Implai Professionals Products
Xerthra™ PRP PURE kit is a new generation, high-performance platelet (PLT) separation device, dedicated to preparation of platelet-rich plasma with reduced content of leukocytes (LP-PRP) from patient’s blood. Large number of growth factors released from PLTs delivered by PRP will lead to improvement of regenerative properties of patient’s cells and tissues. 

Xerthra™ kit consists of a highly efficient separation device, which due to its unique construction allows to separate and isolate the very high number of PLTs for the final injection. Decreased abundance of leukocytes has its rational in chronic, degenerative phase of the disease in which not inflammatory action of leukocytes but the regenerative action of growth factors contained in platelets is essential. 
The final blood-derived product acquired with Xerthra™ PRP PURE kit is characterized by PLTs concentration way above 1 000 000 PLT/µl which constitutes as a threshold of a therapeutical effectiveness for PRP. This is due to ability of Xerthra™ separation device to concentrate PLTs up to 9.7 times more than in patients peripheral blood1.
High number of platelets with reduced leukocytes fraction delivered by PRP obtained with Xerthra™ PRP PURE kit secrete great number of growth factors that in turn will lead to recovery of the homeostasis at the injection site, and further initiation of regeneration and repair processes without influence of regulatory processes of leukocytes2,3,4.
  1. Data on file Biovico / Biovico Research Report Series - Xerthra™  – concentration performance test
  2. Farley, A., Hendry, C., & McLafferty, E. (2012). Blood components. Nursing Standard (through 2013), 27(13), 35.
  3. Zhou, Y., & Wang, J. H. (2016). PRP treatment efficacy for tendinopathy: a review of basic science studies. BioMed Research International, 2016.
  4. Di Martino, A., Boffa, A., Andriolo, L., Romandini, I., Altamura, S. A., Cenacchi, A., ... & Filardo, G. (2022). Leukocyte-rich versus leukocyte-poor platelet-rich plasma for the treatment of knee osteoarthritis: a double-blind randomized trial. The American journal of sports medicine, 50(3), 609-617. 
The homeostasis of musculoskeletal tissues like cartilage, synovium, bone or tendon is able to shift towards the aggravation of catabolic state, related to intense production of tissue degradation enzymes, increased oxidative stress, enhanced inflammation and finally elevated damage due to negatively effecting prolonged overload or trauma1,2.

 However, scientific and clinical data show that leukocyte poor platelet-rich plasma (LP-PRP) therapy can be a respectful treatment for joint or tendon deterioration and pathology3,4. PLTs are the key functional component of the PRP as they release a wide range of bioactive proteins with multiple biological functions. Due to this, LP-PRP contains lower number of leukocytes and increased concentration of platelets rich in several growth factors, which support healing of the injury over a shorter period of time with less side effects and regulate musculoskeletal tissues homeostasis5.
Xerthra™ PRP PURE kit procedure pack contains a highly efficient separation device, which due to its unique design and construction allows to separate and isolate a very high number of PLTs in the final injectable product.

Xerthra™ separation device is made of Makrolon® polycarbonate that maximize the recovery rate of both platelets and growth factors. This effect is provided due to a very low surface energy of Makrolon® polymer which prevent binding of the proteins and cells to the walls of the device, resulting in maximal number of PLT in final injectable product.

As a result, the blood-derived product acquired by Xerthra™ separation device delivers PLTs concentration way above the threshold of a therapeutical effectiveness for PRP stated by PRP definition on 1 000 000 PLT/µl. This is due to ability of Xerthra™ to concentrate PLTs up to 9.7 times more than in patients peripheral blood6. Such high effectiveness delivers 1 mL of highly concentrated LP-PRP from 13.5 mL of patient’s peripheral blood.

The main advantages of PRP obtained by Xerthra™ is its safety as well as simple preparation and administration methods. Moreover, due to the product autologous characteristics, no unintentional immune response will be triggered after the injection7 and no donor-recipient disease transmission is possible. 
Package of Xerthra™ PRP PURE kit contains:
  • Xerthra™ separation device (1 pc)
  • Butterfly needle, 21G (1 pc)
  • Needle, 21G (3 pcs)
  • Single use syringe, 20 mL (1 pc)
  • Single use syringe (with Luer-lock), 10 mL (1 pc)
  • Single use syringe, 2 mL (1 pc)
  • Single use syringe (with Luer-lock), 1 mL (1 pc)
  • Syringe connector female-female (1 pc)
  • Combi stopper, syringe cap (1 pc)
Recent clinical data show that PRP administration can be clinically more effective when administered at least two times with 7 days intervals, what can bring up to 12 months clinical effectiveness8-10.

