Autologous regenerative therapies involve collection of salvageable biomaterial (cells, tissues, or growth-factor–rich preparations) from a patient to stimulate healing and tissue regeneration, at the time of need. As these are autologous products, they are not implicated in immunologic rejection and ethical[1]. These therapies offer several clear advantages by using patient’s own fluids, cells or tissues, they virtually eliminate the risk of immune rejection or graft-versus-host disease, and bypass need for complex pharmaceutical preparations, prevent transfusion transmissible infections which are present with allogenic therapies. This also bypasses the ethical concerns tied to embryonic or donor materials, using potent growth factors and paracrine signalling and can be tailored to individual needs of the patient based on patient condition, disease condition, availability of a specific type of autologous therapy. The disadvantages with the use of these therapies include 1. Harvesting cells (e.g., bone marrow aspiration or liposuction) can be painful and carries procedural risks; 2. Cell yield and potency often decline with patient age or comorbidities; 3. Manufacturing and standardization under good-manufacturing-practice conditions are complex and costly; and, 4. Clinical efficacy remains variable across various indications, with some trials showing only modest or inconsistent improvements. 5. Maintaining sterility of these products Multiple such therapies like PRP, PRF, GFC, BMAC, etc. are in routine use in various departments for numerous diseases like osteoarthritis, tears, non healing ulcers, debrided areas, alopecia, root canal treatments, etc. without any reliable evidence or information in the medical under graduation[1]. These products have become a part of the bigger umbrella term “Medical products of Human Origin”(MPHO). Hence, this study was proposed to assess the awareness about the same in medical fraternities and compare its levels among different sub groups.

Study design: This cross sectional study examined the knowledge, attitude and practice among the medical fraternities. Data collection was conducted in the month of April 2025 using an online survey which was created in Google Forms. The survey link was distributed with the help of Gmail and WhatsApp. Participation was entirely voluntary and no incentives were given. Sample size and inclusion criteria: Sample size was calculated as 139 assuming 90% awareness among medical fraternity as was estimated in a study with 95% confidence level and 5% margin of error for an unlimited population using the formula sample size, n=z2xp(1-p)/e2 where, n is the sample size, z is the z score(1.96), e is the margin of error and p is the population proportion. The study included only those participants who are studying MBBS or those who completed it and doing their internship, post graduation and professorship in any recognised medical college in Andhra Pradesh. Questionnaire: The questionnaire has questions asking the name (optional), age, designation, department they worked in. It had 26 questions in all; 22 multiple choice questions and 4 checkbox type questions. They covered their awareness about Autologous Regenerative Therapies, its purpose, cost, being done in their institute or not, whether it contradicts ethical and religious principles or not, etc. It also asks if they think their curriculum has good information about regenerative therapies. Statistical analysis: Categorical variables including gender, designation were reported as percentages. Based on the type of data, appropriate statistical tests were performed. Age was presented as a median with quartile deviation (Q1, Q3). Statistical analysis was done using Microsoft® Excel for Microsoft 365 (Seattle, USA) and Windows Programme for Epidemiologists (WinPepi). A p value of <0.05 was considered significant. Chi square test was used for statistical analysis among different categories as to responses. Ethical considerations: The study protocol was reviewed by the Institute Research and Ethics Committees before approving the start of this study. All participants received information about the study’s purpose, the voluntary nature of their participation and assurances regarding confidentiality and anonymity.

