The application of advanced methodologies in proteomics facilitated the identification of numerous proteins in CB-PRP. Our study demonstrated that proteomics identified several pathways that were statistically significant in a 15-pool of CB-PRP samples. We examined the pathway demonstrating the highest statistical significance, which may be linked to favorable outcomes in age-related macular degeneration.

Following the findings of Longo et al., we identified distinct proteins that demonstrated pro-inflammatory and anti-inflammatory properties, as well as effects on angiogenesis, cell proliferation, and tissue remodeling. The proteins comprised extracellular matrix molecules, proteases and peptidases along with their inhibitors, peroxidase activity, and calcium ion binding. [17]

The haptoglobin pathway serves as a prominent example, functioning as a scavenger of heme groups. Free heme intercalates into biological membranes, disrupting lipid bilayers and promoting the conversion of low-density lipoprotein to cytotoxic oxidized products, resulting in tissue damage. Moreover, it serves as a source of redox-active iron, generating oxygen radicals through its involvement in the Fenton reaction. This protein may provide advantages in the context of hemorrhagic conditions. [18]

Additional scavenger and binding proteins were identified in CB-PRP, playing significant roles in innate immunity, the prevention of thrombotic events, and the regulation of dyslipidaemia [19, 20]. The presence of scavengers from various classes may enhance the proper turnover and defense mechanisms of the organism.

Other important pathway is linked with hemostasis and platelet activation. For example, we found proteins that support the activation of phospholipase C enzymes. This enzyme raise the intracellular Ca +  + , fundamental element for several protein. [21]These pathways could help to block hemorrhagic conditions [21, 22].

Another fundamental pathway pertains to immunity, encompassing both innate and specific responses. CB-PRP can enhance the immune response due to over 200 types of proteins, including B cell receptor (BCR), CD-22, Fcgamma receptor (FCGR), phospholipids, IL-10, and FCGR-3A, among others [23,24,25,26,27].

Normal eye function requires several protein pathways to ensure physiological functionality. In CB-PRP, we identified proteins involved in retinoid metabolism and transport, proteins associated with the visual phototransduction pathway, as well as cofactors or proteins implicated in the metabolism of both water-soluble and fat-soluble compounds. This may signify a crucial support for photoreceptor health.

Additionally, we have identified a class of proteins in our sample consisting of the heavy chains of immunoglobulins. The latter would function as immunomodulating agents by binding to receptors for heavy chains (FcγRs) present on all immune system cells. [28] The Fc portion of IgG antibodies binds to Fc gamma receptors (FCGRs) on the surface of various immune cells. [29] There are different types of FCGRs, and they can be either activators or inhibitors. FCGRs are expressed on a wide range of immune cell types, including macrophages, neutrophils, dendritic cells, natural killer (NK) cells, and B cells. [30] The interaction, influenced by the type of FCGR and its signaling pathways, may result in either the activation or inhibition of immune responses. This is essential for sustaining a balanced and regulated immune system.

Vasodilator-Stimulated Phosphoprotein (VASP) is also present in both samples. It plays a role in regulating actin dynamics, promoting cell adhesion, and modulating cell migration. It additionally functions to inhibit platelet aggregation and adhesion to endothelial cells. [31]

VASP could play a positive role in maintaining proper communication among photoreceptors and between them and the extracellular matrix. [32] However, by reducing platelet aggregation and adhesion, it could also represent a mechanism that promotes bleeding.

Other class of important protein is represented by the antioxidant proteins. Redox enzymes and cellular processes like respiration produce reactive oxygen species like superoxide (O2.-), peroxides (ROOR), singlet oxygen, peroxynitrite (ONOO-), and hydroxyl radical (OH.). These species are necessary for signaling but can be harmful because of their high reactivity [33]. Reactive oxygen species are detoxified by aerobic cells' defensive mechanisms, which change them into less reactive forms. Thanks to these proteins the potential effect against DNA and membrane could prevented.

Complement factors and immunoglobulins primarily account for most discrepancies observed between the two samples. Platelet function variability in normal populations is significant, stemming from various genotypic and phenotypic differences among individuals. The final composition of PRP is significantly influenced by variations among donors and the patient's condition at the time of blood collection. This may indicate a limitation of the study [34, 35].

The role of oxidizing agents in atrophic macular degeneration is well-documented, and the importance of antioxidants may be critical in slowing the progression of the disease [36].

The presence of VEGF and complement factors may suggest a potential transition from atrophic to neo-vascular disease; however, this is deemed highly improbable in light of our safety findings. Antioxidant and anti-inflammatory factors are considered more effective in slowing the progression of dry AMD. [14]