International Journal of Molecular Sciences · 8 authors, 3 centres
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This narrative review summarizes the multifaceted roles of platelets beyond hemostasis, including their involvement in immunity, atherosclerosis, cancer, and neurodegeneration, and explores their therapeutic applications as platelet derivatives and drug delivery vehicles. A key limitation is the lack of standardization in preparation and study protocols for platelet-based therapies, which hinders reproducibility and clinical translation.
This narrative review provides a comprehensive overview of platelet biology and its broad pathophysiological and therapeutic implications. It details how platelets, beyond their classical role in hemostasis, are integral to innate and adaptive immunity, inflammation, and the pathogenesis of diverse diseases. The authors describe platelet involvement in atherosclerosis, where they facilitate plaque formation and instability; in cancer, where they promote tumor growth, metastasis, and chemotherapy resistance; and in neurodegenerative conditions, where they interact with the nervous system and may contribute to pathology like Alzheimer's disease. The review further explores the therapeutic potential of platelet derivatives, including platelet concentrates (e.g., PRP) used in regenerative medicine for wound healing and orthopedics, and platelet extracellular vesicles (pEVs) as promising biomarkers and drug delivery systems. It also examines the emerging concept of engineering platelets themselves as drug delivery vehicles. A major theme is the platelet's 'protean' nature, mediated by their secreted molecules and surface receptors. However, a significant limitation highlighted is the lack of standardized protocols for preparing platelet derivatives and isolating pEVs, which creates variability in product quality and complicates the comparison of clinical study outcomes. The implications are that a deeper understanding of platelet functions could reveal new therapeutic strategies across cardiology, oncology, neurology, and regenerative medicine, though this potential is currently constrained by methodological inconsistencies.