Demographic characteristics: A total of 146 individuals participated in the study. Among them, 76 were women (52.1%) and 70 were men (47.9%). The ages of the participants ranged from 17 to 55 years with median of 21 years (Q1=19, Q3=22) (Fig 1). Regarding educational status, 114(78.1%) were Under graduate students studying MBBS, 13(8.9%) were interns, 7(4.8%) were post graduate students, 12(8.2%) Professors. Awareness about autologous therapies A total of 41(28.1%) participants were aware about Autologous regenerative therapies, 60(41.1%) were not aware about autologous regenerative therapies and 45(30.8%) did not want to comment about their awareness. Majority of individuals 39(26.7%) assumed that, it involves stem cell therapy(SCT) only; followed by SCT, Platelet rich Plasma (PRP) therapy-24(16.4%); SCT, PRP, Cord Blood Transfusion(CBT)- 22(15.1%); SCT, CBT- 18(12.3%); SCT, CBT, PRP, Platelet rich fibrin(PRF), Bone Marrow Aspirate Concentrate(BMAC)-12(8.2%); others combinations-31(21.2%). 104(71.2%) individuals opined that autologous regenerative therapies would require collection of blood/bone marrow from patient, 32(21.9%) did not comment while 10(6.8%) disagreed that blood/bone marrow will be required from patient for these procedures. Awareness about PRP Among the 146 study participants, 94 (64.3%) were aware of PRP therapy of which maximum awareness rate was seen in post graduates, followed by Professors and interns. 94(64.3%), 92(63%), 84(57.5%), 64(43.8%), 37(25.3%) opined that it is useful in Alopecia; wound healing, skin rejuvenation, osteoarthritis, Root canal treatment respectively. It was opined that PRP is used commonly in the departments of Dermatology, Orthopaedics, General Surgery, Obstetrics and Gynaecology, Dentistry by 120(82.2%), 76(52%), 57(39%), 26(17.8%), 11(7.5%) participants respectively. 42(28.8%) agreed that PRP is a cost effective procedure and a similar number 39(26.7%) disagreed, while 65(44.5%) stayed neutral. Similarly 46(32.2%) agreed that it is painful procedure, 25(17.1%) disagreed that its painful while the rest stayed neutral. 67(45.9%) were aware that this procedure is used in their Institute. 38(26%) participants have experienced PRP for themselves or a close relative/friend. 91(62.3%) opined that they recommend PRP therapy to their patients/friends/relatives, while 42(28.8%) were hesitant and 13(8.9%) opined that they will not recommend PRP therapy. Awareness about Stem cell therapy 136(43.1%) participants have informed that they have heard about stem cell therapy. 118(80.8%) participants agreed that these stem cells are pluripotent/multipotent, 14(9.6%) stayed neutral while 14(9.6%) disagreed that stem cells can form any cell types. 121(82.8%), 113(77.4%), 72(49.3%), 61(41.8%), 16(10.9%), 14(9.6%) participants opined that, stem cells can be collected from Bone marrow, Umbilical cord, Embryo, Amniotic fluid, Adipocytes, Dental pulp respectively. 57(39%) participants agreed that autologous transplants of adult stem cells can fail mainly because of immunogenic reaction while 50(34.2%) disagreed and rest stayed neutral. Awareness about Umbilical cord blood banking 98(67.1%) of participants informed that they are aware of cord blood banking and 48(32.9%) were unaware of it. 126(86.3%) participants agreed that cord blood is obtained from umbilical cord. 18(12.3%) participants felt that use of umbilical cord blood cells contradicts ethical and religious principles while 72(49.3%) disagreed and 56(38.4%) remained neutral. Awareness on Stem Cell banks 79(54.1%) participants are aware of stem cell banks in India. Eight(5.5%) participants are aware that they are being done in their Institute. Gender and key difference of opinion on regenerative therapies The answers based on gender were categorized and analyzed to identify any key differences of opinion and the same is tabulated(Table 1) Educational qualification and differences of opinion The awareness about PRP and regenerative therapies among different educational levels was assessed and tabulated(Table 2) Opinion on curriculum and special training 30(20.6%) participants agreed that the curriculum they study has a good amount of information about regenerative therapies and its potential applications, while 57(39%) have disagreed, and the rest were neutral in their response. 98(67.2%) agreed that addition of a special course concerning regenerative medicine to the curriculum is advisable while 7(4.8%) disagreed and 41 participants were neutral in response. 104(71.3%) participants were interested in attending advanced training courses about autologous regenerative medicine and its applications. Barriers to regenerative treatments 78(53.4%) participants opined that lack of awareness is the main barrier to use of regenerative treatments followed by high cost, 41(28.1%) and lack of sufficient research, 27(18.5%). 