What is pla in medical terms?

Polylactic acid, also known as poly(lactic acid) poly, lactic, acid or polylactide (PLA), is a thermoplastic polyester with backbone formula (C3H4O2)n or [–C(CH3)HC(=O)O–]n, formally obtained by condensation of lactic acid C(CH3)(OH)HCOOH with loss of water (hence its name). It can also be prepared by ring-opening polymerization of lactide [–C(CH3)HC(=O)O–]2, the cyclic dimer of the basic repeating unit.

PLA has become a popular material due to it being economically produced from renewable resources. In 2021, PLA had the highest consumption volume of any bioplastic of the world,[3] although it is still not a commodity polymer. Its widespread application has been hindered by numerous physical and processing shortcomings.[4] PLA is the most widely used plastic filament material in 3D printing. Its low melting point, high strength, low thermal expansion, good layer adhesion, and high heat resistance when annealed make it an ideal material for this purpose. Without annealing, however, PLA has the lowest heat resistance of the common 3D printing plastics.

Although the name "polylactic acid" is widely used, it does not comply with IUPAC standard nomenclature, which is "poly(lactic acid)".[5] The name "polylactic acid" is potentially ambiguous or confusing, because PLA is not a polyacid (polyelectrolyte), but rather a polyester.[6]

The monomer is typically made from fermented plant starch such as from corn, cassava, sugarcane or sugar beet pulp.

Several industrial routes afford usable (i.e. high molecular weight) PLA. Two main monomers are used: lactic acid, and the cyclic di-ester, lactide. The most common route to PLA is the ring-opening polymerization of lactide with various metal catalysts (typically tin octoate) in solution or as a suspension. The metal-catalyzed reaction tends to cause racemization of the PLA, reducing its stereoregularity compared to the starting material (usually corn starch).[7]

The direct condensation of lactic acid monomers can also be used to produce PLA. This process needs to be carried out at less than 200 °C; above that temperature, the entropically favored lactide monomer is generated. This reaction generates one equivalent of water for every condensation (esterification) step. The condensation reaction is reversible and subject to equilibrium, so removal of water is required to generate high molecular weight species. Water removal by application of a vacuum or by azeotropic distillation is required to drive the reaction toward polycondensation. Molecular weights of 130 kDa can be obtained this way. Even higher molecular weights can be attained by carefully crystallizing the crude polymer from the melt. Carboxylic acid and alcohol end groups are thus concentrated in the amorphous region of the solid polymer, and so they can react. Molecular weights of 128–152 kDa are obtainable thus.[7]

Another method devised is by contacting lactic acid with a zeolite. This condensation reaction is a one-step process, and runs about 100 °C lower in temperature.[8][9]

Due to the chiral nature of lactic acid, several distinct forms of polylactide exist: poly-L-lactide (PLLA) is the product resulting from polymerization of L,L-lactide (also known as L-lactide). Progress in biotechnology has resulted in the development of commercial production of the D enantiomer form.[10]

Polymerization of a racemic mixture of L- and D-lactides usually leads to the synthesis of poly-DL-lactide (PDLLA), which is amorphous. Use of stereospecific catalysts can lead to heterotactic PLA which has been found to show crystallinity. The degree of crystallinity, and hence many important properties, is largely controlled by the ratio of D to L enantiomers used, and to a lesser extent on the type of catalyst used. Apart from lactic acid and lactide, lactic acid O-carboxyanhydride ("lac-OCA"), a five-membered cyclic compound has been used academically as well. This compound is more reactive than lactide, because its polymerization is driven by the loss of one equivalent of carbon dioxide per equivalent of lactic acid. Water is not a co-product.[11]

The direct biosynthesis of PLA, in a manner similar to production of poly(hydroxyalkanoate)s, has been reported.[12]

PLA polymers range from amorphous glassy polymer to semi-crystalline and highly crystalline polymer with a glass transition 60–65 °C, a melting temperature 130-180 °C, and a Young's modulus 2.7–16 GPa.[13][14][15] Heat-resistant PLA can withstand temperatures of 110 °C.[16] The basic mechanical properties of PLA are between those of polystyrene and PET.[13] The melting temperature of PLLA can be increased by 40–50 °C and its heat deflection temperature can be increased from approximately 60 °C to up to 190 °C by physically blending the polymer with PDLA (poly-D-lactide). PDLA and PLLA form a highly regular stereocomplex with increased crystallinity. The temperature stability is maximised when a 1:1 blend is used, but even at lower concentrations of 3–10% of PDLA, there is still a substantial improvement. In the latter case, PDLA acts as a nucleating agent, thereby increasing the crystallization rate.[17] Biodegradation of PDLA is slower than for PLA due to the higher crystallinity of PDLA[citation needed]. The flexural modulus of PLA is higher than polystyrene and PLA has good heat sealability.

