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Bone Marrow Aspirate Concentrate versus Platelet Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111193. [PMID: 34833411 PMCID: PMC8623697 DOI: 10.3390/medicina57111193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 01/08/2023]
Abstract
Background: In the last decade, regenerative therapies have become one of the leading disease modifying options for treatment of knee osteoarthritis (OA). Still, there is a lack of trials with a direct comparison of different biological treatments. Our aim was to directly compare clinical outcomes of knee injections of Bone Marrow Aspirate Concentrate (BMAC), Platelet-rich Plasma (PRP), or Hyaluronic acid (HA) in the OA treatment. Methods: Patients with knee pain and osteoarthritis KL grade II to IV were randomized to receive a BMAC, PRP, and HA injection in the knee. VAS, WOMAC, KOOS, and IKDC scores were used to establish baseline values at 1, 3, 6, 9, and 12 months. All side effects were reported. Results: A total of 175 patients with a knee osteoarthritis KL grade II-IV were randomized; 111 were treated with BMAC injection, 30 with HA injection, and 34 patients with PRP injection. There were no differences between these groups when considering KL grade, BMI, age, or gender. There were no serious side effects. The mean VAS scores after 3, 7, 14, and 21 days showed significant differences between groups with a drop of VAS in all groups but with a difference in the BMAC group in comparison to other groups (p < 0.001). There were high statistically significant differences between baseline scores and those after 12 months (p < 0.001) in WOMAC, KOOS, KOOS pain, and IKDC scores, and in addition, there were differences between these scores in the BMAC group in comparison with other groups, except for the PRP group in WOMAC and the partial IKDC score. There were no differences between the HA and PRP groups, although PRP showed a higher level of clinical improvement. Conclusions: Bone marrow aspirate concentrate, Leukocyte rich Platelet Rich Plasma, and Hyaluronic acid injections are safe therapeutic options for knee OA and provide positive clinical outcomes after 12 months in comparison with findings preceding the intervention. BMAC could be better in terms of clinical improvements in the treatment of knee OA than PRP and HA up to 12 months. PRP provides better outcomes than HA during the observation period, but these results are not statistically significant. More randomized controlled trials and high quality comparative studies are needed for direct correlative conclusions.
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Bozhkov AI, Ohiienko SL, Bondar AY, Katrich VO, Kozheshkurt VO, Antonenko YO, Haiovyi SS, Kot YH. The Electrical Conductivity of Bone Marrow Cells Suspension Associated with Proliferative Activity and Depends on the Donor's Age and the Functional Activity of the Liver. Cell Biochem Biophys 2021; 79:823-831. [PMID: 33905109 DOI: 10.1007/s12013-021-00981-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
Copper ions play various roles in mammalian cells. Some investigations indicated that copper correlates with liver fibrosis and changes in bone marrow cells. Here, we explored the role of bone marrow cell parameters in copper liver fibrosis development and possible underlying mechanisms. The age-related features of biochemical indicators, bone marrow cell parameters, and electrical conductivity of 3- and 20-month-old male Wistar rats treated with copper II sulfate pentahydrate (CuSO4 × 5H2O) have been investigated. Based on the obtained earlier experimentally data in our laboratory, dose of 1 mg/100 g (0.58 mg/g of liver) was used. Induced liver fibrosis caused a change in the number and ratio of morphotypes of bone marrow cells, calcium and copper content, redox-system activity. These parameters depended of animals' age and presence of liver fibrosis. We also demonstrated that electrical conductivity can be used as integral parameter. In conclusion, the "adaptive response" modifies the emerging reactions of the organism to new external factors.
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Affiliation(s)
- A I Bozhkov
- Research Institute of Biology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine.
| | - S L Ohiienko
- Research Institute of Biology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - A Yu Bondar
- Research Institute of Biology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - V O Katrich
- Department of Physical and Biomedical Electronics and Complex Information Technologies, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - V O Kozheshkurt
- Department of Physical and Biomedical Electronics and Complex Information Technologies, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Ye O Antonenko
- Department of Physical and Biomedical Electronics and Complex Information Technologies, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - S S Haiovyi
- Research Institute of Biology, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
| | - Yu H Kot
- Biochemistry Department, V. N. Karazin Kharkiv National University, Kharkiv, Ukraine
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Kruel AVS, Ribeiro LL, Gusmão PD, Huber SC, Lana JFSD. Orthobiologics in the treatment of hip disorders. World J Stem Cells 2021; 13:304-316. [PMID: 33959220 PMCID: PMC8080542 DOI: 10.4252/wjsc.v13.i4.304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/26/2020] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
Orthobiologics are biological materials that are intended for the regeneration or healing of bone, cartilage and soft tissues. In this review we discuss the use of orthobiologics for hip disorders providing an update. The orthobiologics included in this article are hyaluronic acid, platelet rich plasma, bone marrow, adipose tissue and expanded mesenchymal stem cells. We explain the concepts and definitions of each orthobiological product, and the literature regarding its use in the hip joint. The paucity of guidelines for the production and characterization of the biological products leads to uneven results across the literature. Each biologic therapy has indications and benefits; however, noteworthy are the characterization of the orthobiologics, the application method and outcome analysis for further improvement of each technique.
