Professional athletes who opt for an emerging treatment called “blood-spinning” in the hope of healing their injuries faster could fall foul of the World Anti-Doping Agency. The agency ruled last week that the procedure, based on concentrating and re-injecting a person’s own blood, could introduce banned substances into the body. But proponents of blood-spinning argue that the ruling may deny injured athletes access to a technique that could heal their injuries faster than existing treatments and potentially with fewer complications.
WADA, based in Montreal, Canada, already bans the concentration, storage and re-injection of an athlete’s own red blood cells just prior to competition, because the procedure boosts oxygen supply and enhances performance.
But blood-spinning is different: small samples of a patient’s blood are centrifuged to discard red blood cells and concentrate the platelets into platelet-rich plasmas (PRPs). When the platelets are concentrated to typically five times their normal level, calcium and the enzyme thrombin are added to the mix, which makes the platelets coagulate to form a clot-like gel. The platelets then start releasing the natural growth factors (NGFs) that accelerate healing, just as they would in a natural wound, but at five times the usual concentration.
The gel can be applied to a wound or injected into the site of an internal injury.
It is the NGFs produced by the procedure that concern the anti-doping agency, which already bans other NGFs such as growth hormones. Blood-spinning usually produces copious amounts of NGFs, and so the procedure contravenes WADA’s criteria, even though it is not used specifically to enhance performance. “Because it is a recovery procedure, it’s unlikely the athletes would benefit from it in a competition,” admits Oliver Rabin, WADA’s science director. “But we don’t want to open the door, so for now the chapter is closed.”
Robert Marx, a maxillofacial surgeon at the University of Miami’s Miller School of Medicine who pioneered blood-spinning in 1998, thinks the WADA ruling is misguided. He says that the platelets and growth factors are all in the patient to start with: “You don’t increase the body’s number of platelets- you simply direct them to where you need them.”
Marx developed the technique for use in dentistry and in facial reconstruction. By applying gels made from blood-spinning to wounds and damaged tissues, he says he can almost halve the recovery time. But importantly, the quality of healing is better too. There is less permanent scarring in skin wounds, for example. “It just heals faster and better,” he says.
The technique is now working its way from periodontal and other general types of surgery into sport. Frank Stephenson of Harvest Technologies in Plymouth, Massachusetts, a company developing the treatment, says that PRPs are increasingly being used to heal tendon and ligament injuries faster. “Anecdotal reports are that it works well,” he says.
Stephenson says that PRP treatments don’t wear out tissue, as can happen with standard treatments for inflammation, such as steroids. Although they ease pain, “steroids are themselves degenerative and can hurt tissue”, he says. But he accepts that large-scale clinical trials are needed to find out if PRP therapy heals sports injuries better than existing treatments.
In sport, the matter came to a head last month after the London soccer team Chelsea considered, but rejected, the idea of using the treatment on injured players. “No Chelsea player has undergone this treatment,” says a club spokesman.
WADA has issued its verdict to all national sporting authorities. “We’ll be seeking assurances from Chelsea that the technique being offered to players is in line with the rules that have been set out,” says a spokesman from UK Sport, the nation’s sporting authority. “In the meantime, we will continue to advise caution in the use of this technique.”
In a conciliatory gesture, WADA says athletes who are injured and not competing can apply for special permission for the treatment. The agency will decide for how long after treatment the player should not compete.