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Feizi A, Bell CE, Roytman GR, Park N, Wang A, Tommasini S, Wiznia D. Using Computed Tomography-Based Three-dimensional Modeling and Computer Navigation for Minimally Invasive Core Decompression and Adjuvant Orthobiologic Therapy of Femoral Head Avascular Necrosis. Arthroplast Today 2024; 26:101337. [PMID: 38497084 PMCID: PMC10940782 DOI: 10.1016/j.artd.2024.101337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/20/2023] [Accepted: 02/01/2024] [Indexed: 03/19/2024] Open
Abstract
Avascular necrosis of the femoral head is a debilitating condition that can lead to femoral head collapse. Core decompression with adjuvant cellular therapies, such as bone marrow aspirate concentrate, delays disease progression and improves outcomes. However, inconsistent results in the literature may be due to limitations in surgical technique and difficulty in targeting the necrotic lesions. Here, we present a surgical technique utilizing computed tomography-based three-dimensional modeling and instrument tracking to guide the therapy to the center of the lesion. This method minimizes the number of attempts to reach the lesion and confirms the three-dimensional positioning of the instrumentation within the lesion. Our technique may improve the outcomes of core decompression and adjuvant therapy and prevent or delay hip collapse in patients with femoral head avascular necrosis.
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Affiliation(s)
- Alborz Feizi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Yale University, School of Medicine, New Haven, CT, USA
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, USA
| | | | - Gregory Ronald Roytman
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Yale School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, USA
| | - Nancy Park
- Yale University, School of Medicine, New Haven, CT, USA
| | - Annie Wang
- Yale School of Medicine, Department of Radiology & Biomedical Imaging, New Haven, CT, USA
| | - Steven Tommasini
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Yale School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, USA
- Department of Mechanical Engineering & Materials Science, Yale University, New Haven, CT, USA
| | - Daniel Wiznia
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Yale School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, USA
- Department of Mechanical Engineering & Materials Science, Yale University, New Haven, CT, USA
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Amato M, Santonocito S, Viglianisi G, Tatullo M, Isola G. Impact of Oral Mesenchymal Stem Cells Applications as a Promising Therapeutic Target in the Therapy of Periodontal Disease. Int J Mol Sci 2022; 23:ijms232113419. [PMID: 36362206 PMCID: PMC9658889 DOI: 10.3390/ijms232113419] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Periodontal disease is a chronic inflammatory condition affecting about 20–50% of people, worldwide, and manifesting clinically through the detection of gingival inflammation, clinical attachment loss, radiographically assessed resorption of alveolar bone, gingival bleeding upon probing, teeth mobility and their potential loss at advanced stages. It is characterized by a multifactorial etiology, including an imbalance of the oral microbiota, mechanical stress and systemic diseases such as diabetes mellitus. The current standard treatments for periodontitis include eliminating the microbial pathogens and applying biomaterials to treat the bone defects. However, periodontal tissue regeneration via a process consistent with the natural tissue formation process has not yet been achieved. Developmental biology studies state that periodontal tissue is composed of neural crest-derived ectomesenchyme. The aim of this review is to discuss the clinical utility of stem cells in periodontal regeneration by reviewing the relevant literature that assesses the periodontal-regenerative potential of stem cells.
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Affiliation(s)
- Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
- Correspondence: (S.S.); (G.I.); Tel.: +39-0953782638 (S.S. & G.I.)
| | - Gaia Viglianisi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
| | - Marco Tatullo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70122 Bari, Italy
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, 95124 Catania, Italy
- Correspondence: (S.S.); (G.I.); Tel.: +39-0953782638 (S.S. & G.I.)
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Behr B, Lotzien S, Flecke M, Wallner C, Wagner JM, Dadras M, Daigeler A, Schildhauer TA, Lehnhardt M, Geßmann J. Comparative analysis of clinical outcome and quality of life between amputations and combined bone and flap reconstructions at the lower leg. Disabil Rehabil 2022; 44:6744-6748. [PMID: 34546826 DOI: 10.1080/09638288.2021.1971309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE At the lower leg, soft tissue defects with exposed bones, tendons, or hardware require flap coverage. In this retrospective study, we analyzed combined bone and soft tissue reconstructions compared to amputations of the lower leg in a civilian setting. MATERIALS AND METHODS Patients who underwent combined bone and flap reconstruction (LR) or amputation (LA) of the lower leg were eligible for the study. Bone conditions included fractures and bony defects due to posttraumatic osteomyelitis and non-union. Besides the analysis of the medical history, the study included clinical examination including extremity functional scale (LEFS) and SF-36-questionnaire. RESULTS LEFS score was significantly higher in the LR group compared to the LA group. Importantly, 42% in the LR group as opposed to 80% in the LA group could not return to their occupation. Mean hospitalization was 119 in the LR and 49 days in the LA group. SF-36 body item scores were significantly higher in the LR group as compared to LA. CONCLUSIONS Patients undergoing complex extremity reconstructions, including flap transfer to the lower leg have better functionality and higher quality of life than amputated patients. These data emphasize the advantages of these procedures and justify reconstructive efforts for limb salvage. Level of Evidence III.Implications for RehabilitationAmputation and combined bone and flap reconstruction in severe injuries of the lower leg can imply functional disabilities even after successful treatment.Albeit longer hospitalizations, patients with complex reconstructions showed better functional outcomes and had a higher quality of life.Limb salvage showed better functional outcomes and a higher rate in reintegration to work as compared to limb amputation.These data emphasize the importance of complex bone and soft tissue reconstruction in this patient cohort.
