Bone marrow aspirate from iliac crest with donor bone scaffold results in healing of 4/5 patients with acetabular bone defects in revision hip arthroplasty

Eur Rev Med Pharmacol Sci. 2013 Aug;17(16):2240-9.

Bone marrow aspirate and bone allograft to treat acetabular bone defects in revision total hip arthroplasty: preliminary report.

Vulcano E1, Murena L, Falvo DA, Baj A, Toniolo A, Cherubino P.

Author information

• 1Department of Trauma and Orthopaedic Surgery, and Department of Microbiology; University of Insubria, Varese, Italy. ettorevulcano@hotmail.com  

Abstract

OBJECTIVES:

The safety and effectiveness of autologous mesenchymal cells for treating bone defects in humans is still uncertain. The present study presents a new technique consisting of allogeneic bone grafting enriched with bone marrow concentrate to treat acetabular bone defects resulting from aseptic loosening of the acetabular cup after total hip replacement.

PATIENTS AND METHODS:

Five adult patients were included in the study. Prior to surgery, patients were tested for antibodies to common pathogens. Treatment consisted of bone allogeneic scaffold seeded with bone marrow mesenchymal cells harvested from the iliac crest and concentrated using an FDA-cleared device. Clinical and radiographic follow-up was performed at 1, 3, 6, and 12 months after surgery. To assess viability, morphology, and the immunophenotype, bone marrow nucleated cells were cultured in vitro, then tested for sterility and evaluated for the possible replication of adventitious viruses.

RESULTS:

In 4 of 5 patients, both clinical and radiographic healing of the bone defect together with bone graft integration was observed at the mean time of 3.5 months. Mean follow-up was 2 years. One patient failed to respond. No post-operative complications were observed. Bone marrow nucleated cells were enriched 3.8-fold by a single concentration step. Enriched cells were free of microbial contamination. The immunophenotype of adherent cells was compatible with that of mesenchymal stem cells. No viral reactivation was observed.

CONCLUSIONS:

Allogeneic bone scaffold enriched with concentrated autologous bone marrow cells obtained from the iliac crest, may represent a good alternative to treat acetabular bone defects observed in revision hip arthroplasty.

Autologous bone marrow concentrate review from UCLA

Review of bone marrow concentrate uses in orthopedics.

Phys Sportsmed. 2013 Sep;41(3):7-18. doi: 10.3810/psm.2013.09.2022.

Autologous bone marrow concentrate: review and application of a novel intra-articular orthobiologic for cartilage disease.

Sampson S1, Botto-van Bemden A, Aufiero D.

Author information

• 1Clinical Instructor of Medicine, David Geffen School of Medicine at UCLA; Clinical Assistant Professor, Western University of Health Sciences; Adjunct Assistant Professor, Touro University; Founder, The Orthohealing Center and The Orthobiologic Institute (TOBI), Los Angeles, CA. drsampson@orthohealing.com.

Abstract

Younger adults, aged < 65 years, increasingly present to their physicians with advanced cartilage disease or post-traumatic osteoarthritis. A number of treatments exist for lessening patient pain and improving patient function. However, many patients are becoming aware of the potential of regenerative therapies and are now seeking solutions to the impaired biology underlying their conditions rather than addressing only their symptoms. Patients do not want to merely lessen their symptoms temporarily with a surgical procedure that replaces damaged tissue, but instead seek correction and repair of the underlying biology to regenerate damaged tissue and alleviate their symptoms altogether. Current therapies for patients with cartilage disease or osteoarthritis range from non-surgical intra-articular injections with biologics, such as hyaluronic acid (HA), to total joint arthroplasty for advanced stages of disease. Total joint arthroplasty is a successful procedure for patients aged > 65 years; however, the limited long-term durability of implanted prostheses decreases the preference of using such methods in more active patients aged < 65 years. The potential of cell-based orthobiologic injection therapies (pertaining to therapeutic injectables that aim to restore the biologic environment and/or structural components of diseased or damaged musculoskeletal tissue) is of tremendous interest for younger, more active patients, and is even more appealing in that such therapy can be delivered at point-of-care in the clinic during an office visit. Notably, the exponential rate of progress in biotechnology has allowed for immediate application of myriad novel therapies prior to clear evidence of benefit from randomized clinical trials. Orthobiologic intra-articular injection therapies include HA and platelet-rich plasma (PRP). We report on current, available findings for a third-generation intra-articular orthobiologic injectable therapy for cartilage disease, bone marrow concentrate (BMC). Bone marrow concentrate contains mesenchymal stem cells (MSCs), hematopoetic stem cells, platelets (containing growth factors), and cytokines. The anti-inflammatory and immunomodulatory properties ofbone marrow stem cells (BMSCs) can facilitate regeneration of tissue. Additionally, BMSCs enhance the quality of cartilage repair by increasing aggrecan content and tissue firmness. Following bone marrow aspiration (BMA), BMC is easily prepared using centrifugation, and is available for a same-day procedure with minimal manipulation of cells, thus complying with US Food and Drug Association (FDA) restrictions. To date, there are no published randomized controlled trials on the efficacy of use of autologous BMC intra-articular injections performed as a same-day in-office procedure for treating patients with cartilage disease; however, several publications have reported the ease of use of this method, its strong safety profile, and the fundamental science suggesting great therapeutic potential.

