Randomized Clinical Trial: Comparing In-Vitro Release of Growth Factors from Combination of Hyaluronic Acid and Advanced Platelet Rich Fibrin (A-PRF) Gel

Liquid fibrinogen (Advanced platelet-rich fibrin – A-PRF) is an injectable platelet concentrate rich in platelets, leukocytes, and fibrinogen obtained by blood centrifugation. Hyaluronic acid (HA) had been known to induce growth factor release from PRF. This study aimed to analyze and assess the in-vitro release of different growth factors from the combination of HA + A-PRF at different times. The concentration of platelet-derived growth factor-AB (PDGF-AB) and vascular endothelial growth factor (VEGF) released by liquid fibrinogen were examined with ELISA at three-time points (D-0, D-3, D-14). Twenty DFU subjects were involved in this study and randomized into HA + A-PRF group and A-PRF only group. A-PRF was obtained by peripheral blood centrifugation. HA+ A-PRF was prepared by homogenizing PRF and HA with a ratio of 1:0.6. PDGF-AB and VEGF were quantified in HA + A-PRF and the supernatant serum after freezing it in 80 o C while protein profiles were determined by SDS-PAGE. Fibrin gel VEGF level was found to be significantly higher in HA + A-PRF compared PRF alone (on D-3, p=0.010, and D-7, p= 0.043). The PDGF level was found to be significantly higher in fibrin gel on D-3 (p=0.049) and D-7 (p=0.023). Observation of the fibrin gel’s density revealed that the HA + A-PRF group showed a longer melting time compare with A-PRF group (p =0.002). The combination of HA + PRF results in better induction of growth factor release, denser fibrin gel, and better retention of growth factors compared to PRF alone. Funding: This study was funded by Medical Science Doctoral Programme, Universitas Indonesi Ethical Approval: The study has been approved by The Ethics Committee of the Faculty of Medicine Universitas Indonesia ID 0855/UN2.F1/ETIK/2018.