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Affiliation(s)
- Björn Behr
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcel Flecke
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - J Maximillian Wagner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Mehran Dadras
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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Datta B, Shanbhag A. Fibular hemimelia treated by autologous osteoblasts: a case report. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acetabular Bone Marrow Aspiration During Total Hip Arthroplasty. J Am Acad Orthop Surg 2021; 29:e815-e819. [PMID: 34106093 DOI: 10.5435/jaaos-d-21-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Biologically augmented surgical treatments of orthopaedic conditions are increasingly popular. Bone marrow aspirate concentrate is a key orthobiologic tissue source, and the field is moving from the standard iliac crest marrow aspiration toward local aspirations of marrow depots that are accessible during the standard-of-care procedures in an attempt to reduce morbidity, surgery time, and cost. Here, we present the aspiration of the standard iliac marrow depot, but through a novel acetabular approach during total hip arthroplasty. This procedure markedly simplifies biologic augmentation with bone marrow aspirate concentrate in this large patient cohort.
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Feddahi N, Herten M, Tassemeier T, Rekasi H, Hackel A, Haversath M, Jäger M. Does Needle Design Affect the Regenerative Potential of Bone Marrow Aspirate? An In Vitro Study. Life (Basel) 2021; 11:748. [PMID: 34440491 PMCID: PMC8401947 DOI: 10.3390/life11080748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
While autologous bone is still the gold standard for treatment of bone defects, its availability is limited. Sufficient numbers of mesenchymal stroma cells (MSC) may be an alternative. Small volumes of bone marrow aspirate (BMA) were harvested with two different needle systems comparing the yield and regenerative potency of the MSCs. BMA (10 mL) was aspirated from the posterior iliac crest of 12 patients with degenerative spinal disc disease using both needle systems in each patient: the Jamshidi needle (JAM) and on the contralateral side the Marrow Cellution® Needle (AMC). Number of mononuclear cells (MNCs) and regeneration capacity (colony-forming unit/CFU) were determined. MSCs were characterized for surface markers and their differentiation into trilineages. There was no significant difference between the two harvesting needles regarding the quantity of MNCs in BMA: 5.2 ± 1.8 × 109 MNC/mL for AMC vs. 4.8 ± 2.5 × 109 MNC/mL for JAM, p = 0.182. The quantity of CFUs per ml BMA was similar for both groups: 3717 ± 5556 for AMC and 4305 ± 5507 for JAM (p = 0.695). The potency of MSCs expressed as colony-forming potential per 106 MNC resulted in 0.98 ± 1.51 for AMC and 1.00 ± 0.96 for JAM (p = 0.666). Regardless of the needle design, 10 mL bone marrow aspirate contains a sufficient number of about 40,000 MSCs that can be used to enhance bone healing.
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Affiliation(s)
- Nadia Feddahi
- Department of Orthopedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany; (H.R.); (M.H.)
| | - Monika Herten
- Clinic of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany;
| | - Tjark Tassemeier
- Department of Orthopedic, Gelenkzentrum Bergisch Land, Freiheitstraße 203, D-42853 Remscheid, Germany;
| | - Heike Rekasi
- Department of Orthopedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany; (H.R.); (M.H.)
| | - Alexander Hackel
- Department of Otorhinolaryngology, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany;
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
| | - Marcel Haversath
- Department of Orthopedic and Trauma Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, D-45147 Essen, Germany; (H.R.); (M.H.)
- Department of Orthopedic, St. Vinzenz Krankenhaus Düsseldorf, Schloßstraße 85, D-40477 Düsseldorf, Germany
| | - Marcus Jäger
- Department of Trauma, Reconstruction and Orthopedic Surgery, St. Marien Hospital, Mülheim an der Ruhr, Kaiserstraße 50, D-45468 Mülheim an der Ruhr, Germany;
- Orthopedics and Trauma Surgery, University of Duisburg Essen, D-45147 Essen, Germany
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Chen J, Hua J, Song W. Screen Key Genes Associated with Distraction-Induced Osteogenesis of Stem Cells Using Bioinformatics Methods. Int J Mol Sci 2021; 22:ijms22126505. [PMID: 34204414 PMCID: PMC8235684 DOI: 10.3390/ijms22126505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Applying mesenchymal stem cells (MSCs), together with the distraction osteogenesis (DO) process, displayed enhanced bone quality and shorter treatment periods. The DO guides the differentiation of MSCs by providing mechanical clues. However, the underlying key genes and pathways are largely unknown. The aim of this study was to screen and identify hub genes involved in distraction-induced osteogenesis of MSCs and potential molecular mechanisms. Material and Methods: The datasets were downloaded from the ArrayExpress database. Three samples of negative control and two samples subjected to 5% cyclic sinusoidal distraction at 0.25 Hz for 6 h were selected for screening differentially expressed genes (DEGs) and then analysed via bioinformatics methods. The Gene Ontology (GO) terms and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment were investigated. The protein–protein interaction (PPI) network was visualised through the Cytoscape software. Gene set enrichment analysis (GSEA) was conducted to verify the enrichment of a self-defined osteogenic gene sets collection and identify osteogenic hub genes. Results: Three hub genes (IL6, MMP2, and EP300) that were highly associated with distraction-induced osteogenesis of MSCs were identified via the Venn diagram. These hub genes could provide a new understanding of distraction-induced osteogenic differentiation of MSCs and serve as potential gene targets for optimising DO via targeted therapies.