Several technologies such as annealing,[18][19][20] adding nucleating agents, forming composites with fibers or nano-particles,[21][22][23] chain extending[24][25] and introducing crosslink structures have been used to enhance the mechanical properties of PLA polymers. Polylactic acid can be processed like most thermoplastics into fiber (for example, using conventional melt spinning processes) and film. PLA has similar mechanical properties to PETE polymer, but has a significantly lower maximum continuous use temperature.[26]

Racemic PLA and pure PLLA have low glass transition temperatures, making them undesirable because of low strength and melting point. A stereocomplex of PDLA and PLLA has a higher glass transition temperature, lending it more mechanical strength.[27]

The high surface energy of PLA results in good printability, making it widely used in 3D printing. The tensile strength for 3D printed PLA was previously determined.[28]

PLA is soluble in a range of organic solvents.[29] Ethyl acetate is widely used because of its ease of access and low risk. It is useful in 3D printers for cleaning the extruder heads and for removing PLA supports.

Other safe solvents include propylene carbonate, which is safer than ethyl acetate but is difficult to purchase commercially. Pyridine can be used, but it has a distinct fish odor and is less safe than ethyl acetate. PLA is also soluble in hot benzene, tetrahydrofuran, and dioxane.[30]

PLA objects can be fabricated by 3D printing, casting, injection moulding, extrusion, machining, and solvent welding.

PLA is used as a feedstock material in desktop fused filament fabrication by 3D printers, such as RepRap printers.[31][32]

PLA can be solvent welded using dichloromethane.[33] Acetone also softens the surface of PLA, making it sticky without dissolving it, for welding to another PLA surface.[34]

PLA-printed solids can be encased in plaster-like moulding materials, then burned out in a furnace, so that the resulting void can be filled with molten metal. This is known as "lost PLA casting", a type of investment casting.[35]

PLA is used in a large variety of consumer products such as disposable tableware, cutlery, housings for kitchen appliances and electronics such as laptops and handheld devices, and microwavable trays. (However, PLA is not suitable for microwavable containers because of its low glass transition temperature.) It is used for compost bags, food packaging and loose-fill packaging material that is cast, injection molded, or spun.[36] In the form of a film, it shrinks upon heating, allowing it to be used in shrink tunnels. In the form of fibers, it is used for monofilament fishing line and netting. In the form of nonwoven fabrics, it is used for upholstery, disposable garments, awnings, feminine hygiene products, and diapers.

PLA has applications in engineering plastics, where the stereocomplex is blended with a rubber-like polymer such as ABS. Such blends have good form stability and visual transparency, making them useful in low-end packaging applications.

PLA is used for automotive parts such as floor mats, panels, and covers. Its heat resistance and durability are inferior to the widely used polypropylene (PP), but its properties are improved by means such as capping of the end groups to reduce hydrolysis.[36]

In the form of fibers, PLA is used for monofilament fishing line and netting for vegetation and weed prevention. It is used for sandbags, planting pots, binding tape and ropes .[36]

PLA can degrade into innocuous lactic acid, making it suitable for use as medical implants in the form of anchors, screws, plates, pins, rods, and mesh.[36] Depending on the type used, it breaks down inside the body within 6 months to 2 years. This gradual degradation is desirable for a support structure, because it gradually transfers the load to the body (e.g., to the bone) as that area heals. The strength characteristics of PLA and PLLA implants are well documented.[37]

Thanks to its bio-compatibility and biodegradability, PLA found interest as a polymeric scaffold for drug delivery purposes.

The composite blend of poly(L-lactide-co-D,L-lactide) (PLDLLA) with tricalcium phosphate (TCP) is used as PLDLLA/TCP scaffolds for bone engineering.[38][39]

Poly-L-lactic acid (PLLA) is the main ingredient in Sculptra, a facial volume enhancer used for treating lipoatrophy of the cheeks.