The product is meant to be used by medical practitioners only.
  1. Oliva F, Marsilio E, Asparago G, Frizziero A, Berardi AC, Maffulli N. The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies. Cells. 2021 Nov 9;10(11):3081
  2. Smith, M. D., Triantafillou, S., Parker, A., Youssef, P. P., & Coleman, M. (1997). Synovial membrane inflammation and cytokine production in patients with early osteoarthritis. The Journal of rheumatology, 24(2), 365-371.
  3. Filardo, G., Kon, E., Di Matteo, B., Di Marino, A., Sessa, A., Merli, M. L., & Marcacci, M. (2013). Leukocyte-poor PRP application for the treatment of knee osteoarthritis. Joints, 1(03), 112-120.Andia, I., & Maffulli, N. (2013). Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nature Reviews Rheumatology, 9(12), 721-730.
  4. Scott, A., LaPrade, R. F., Harmon, K. G., Filardo, G., Kon, E., Della Villa, S., ... & Engebretsen, L. (2019). Platelet-rich plasma for patellar tendinopathy: a randomized controlled trial of leukocyte-rich PRP or leukocyte-poor PRP versus saline. The American Journal of Sports Medicine, 47(7), 1654-1661.Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004 Oct 15;117(8):556-62.
  5. Kim, J. H., Park, Y. B., Ha, C. W., Roh, Y. J., & Park, J. G. (2021). Adverse reactions and clinical outcomes for leukocyte-poor versus leukocyte-rich platelet-rich plasma in knee osteoarthritis: a systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 9(6), 23259671211011948.
  6. Data on file Biovico / Biovico Research Report Series - Xerthra™ PRP kit – concentration performance test
  7. Guillibert C, Charpin C, Raffray M, Benmenni A, Dehaut FX, El Ghobeira G, Giorgi R, Magalon J, Arniaud D. Single Injection of High Volume of Autologous Pure PRP Provides a Significant Improvement in Knee Osteoarthritis: A Prospective Routine Care Study. Int J Mol Sci. 2019 Mar 15;20(6):1327.
  8. Andriolo, L., Altamura, S. A., Reale, D., Candrian, C., Zaffagnini, S., & Filardo, G. (2019). Nonsurgical treatments of patellar tendinopathy: multiple injections of platelet-rich plasma are a suitable option: a systematic review and meta-analysis. The American journal of sports medicine, 47(4), 1001-1018.
  9. Yurtbay, A., Say, F., Çinka, H., & Ersoy, A. (2021). Multiple platelet-rich plasma injections are superior to single PRP injections or saline in osteoarthritis of the knee: the 2-year results of a randomized, double-blind, placebo-controlled clinical trial. Archives of orthopaedic and trauma surgery, 1-14.
  10. Riboh, J. C., Saltzman, B. M., Yanke, A. B., Fortier, L., & Cole, B. J. (2016). Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. The American journal of sports medicine, 44(3), 792-800.
Therapeutic rational of leukocyte poor platelet-rich plasma (LP-PRP) for joint and tendon associated injuries
LP-PRP is a concentrated and isolated fraction of the peripheral blood, which contains very high amount of platelets (PLTs) with simultaneously decreased abundance of leukocytes1. Growth factors released by the PLTs, acts as a natural signaling molecules for the cells and tissues, provide the necessary molecular information at the injury and damage site. Up to date, more than 300 biologically active molecules were identified in the platelet secretome2. 
Among all, the signaling proteins like growth factors are closely linked with the beneficial effects of the PRP therapy – including platelet derived growth factors (PDGF), transforming growth factor β1 (TGF-β1), insulin-like growth factor 1 (IGF-1), fibroblast growth factor 2 (FGF-2), hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF)3 and many more. Moreover, the lower content of leukocytes won’t influence pro-inflammatory cascade in the injection site, thus will lead to decrease the inflammation. Thus, LP-PRP is recommended for use in chronic, degenerative phase of the disease in which not inflammatory action of leukocytes but the regenerative action of growth factors contained in platelets is essential4.
One of the crucial effects of PLT-derived growth factors in general can be described as anti-inflammatory when applied into the OA affected joint or into the tendon affected by tendinopathy. This anti-inflammatory effect lays mainly in the ability of PRP to inhibit the production of strong proinflammatory cytokines, such as IL-6 and IL-85.
Foremost, PRP with high concentration of PLTs and thus loads of different growth factors was described as potent modulator of cell metabolism in OA affected joint or in tendinopathy. Growth factors secreted by the PLTs can positively affect the production and secretion of tissue extracellular matrix (ECM) components like ACAN, COL1A1, COL2A1, COL3A1 and HA. As this leads to induced biosynthesis of ECM components like aggrecan, type II collagen and hyaluronic acid (associated with joint cartilage tissue6); as also type I and III collagen (associated with tendon tissue7) PRP will contribute significantly to increase of regeneration processes of both articular cartilage and tendon.
Furthermore, the effect of PRP treatment includes also the induction of specific tissue cell proliferation, which is a major process in tissue healing. Data show that PRP-derived growth factors are able to induce the migration and proliferation of tendon or cartilage progenitor cells8,9.