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Affiliation(s)
| | - Lucas Leite Ribeiro
- Department of Orthopedics, Instituto Médico Salus, São Paulo, SP 01308-050, Brazil
| | - Paulo David Gusmão
- Department of Orthopedics, the Bone and Cartilage Institute, Porto Alegre, RS 90570-020, Brazil
| | - Stephany Cares Huber
- Department of Hematology, University of Campinas, Campinas, SP 13334-170, Brazil
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Schumacher-Kuckelkorn R, Atra A, Belli ML, den Engelsman G, Fréneaux P, Gauthier A, Heijlaerts-Klever A, Scuderi F, Senent Peris L, Tewari S, Zapletal O, Ernst A, Berthold F. The reliability of bone marrow cytology as response criterion in metastatic neuroblastoma. Pediatr Blood Cancer 2021; 68:e28819. [PMID: 33245195 DOI: 10.1002/pbc.28819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The quantitative assessment of neuroblastoma cell content in bone marrow aspirates for response evaluation has been introduced recently. Data on the concordance of interobserver reports are lacking so far. METHODS Investigators of seven European countries representing national reference or large oncological centers convened in 2016. They agreed to quantitatively assess routine bone marrow smears of the participating institutions and to discuss the discrepant results in joint meetings. RESULTS From 2017 through 2019, three cytology rounds with 24, 28, and 28 bone marrow samples were run evaluating the representativity of the smears (yes/[restricted]/no) and the presence of tumor cells (yes/no and %). The comparison of the reports using κ (Fleiss) and α (Krippendorff) statistics demonstrated no robust reliabilities. The agreement on the representativity was moderate to poor, on the presence of tumor cells moderate to good, and on the percentage of tumor cells slight to moderate. Though the value of cytology is unquestioned to detect even tiny metastatic cells in bone marrow, the investigators unanimously agreed that a reliable quantification of the tumor cell content in bone marrow smears is unrealistic. For the key issue of representativity, a new practical definition was developed. CONCLUSION For any work with bone marrow aspirates, the representativity of the material is of paramount importance. A practical definition is proposed. A reliable quantitative cytological assessment of tumor cell content in bone marrow aspirates is not feasible in metastatic neuroblastoma. Therefore, its use as response criterion should be reconsidered.
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Affiliation(s)
- Roswitha Schumacher-Kuckelkorn
- Department of Pediatric Oncology and Hematology, National Neuroblastoma Reference Cytology Lab, University of Cologne, Cologne, Germany
| | - Ayad Atra
- Department of Paediatric Oncology/Haematology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Maria Luisa Belli
- Department of Haematology and Oncology, Cytomorphology Laboratory, IRCCS, G. Gaslini Institute, Genoa, Italy
| | | | - Paul Fréneaux
- Service de Pathologie, Pôle de médicine diagnosique et théranostic, Institut Curie, Paris, France
| | - Arnaud Gauthier
- Service de Pathologie, Pôle de médicine diagnosique et théranostic, Institut Curie, Paris, France
| | | | - Francesca Scuderi
- Department of Haematology and Oncology, Cytomorphology Laboratory, IRCCS, G. Gaslini Institute, Genoa, Italy
| | - Leonor Senent Peris
- Department of Hematology, Cytomorphology Laboratory, Diagnosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.,La Fe Health Research Institute, Hematology Research Group, Valencia, Spain.,Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sanjay Tewari
- Department of Paediatric Oncology/Haematology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Ondrej Zapletal
- Department of Paediatric Haematology, University Hospital Brno, Brno, Czech Republic
| | - Angela Ernst
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, National Neuroblastoma Reference Cytology Lab, University of Cologne, Cologne, Germany
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A Comparative Study of Bone Marrow Squash and Wedge Aspiration Smears. Indian J Hematol Blood Transfus 2020; 37:108-118. [PMID: 33707843 DOI: 10.1007/s12288-020-01321-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022] Open
Abstract