PLLA is used to stimulate collagen synthesis in fibroblasts via foreign body reaction in the presence of macrophages. Macrophages act as a stimulant in secretion of cytokines and mediators such as TGF-β, which stimulate the fibroblast to secrete collagen into the surrounding tissue. Therefore, PLLA has potential applications in the dermatological studies.[40][41]

PLLA is under investigation as a scaffold that can generate a small amount of electric current via the piezoelectric effect that stimulates the growth of mechanically robust cartilage in multiple animal models.[42]

PLA is degraded abiotically by three mechanisms:[44]

The hydrolytic reaction is: − COO + H 2 O ⟶ − COOH + − OH − {\displaystyle {\ce {-COO + H2O -> - COOH + -OH-}}}

The degradation rate is very slow in ambient temperatures. A 2017 study found that at 25 °C (77 °F) in seawater, PLA showed no loss of mass over a year, but the study did not measure breakdown of the polymer chains or water absorption.[45] As a result, it degrades poorly in landfills and household composts, but is effectively digested in hotter industrial composts, usually degrading best at temperatures of over 60 °C (140 °F).[46]

Pure PLA foams are selectively hydrolysed in Dulbecco's modified Eagle's medium (DMEM) supplemented with fetal bovine serum (FBS) (a solution mimicking body fluid). After 30 days of submersion in DMEM+FBS, a PLLA scaffold lost about 20% of its weight.[47]

PLA samples of various molecular weights were degraded into methyl lactate (a green solvent) by using a metal complex catalyst.[48][49][50]

PLA can also be degraded by some bacteria, such as Amycolatopsis and Saccharothrix. A purified protease from Amycolatopsis sp., PLA depolymerase, can also degrade PLA. Enzymes such as pronase and most effectively proteinase K from Tritirachium album degrade PLA.[51]

Four possible end-of-life scenarios are the most common:

The PLA-TAG will discuss PLA applications on or around April 25, 2023. The deadline for applications was April 6, 2023.

The CPT® Editorial Panel will discuss PLA applications at the May 2023 CPT® Editorial Panel meeting. Make sure to review the PLA agenda (PDF) and register for the meeting. All attendees, whether virtual or in person, must register for the CPT® Editorial Panel discussion.

For questions or further information, contact Thilani Attale.

Visit the COVID-19 coding and guidance page for new SARS-CoV-2 (COVID-19)-related testing codes.

The PLA Code section includes (but is not limited to) Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs) as defined under the Protecting Access to Medicare Act of 2014 (PAMA). These analyses may include a range of medical laboratory tests including, but not limited to, Multianalyte Assays with Algorithmic Analyses (MAAA) and Genomic Sequencing Procedures (GSP). The descriptor nomenclature follows, where possible, existing code conventions (e.g. MAAA, GSP).

To submit an application please log into the PLA Portal. Applications are reviewed on a quarterly review cycle and codes submissions are accepted all year. Please check the CPT PLA calendar for cycle close dates.

PLA test codes will be released and posted online on a quarterly basis (fall, winter, spring and summer) in data files. New codes are effective the quarter following their publication. These codes will also be included in the annual update of the CPT codebook beginning in 2018. Review the application submission calendar for additional information on:

For additional information on the application and review process, visit the FAQ section.

On June 23, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Medicare clinical diagnostic laboratory tests payment system final rule page. This Final Rule implements PAMA provisions pertaining to pricing and coding for clinical laboratory tests covered on the Medicare Clinical Lab Fee Schedule (CLFS), as well as reporting requirements for clinical laboratories performing these tests.

View the CPT PLA Codes with full descriptions, CPT PLA Code Medium Descriptors, and the CPT PLA Code Short Descriptors that were approved by the CPT Editorial Panel.

CPT Proprietary Laboratory Analyses Codes Short Descriptors (PDF, updated March 31, 2023)

Proprietary Laboratory Analyses (PLA) Codes are an addition to the CPT® code set approved by the AMA CPT® Editorial Panel. They are alpha-numeric CPT codes with a corresponding descriptor for labs or manufacturers that want to more specifically identify their test.