DOI: 10.1097/PRS.0000000000001095

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PMID: 25664895

Issn Print: 0032-1052

Publication Date: 2015/04/01


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Double-Blind Clinical Trial to Compare Autologous Fat Grafts versus Autologous Fat Grafts with PDGF: No Effect of PDGF

Barbara Hersant; Frederic Picard; Jean Paul Meningaud

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Excerpt

We read with plenty of interest the original article by Fontdevila et al. entitled “Double-Blind Clinical Trial to Compare Autologous Fat Grafts versus Autologous Fat Grafts with PDGF: No Effect of PDGF.”1 The authors’ reputation regarding autologous facial fat transfer to treat human immunodeficiency virus facial lipoatrophy is indisputable. We fully share the belief that double-blind clinical trials are necessary to assess the effect of adding platelet-derived growth factor, as this procedure is widespread. However, we have some concerns regarding the methodology.
First, the authors do not inform us about the platelet count of their platelet-rich plasma. As for any drug, it is critical to know the exact concentration of the active substance being studied.
Second, the platelet-rich plasma fraction has been activated. When platelets are activated, their morphology changes irreversibly, and more than 70 percent of preserved growth factors are released within 10 minutes. Very likely, such an important but short-lived concentration of growth factors has nothing to do with a gradual release. In a recent study, nonactivated platelets were reported to possess better effects to enhance adipose-derived mesenchymal stem cell proliferation than activated platelets.2
Third, the fat obtained was purified by centrifugation at 3000 rpm for 3 minutes. The authors described centrifugal force in terms of revolutions per minute and not in Newtons (or the acceleration in gravity, or g), it is well known that a given revolutions per minute value can result in different forces according to the radius of rotation. Indeed, it seems that strong centrifugation over 900 g and for more than 1 minute is deleterious to the adipose tissue, notably to preadipocytes.3 Thus, the number and viability of preadipocytes are not preserved, and they might be the real targets of the platelet-rich plasma.
Fourth, more than 40 percent of acquired immunodeficiency syndrome patients on antiretroviral therapies have a thrombocytopenia. Furthermore, several studies have shown alteration in morphology and function of platelet aggregates in human immunodeficiency virus–positive patients.4,5 Obviously, it is difficult to infer conclusions if their platelet-rich plasma has been used. Has it been excluded from the study?
Finally, patients were recruited from December of 2004 to December of 2005. We supposed that the study has been conducted right away. It is intriguing that it is published only now.
We fully share the authors’ opinion that it is possible to achieve excellent results without platelet-rich plasma. In addition, we would like to commend the authors for the accuracy of their method of measuring and comparing the volume gains. However, in our opinion, the methodology as a whole does not support the main conclusion. We are available to cooperate with this team for future studies in that field.
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