CD34 Positive cells enhance hair growth in pattern hair loss

Inter follicular injection of CD34+ cells with PRP achieved better results than placental extract treatment.

J Eur Acad Dermatol Venereol. 2014 Jan;28(1):72-9. doi: 10.1111/jdv.12062. Epub 2012 Dec 20.

The effect of CD34+ cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study.

Abstract

BACKGROUND:

Mobilized CD34+ cells in peripheral blood have angiogenic potential, which is an important factor in active hair growth. In addition, activated autologous platelet-rich plasma (PRP) has been reported to induce the proliferation of dermal papilla cells.

OBJECTIVES:

To investigate the clinical efficacy of interfollicular injection of CD34+ cell-containing PRP preparation for pattern hair loss.

PATIENTS AND METHODS:

CD34+ cell-containing PRP preparation was injected on the scalps of 13 patients with pattern hair loss, and 13 patients were treated with interfollicular placental extract injection as a control. The numbers of platelets in PRP were microscopically counted and CD34+ cells were evaluated with flow cytometry.

RESULTS:

Three months after the first treatment, the patients presented clinical improvement in the mean number of hairs, 20.5 ± 17.0% (P < 0.0001), mean hair thickness, 31.3 ± 30.1% (P < 0.0001), and mean two-point score, 84.4 ± 51.7% (P < 0.0001) compared with baseline values. At 6 months, the patients presented clinical improvement in mean hair count, 29.2 ± 17.8% (P < 0.0001), mean hair thickness, 46.4 ± 37.5% (P < 0.0001), and mean two-point score, 121.3 ± 66.8% (P < 0.0001) compared with baseline. The MIXED procedure revealed that CD34+ cell-containing PRP treatment presented a higher degree of improvement than placental extract treatment in hair thickness (P = 0.027) and overall clinical improvement (P = 0.023).

CONCLUSION:

Our data suggest that the interfollicular injection of autologous CD34+ cell-containing PRP preparation has a positive therapeutic effect on male and female pattern hair loss without remarkable major side-effects.

© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.

Bone marrow concentrate enhanced healing of lumbar fusion.

80 percent vs 40 percent using allograft bone chips alone.

Spine J. 2013 Dec 20. pii: S1529-9430(13)01992-X. doi: 10.1016/j.spinee.2013.12.014. 

Allograft alone versus allograft with bone marrow concentrate for the healing of the instrumented posterolateral lumbar fusion.

Hart R1, Komzák M2, Okál F3, Náhlík D3, Jajtner P4, Puskeiler M5.

Abstract

BACKGROUND CONTEXT:

Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades. The posterolateral fusion (PLF) with pedicle screw fixation is a commonly used procedure.

PURPOSE:

To determine whether the addition of bone marrow concentrate (BMC) to allograft bone increases fusion rate after instrumented posterior lumbar fusion.

STUDY DESIGN:

The study was prospective, randomized, controlled, and blinded.

METHODS:

Eighty patients with degenerative disease of the lumbar spine underwent instrumented lumbar or lumbosacral PLF (22 men, 58 women; body mass index less than 35 for a good visualization of the PLF in the X-rays). In 40 cases, the PLF was done with spongious allograft chips alone (Group I, age 62.7 years in average, range 47-77 years, level of fusion 1-2). In another 40 cases, spongious allograft chips were mixed with BMC (Group II, age 58.5 years in average, range 42-80, level of fusion 1-3), including the mesenchymal stem cells (MSCs). Patients were scheduled for anteroposterior and lateral radiographs 12 and 24 months after the surgery and for computed tomography scanning 24 months after the surgery. Fusion status and the degree of mineralization of the fusion mass were evaluated separately by two radiologists blinded to patient group affiliation. The bony mass was judged as fused if there was uninterrupted bridging of well-mineralized bone between the transverse processes or sacrum, with trabeculation indicating bone maturation on least at one side of the spines.

RESULTS:

In Group I at 12 months, the bone graft mass was assessed in X-rays as fused in no cases (0%) and at 24 months in four cases (10%). In Group II, 6 cases (15%) achieved fusion at 12 months and 14 cases (35%) at 24 months. The statistically significant difference between both groups was proven for complete fusion at both 12 (p=.041) and 24 months (p=.011). Computed tomography scans showed that 16 cases (40%) in Group I and 32 cases (80%) in Group II had evidence of at least unilateral continuous bridging bone between neighboring vertebrae at 24 months (p<.05).

CONCLUSIONS:

We have confirmed the hypothesis that the autologous BMC together with the allograft is a better alternative for PLF than the allograft alone. The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing.

Copyright © 2014 Elsevier Inc. All rights reserved.