Bone marrow examination entails study of aspirate smears, touch imprints and trephine biopsy. Bone marrow aspirate smears can be prepared by the squash (crush) or wedge method. Both techniques have their own advantages and disadvantages. There is paucity of studies that have compared these smear types. This study was conducted over a period of one year. Two hundred and five bone marrow aspirates were included. Both squash and wedge smears were made. Blinded slide review was done. Bone marrow cellularity, megakaryocyte number, myeloid to erythroid (M:E) ratio, morphology and final diagnosis on each smear type was compared. Chi square test, t-test and Kappa were applied to study the agreement between the wedge and squash smears. Among the 205 patients studied, squash smears showed significant over estimation of cellularity and megakaryocyte number (p < 0.05). There was no significant difference (p > 0.05) in the M:E ratio and morphological scores. Most patients (188/205 [91.7%]) showed complete diagnostic concordance while 17 (8.3%) patients had discrepancy in diagnosis between the squash and wedge smears. In 8 (3.9%) of these, major discrepancies were seen while 9 (4.4%) patients had minor discrepancies. Bone marrow cellularity and megakaryocyte numbers were underestimated in wedge smears with no differences in M:E ratio or morphology. Acceptable agreement for diagnosis was seen for patients with most disorders. Major diagnostic discrepancies were seen in patients with lesions known to have focal distribution-lymphoma, myeloma and tuberculosis (granulomas). Both squash and wedge smears should be studied for bone marrow examination.
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Bozhkov AI, Ohiienko SL, Bondar AY, Klimova EM, Ivanov EG. Induced Liver Fibrosis Is Accompanied in Young and Old Animals by Age-Dependent Changes in Bone Marrow Cells. ADVANCES IN GERONTOLOGY 2019. [DOI: 10.1134/s2079057019030032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ulasli AM, Ozcakar L, Murrel WD. Ultrasound imaging and guidance in the management of knee osteoarthritis in regenerative medicine field. J Clin Orthop Trauma 2019; 10:24-31. [PMID: 30705527 PMCID: PMC6349666 DOI: 10.1016/j.jcot.2018.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022] Open
Abstract
Ultrasound (US) is an excellent imaging tool to evaluate most of the structures in the knee joint. US is useful in various applications of regenerative medicine, starting from the biomaterial harvesting stage of the procedures, it can thus/conveniently be used for the diagnosis and treatment of various forms of knee osteoarthritis (OA) where the interventions need to be carried out under US guidance. In this paper, we have reviewed US guided bioharvesting of venous blood, bone marrow and adipose tissue, the US evaluation of the knee joint and the relevant findings in knee OA along with US guided regenerative interventions for the knee joint.
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Affiliation(s)
- Alper Murat Ulasli
- Lokman Hekim University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey,Corresponding author. Lokman Hekim Akay Hastanesi, Büklüm Sokak No: 3 Kavaklıdere, Çankaya, Ankara, Turkey.
| | - Levent Ozcakar
- Hacettepe University, School of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
| | - William D. Murrel
- Emirates Integra Medical & Surgery Centre, Department Orthopaedic Sports Medicine, Dubai Healthcare City, Dubai, United Arab Emirates,Emirates Healthcare, Dubai, United Arab Emirates,Landsthul Regional Medical Center, Division of Surgery, Department of Orthopedic Surgery, Landsthul, Germany,7th Medical Support Unit-Europe, Kaiserslautern, Germany
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Bozhkov AI, Ohiienko SL, Kuznetsova YA, Bondar’ AY, Marchenko VP, Gumennaya MS. Donor Age Affects Behavior and Sensibility of Bone Marrow Cells to Copper Ions in Primary Culture. ADVANCES IN GERONTOLOGY 2017. [DOI: 10.1134/s2079057017040026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Janel A, Berger J, Bourgne C, Lemal R, Boiret-Dupré N, Dubois-Galopin F, Déchelotte P, Bothorel C, Hermet E, Chabi S, Bay JO, Lambert C, Pereira B, Pflumio F, Haddad R, Berger MG. Bone marrow hematons: An access point to the human hematopoietic niche. Am J Hematol 2017. [PMID: 28639326 DOI: 10.1002/ajh.24830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To understand the complex interactions between hematopoietic stem cells and the bone marrow niche, a human experimental model is needed. Our hypothesis is that hematons are an appropriate ex vivo model of human bone marrow. We analyzed the hierarchical hematopoietic cell content and the tissue organization of single hematons from healthy donors. Most (>90%) hematons contained precursors of all cell lineages, myeloid progenitors, and LTC-ICs without preferential commitment. Approximately, half of the hematons could generate significant levels of lympho-myeloid hematopoiesis after transplantation in an NSG mouse model, despite the low absolute numbers of transplanted CD34+ cells. Mesenchymal STRO-1+ and/or CD271+ cells formed a critical network that preserved hematon cohesion, and STRO-1+ cells colocalized with most hematopoietic CD34+ cells (68%). We observed an influence of age and gender. These structures represent a particularly attractive model for studying the homeostasis of the bone marrow niche and pathological changes that occur during diseases.
