Polyethylene terephthalate (PET) tubes commonly recognized as “red top tubes” are standard tubes used for the collection of blood samples for serum analysis. These tubes have internal coating and are not suitable for the preparation of platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) which is then introduced back into the body. This internal coating negatively affects cellular components contained in PRP and PRF.
The inner surface of these red top tubes is coated with silica microparticles. The silica promotes blood clotting. However, these silica particles are not designed and are unsuitable where platelet and fibrin preservation are crucial to the regeneration of tissues.
The cytotoxicity of silica coatings is due to the propensity of this compound to disrupt cell membranes and reduce cell proliferation.
Platelet concentrates have been increasingly used in all fields of medicine and dentistry due to their regenerative potential. Platelet Rich Fibrin was invented and first used in the field of dentistry in France by Choukroun. The PRF required a simple glass tube to activate coagulation and the formation of a fibrin clot. However, the major manufacturers of plain glass tubes have discontinued their production. This caused a transition to the use of silica coated blood collection tubes as they are readily available.
In the laboratory, the silica microparticles used for the glass coating acts as an activator of the coagulation cascade. Thus, they are routinely used for blood collection in all labs across the world.
Silica dust is a known carcinogen causing lung silicosis and lung cancer. Amorphous silica is generally thought to be less toxic. It is used in various industrial products such as additives in paints, varnishes and glues. Silica is also used in production of powders, food stuffs and cosmetics. However, increasing studies have demonstrated that silica induces toxic effects on cells. The mechanism of its cytotoxicity is injury to the plasma membrane by silica dependent production of reactive oxygen species.
Judging from the accumulated studies and data, there is conclusive evidence that silica microparticles are hazardous in the human body.
This study examined the health hazard caused by silica microparticles derived from the platelet rich fibrin matrix when red top tubes were used.
Studies
Odontology 2020;108(4):545-552 PMID 31997225
The purpose of this study was to provide absolutely convincing evidence of the public health hazard caused by silica microparticles derived
from platelet rich fibrin matrix. Also, in a previous study done by the same authors, they demonstrated by usingspectrophotometric and microscopic methods, that silica microparticles detached from the inner wall of the glass and were immediatelyincorporated into the PRF. (PMID 31248187)
Silica particles were tested on the proliferation and viability of human periosteal cells. The silica microparticles significantly reduced cell viability at low dilutions. However, even when not diluted, the silica substantially inhibited growth. The periosteal cells absorbed the silica and incorporated some into the cytoplasm. This caused cytotoxic effects of membrane disruption and subsequent cell death. See the effects of silica microparticles on the migration and density of human periosteal cells form Figure 5 to the right.
Conclusion: Commercially available silica coated blood collection tubes contain cytotoxic silica microparticles. These silica microparticles are incorporated into the resulting PRF matrix and implanted for regeneration and repair of injured tissues. Thus, it is plausible to suggest that tissue regeneration could be hampered or disrupted. Even though severe complications have not been reported, we still provide this data to alert clinicians not to use this type of blood collection tubes fro Platelet Rich Fibrin preparation.
Quote from this study:
“Silica nanoparticles were recently reported to induce cytotoxicity and inflammatory responses. The proposed mechanisms involve interactions between silica nanoparticles and the cell surface and the generation of reactive oxygen species. A recent report described that specific types of amorphous silic
a nanoparticles can act as tumor promoting substances. It is difficult to predict how silica nanoparticles ,that detach from tubes ,will influence the surrounding tissue and implantation sites. We found that silica microparticles obtained from silica coated tubes have substantial cytotoxic effects, we recommend that clinicians observe the manufactures caution of “in vitro use only” and not use silica coated tubes for PRF preparation.
Figure 2. Summary of platelet distribution under various conditions. Asterisks represent wide-open spaces, where platelets were distributed sparsely. Double asterisks represent wider spaces than single asterisks. Bar scales are 200 µm.
- Evidence for Contamination of Silica Microparticles in Advanced Platelet Rich Fibrin Matrices Prepared Using Silica Coated Plastic Tubes
Biomedicine 2019 Jun 19;7(2):45 PMID 31248187
Conclusion: Regardless of tube brands and individual donors, significant, but not accidental levels of silica were found to be incorporated into the PRF matrix which will consequently be incorporated into the implantation site. From increasing data for cytotoxicity of silica, we cannot exclude the possibility that such negatively influences tissue regeneration through induction of inflammation.
Figure 1: Macroscopic appearance of the silica-coated plastic tube (Neotube) pre- (a) and post-centrifugation (b).
Author note
These tubes should never be used in the production of Platelet Rich Plasma or Platelet Rich Fibrin. They are not FDA approved, cause cell death and are toxic to tissues. Regeneration is retarded or nonexistent. If a malpractice case is ever brought, for any reason, the use of non-approved and potentially toxic, non-FDA approved tubes is a non-defensible position.
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Juventix Regenerative Medical offers a LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of cytokines, growth factors and bioactive proteins from the alpha granules on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimum manipulation standards of the FDA.
Juventix Regenerative Medical supplies a patented Bio-Incubator to transform the Platelet Rich plasma into and Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different cytokines and growth factors than the original PRP. These different cytokines provide and anti-inflammatory microenvironment that is critical in the stimulation of regeneration in implant and restorative dentistry.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