Finally, all of these processes induced by PRP, when combined, will substantially restore the proper homeostasis balance in OA affected join and in tendinopathy, thus contributing to tissue regeneration and reduction of degradation processes.
All the mentioned effects makes the LP-PRP injections a worth considerable therapy for tendon and joint associated pathologies. Based on significant scientific proofs, the LP-PRP treatment was estimated as an therapeutically effective against tendinopathy10 and osteoarthritis11. Clinical studies describe that intra-articular PRP administration has clinical effectiveness, characterized with pain alleviation from 8 weeks12 after the injection, which lasts up to 12 months13.
PRP vs Corticosteroids
PRP treatment was proven to be clinically efficient and safe, based on the reports which pointed out the lack of adverse events related to the therapy, in contrast to corticosteroids injection (CS) which safety has been put into serious consideration14,15,16,17. There is vast of scientific publications which describes that CS injections contributes to cartilage thinning and damage18 or leads to significant tenocyte viability reduction and increase in possibility of future tendon rupture19. 
  1. Zhou Y, Wang JHC. PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies. BioMed Research International. 2016;2016:1-8. doi:10.1155/2016/9103792
  2. Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol. 2013;9(12):721-730. doi:10.1038/nrrheum.2013.141
  3. Andia I, Sanchez M, Maffulli N. Tendon healing and platelet-rich plasma therapies. Expert Opinion on Biological Therapy. 2010;10(10):1415-1426. doi:10.1517/14712598.2010.514603
  4. Gupta A, Jeyaraman M, Potty A. Leukocyte-Rich vs. Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis. Biomedicines. 2023;11(1):141. doi:10.3390/biomedicines11010141
  5. Bendinelli P, Matteucci E, Dogliotti G, et al. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: Mechanisms of NF-κB inhibition via HGF. J Cell Physiol. 2010;225(3):757-766. doi:10.1002/jcp.22274
  6. Sundman EA, Cole BJ, Karas V, et al. The Anti-inflammatory and Matrix Restorative Mechanisms of Platelet-Rich Plasma in Osteoarthritis. Am J Sports Med. 2014;42(1):35-41. doi:10.1177/0363546513507766
  7. Schnabel LV, Mohammed HO, Miller BJ, et al. Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res. 2007;25(2):230-240. doi:10.1002/jor.20278
  8. Zhou Y, Zhang J, Wu H, Hogan MV, Wang JHC. The differential effects of leukocyte-containing and pure platelet-rich plasma (PRP) on tendon stem/progenitor cells - implications of PRP application for the clinical treatment of tendon injuries. Stem Cell Res Ther. 2015;6(1):173. doi:10.1186/s13287-015-0172-4
  9. Krüger JP, Hondke S, Endres M, Pruss A, Siclari A, Kaps C. Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells. J Orthop Res. 2012;30(6):845-852. doi:10.1002/jor.22005
  10. Scott A, LaPrade RF, Harmon KG, et al. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Am J Sports Med. 2019;47(7):1654-1661. doi:10.1177/0363546519837954
  11. Filardo G, Kon E, Di Matteo B, et al. Leukocyte-poor PRP application for the treatment of knee osteoarthritis. Joints. 2013;01(03):112-120. doi:10.11138/jts/2013.1.3.112
  12. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis: A Prospective, Double-Blind, Randomized Trial. Am J Sports Med. 2013;41(2):356-364. doi:10.1177/0363546512471299
  13. Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of Leukocyte Concentration on the Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis. Am J Sports Med. 2016;44(3):792-800. doi:10.1177/0363546515580787
  14. Rodas G, Soler-Rich R, Rius-Tarruella J, et al. Effect of Autologous Expanded Bone Marrow Mesenchymal Stem Cells or Leukocyte-Poor Platelet-Rich Plasma in Chronic Patellar Tendinopathy (With Gap >3 mm): Preliminary Outcomes After 6 Months of a Double-Blind, Randomized, Prospective Study. Am J Sports Med. 2021;49(6):1492-1504. doi:10.1177/0363546521998725
  15. Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-Rich Plasma as a Treatment for Patellar Tendinopathy: A Double-Blind, Randomized Controlled Trial. Am J Sports Med. 2014;42(3):610-618. doi:10.1177/0363546513518416
  16. Chen P, Huang L, Ma Y, et al. Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses. J Orthop Surg Res. 2019;14(1):385. doi:10.1186/s13018-019-1363-y
  17. Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis: A Pilot Study. American Journal of Physical Medicine & Rehabilitation. 2010;89(12):961-969. doi:10.1097/PHM.0b013e3181fc7edf
  18. McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967. doi:10.1001/jama.2017.5283
  19. Crimaldi S, Liguori S, Tamburrino P, et al. The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review. Medicina. 2021;57(10):1088. doi:10.3390/medicina57101088

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