286. https://pubmed.ncbi.nlm.nih.gov/31836018/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Chen CPC, Cheng CH, Hsu CC, Lin HC, Tsai YR, Chen JL. The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol. 2017;93:68–72. https://pubmed.ncbi.nlm.nih.gov/28433472/.

    Article  CAS  PubMed  Google Scholar 

  17. Akkurt I, Bakar B, Dincel GC, Yıldıran FAB, Ogden M, Nursoy E, et al. Effectiveness of the Biophysical Barriers to the Peridural Fibrosis in Rat Laminectomy Model. J Invest Surg. 2019;32:361–8. https://pubmed.ncbi.nlm.nih.gov/29345503/.

    Article  PubMed  Google Scholar 

  18. Russo GI, Milenkovic U, Hellstrom W, Levine LA, Ralph D, Albersen M. Clinical Efficacy of Injection and Mechanical Therapy for Peyronie’s Disease: A Systematic Review of the Literature. Eur Urol. 2018;74:767–81. https://pubmed.ncbi.nlm.nih.gov/30237020/.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We send our dearest appreciation and gratitude to Solange Vischer for the precious input.

Author information

Authors and Affiliations

  1. Urology Division, Department of Surgery, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia

    Ahmed S. Zugail

  2. Department of Urology, Clinique Turin, Groupe Almaviva Santé, Paris, France

    Ahmed S. Zugail & Sébastien Beley

  3. Urology Division, Department of Urology, Faculty of Medicine, University of Ha’il, Ha’il, Saudi Arabia

    Muaath Alshuaibi

Authors
  1. Ahmed S. Zugail
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muaath Alshuaibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sébastien Beley
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Research conception and design: AZ, MA, and SB. Data/information acquisition: AZ, MA, and SB. Drafting of the manuscript: AZ. Critical revision of the manuscript: MA and SB. Supervision: SB. Approval of the final manuscript: AZ, MA, SL and SB.

Corresponding author

Correspondence to Ahmed S. Zugail.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zugail, A.S., Alshuaibi, M. & Beley, S. Response to the Commentary on: Safety and feasibility of percutaneous needle tunneling with platelet-rich plasma injections for Peyronie’s disease in the outpatient setting: a pilot study. Int J Impot Res 36, 299–300 (2024). https://doi.org/10.1038/s41443-024-00874-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-024-00874-x

Search

Advanced search

Quick links