120(82.6%) participants opined that more public awareness programs about autologous regenerative therapies and their therapeutic applications should be organized. 109(74.7%) participants opined that they will recommend regenerative therapies if available. Table 1: Key difference in opinion among genders S.No Opinion Agreed Male/Female Neutral Male/Female Disagreed Male/Female p value 1 PRP is painful 16/31 38/36 13/9 0.038 2 PRP awareness in respective institutes 34/33 14/30 22/13 0.019 3 Experienced PRP for self or close ones 22/16 - 48/60 0.153 4 Heard about stem cell therapy 58/72 4/2 8/2 0.063 5 Knowledge about stem cells 53/65 7/7 10/4 0.169 6 Embryonic stem cells from umbilical cord 54/72 - 16/4 0.002 7 Cord blood banking 30/54 6/8 34/14 <0.001 8 Awareness of Stem cell banks in India 37/42 27/34 6/0 0.032 PRP= Platelet rich plasma. Table 2: Awareness on regenerative therapies among different educational levels S.No Topic UG, n(%) Interns, n(%) Post graduates, n(%) Professor, n(%) P value 1 Awareness about PRP 13(11.4%) 10(76.9%) 7(100%) 11(91.6%) <0.001 2 Awareness about regenerative therapies 13(11.4%) 2(15.3%) 4(57.1%) 7(58.3%) <0.001 PRP= Platelet rich plasma, UG=Undergraduates.

In our study, 41 (28.1%) participants were aware about regenerative autologous therapies. Participants were more aware of stem cell therapies: 130 (89%), than PRP therapy which was 77 (52.7%). Females opined more that PRP is painful, and were more aware as to embryonic stem cell collection from umbilical cord, cord blood banking, stem cell banks in India with a statistically significant difference between different genders. Males were more aware about PRP procedures, and used it for self or close kin, in their Institute and this difference across gender was statistically significant. Awareness was more in professors (91.6%), postgraduates (100%) and interns (76.9%) while only about 11.4% in MBBS students. Awareness about rarer therapies like BMAC was also found to be high in professors (58.3%) and post graduates (57.1%) as compared to interns (15.3%) and MBBS students (11.4%). Awareness among professors and postgraduates is more compared to interns and undergraduates with a statistically significant difference among various educational levels. In terms of attitude, only 91 (62.3%) participants had positive attitude towards usage of these therapies, 42 (28.8%) were unsure while 13 (8.9%) were not willing. It is possible that misconceptions, lack of strong evidence of its effectiveness, inconsistent results on research findings, high cost for some therapies, no guaranteed cure, etc. can be one of the many reasons for negative responses. Reasons given for less comprehensive usage of these therapies provide insight into obstacles that need to be overcome. The most common reason cited was lack of awareness on the subject by 78 (53.4%) participants, followed by high cost as cited by 41 (28.1%) participants and lack of sufficient research by 27 (18.5%) participants. Majority of the participants: 116 (79.4%), cited that the knowledge about these new novel therapies in the current curriculum is not adequate or are unsure. Encouragingly, 98 (65.2%) participants are willing to learn about these topics either by its addition in a new curriculum or attending advanced training courses. Similar results were obtained in studies on awareness about stem cells among medical, dental, nursing students and faculty[2,3,4], about PRP[5] and regenerative therapies[6] signifying the importance of awareness generation. This study has several limitations. An attempt to minimize the non-response rate was done by pre notifying the participants that they will be invited to participate, keeping the questionnaire concise and user friendly, sending gentle follow up reminders via gmail, etc. The validity of the responses depends on self-reporting that is susceptible to recall biases. Lack of guidance from an interviewer also might have caused a misunderstanding of certain questions. To conclude, our study provides useful data on knowledge, attitude and practices of autologous regenerative therapies among the medical fraternity in the state of Andhra Pradesh. The findings point us to the need for additional campaigns, seminars for promoting different therapies and dispelling myths. It also raises the need for more research into this area since although such therapies show promising results in preclinical studies but have not yet translated effectively into widespread clinical practices. There is also need to standardise the procedures which can be helped by more research by establishing regulatory frameworks and quality assurance. Also research into scalable, cost-effective methods is needed to make these therapies accessible to broader populations.

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