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Affiliation(s)
- Alexandre Janel
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
- Université Clermont Auvergne, Equipe d'accueil l'EA 7453 CHELTER; 1 place L. et R. Aubrac, Clermont-Ferrand Cedex 63003 France
| | - Juliette Berger
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
- Université Clermont Auvergne, Equipe d'accueil l'EA 7453 CHELTER; 1 place L. et R. Aubrac, Clermont-Ferrand Cedex 63003 France
- CHU Clermont-Ferrand, Hôpital Estaing, CRB-Auvergne; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Céline Bourgne
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
- Université Clermont Auvergne, Equipe d'accueil l'EA 7453 CHELTER; 1 place L. et R. Aubrac, Clermont-Ferrand Cedex 63003 France
| | - Richard Lemal
- Université Clermont Auvergne, Equipe d'accueil l'EA 7453 CHELTER; 1 place L. et R. Aubrac, Clermont-Ferrand Cedex 63003 France
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Clinique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Nathalie Boiret-Dupré
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Frédérique Dubois-Galopin
- CHU de Toulouse, Hôpital Purpan, Laboratoire d'Hématologie, Place du Docteur Baylac - TSA 40031 31059; Toulouse Cedex 9 France
| | - Pierre Déchelotte
- CHU Clermont-Ferrand, Hôpital Estaing, Anatomie Pathologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Charlotte Bothorel
- CHU Clermont-Ferrand, Hôpital Estaing, Anatomie Pathologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Eric Hermet
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Clinique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Sara Chabi
- INSERM UMR967, CEA/DSV/iRCM, Laboratory of Hematopoietic Stem cells and Leukemic Cells, Equipe labellisée par la Ligue Nationale Contre le Cancer, Université Paris Diderot, Université Paris-Saclay, Univ Paris Sud, Commissariat à l'Energie Atomique et aux Energies Alternatives; Fontenay-aux-Roses 92265 France
| | - Jacques-Olivier Bay
- Université Clermont Auvergne, Equipe d'accueil l'EA 7453 CHELTER; 1 place L. et R. Aubrac, Clermont-Ferrand Cedex 63003 France
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Clinique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Céline Lambert
- CHU Clermont-Ferrand, Département de Recherche Clinique et Innovation, Bd Léon Malfreyt; Clermont-Ferrand France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Département de Recherche Clinique et Innovation, Bd Léon Malfreyt; Clermont-Ferrand France
| | - Françoise Pflumio
- CHU Clermont-Ferrand, Hôpital Estaing, Anatomie Pathologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Rima Haddad
- CHU Clermont-Ferrand, Hôpital Estaing, Anatomie Pathologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
| | - Marc G. Berger
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
- Université Clermont Auvergne, Equipe d'accueil l'EA 7453 CHELTER; 1 place L. et R. Aubrac, Clermont-Ferrand Cedex 63003 France
- CHU Clermont-Ferrand, Hôpital Estaing, CRB-Auvergne; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Clinique; 1 place Lucie et Raymond Aubrac, Clermont-Ferrand Cedex 1 63003 France
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Sampson S, Botto-van Bemden A, Aufiero D. Stem Cell Therapies for Treatment of Cartilage and Bone Disorders: Osteoarthritis, Avascular Necrosis, and Non-union Fractures. PM R 2015; 7:S26-S32. [DOI: 10.1016/j.pmrj.2015.01.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 12/16/2022]
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Sampson S, Botto-van Bemden A, Aufiero D. Autologous bone marrow concentrate: review and application of a novel intra-articular orthobiologic for cartilage disease. PHYSICIAN SPORTSMED 2013; 41:7-18. [PMID: 24113698 DOI: 10.3810/psm.2013.09.2022] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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 of bone 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.
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Affiliation(s)
- Steven Sampson
- Clinical 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.
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