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Affiliation(s)
- Jishizhan Chen
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Division of Surgery & Interventional Science, University College London, London NW3 2PF, UK;
| | - Jia Hua
- UCL Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery & Interventional Science, University College London, Stanmore, London HA7 4AP, UK;
- The Griffin Institute (Northwick Park Institute for Medical Research), Harrow, London HA1 3UJ, UK
- Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK
| | - Wenhui Song
- UCL Centre for Biomaterials in Surgical Reconstruction and Regeneration, Division of Surgery & Interventional Science, University College London, London NW3 2PF, UK;
- Correspondence:
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Rosteius T, Pätzholz S, Rausch V, Lotzien S, Behr B, Lehnhardt M, Schildhauer TA, Seybold D, Geßmann J. Ilizarov bone transport using an intramedullary cable transportation system in the treatment of tibial bone defects. Injury 2021; 52:1606-1613. [PMID: 33436268 DOI: 10.1016/j.injury.2020.12.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Segmental tibia defects remain challenging for orthopedic surgeons to treat. The aim of this study was to demonstrate bone-related and functional outcomes after treatment of complex tibial bone defects using Ilizarov bone transport with a modified intramedullary cable transportation system (CTS). PATIENTS AND METHODS We conducted a single-center, retrospective study including all 42 patients treated for tibial bone loss via Ilizarov bone transport with CTS between 2005 and 2018. Bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. Complication and failure rates were determined by the patients' medical files. RESULTS Patients had a mean age of 45.5 ± 15.1 years. The mean bone defect size was 7.7 ± 3.4 cm, the average nonunion scoring system (NUSS) score was 59 ± 9.5 points, and the mean follow-up was 40.8 ± 24.4 months (range, 13-139 months). Complete bone and soft tissue healing occurred in 32/42 patients (76.2%). These patients had excellent (10), good (17), fair (2), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 19 patients had excellent, 10 good, and 3 fair results. In total, 37 minor complications and 62 major complications occurred during the study. In 7 patients, bone and soft tissue healing occurred after CTS failure with either an induced membrane technique or classic bone transport; 3 patients underwent lower leg amputation. Patients with treatment failure were significantly older (57.6 vs. 41.8 years; p = 0.003). Charlson score and treatment failure had a positive correlation (Spearman's rho 0.43; p = 0.004). CONCLUSION Bone transport using both intramedullary CTS and Ilizarov ring fixation is viable for treating patients with bone loss of the tibia and complex infection or soft tissue conditions. However, a high number of complications and surgical revisions are associated with the treatment of this severe clinical entity and should be taken into account.
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Affiliation(s)
- Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany.
| | - Simon Pätzholz
- Department of Radiological Diagnostics, Interventional Radiology and Nuclear Medicine, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Björn Behr
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Markus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Dominik Seybold
- OPND Orthopädie Unfallchirurgie Praxis/Klinik Neuss, Plange Mühle 1, 40221 Düsseldorf, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
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Yang Y, Pan Q, Zou K, Wang H, Zhang X, Yang Z, Lee WYW, Wei B, Gu W, Yang YP, Lin S, Li G. Administration of allogeneic mesenchymal stem cells in lengthening phase accelerates early bone consolidation in rat distraction osteogenesis model. Stem Cell Res Ther 2020; 11:129. [PMID: 32197646 PMCID: PMC7083044 DOI: 10.1186/s13287-020-01635-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/20/2020] [Accepted: 03/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Distraction osteogenesis (DO) is a surgical technique to promote bone regeneration which may require long duration for bone consolidation. Bone marrow-derived mesenchymal stem cells (MSCs) have been applied to accelerate bone formation in DO. However, the optimal time point for cell therapy in DO remains unknown. This study sought to determine the optimal time point of cell administration to achieve early bone consolidation in DO. We hypothesized that the ratio of circulating MSCs to peripheral mononuclear cells and the level of cytokines in serum might be indicators for cell administration in DO. METHODS Unilateral tibial osteotomy with an external fixator was performed in adult Sprague Dawley rats. Three days after osteotomy, the tibia was lengthened at 0.5 mm/12 h for 5 days. At first, 5 rats were used to analyze the blood components at 6 different time points (3 days before lengthening, on the day lengthening began, or 3, 6, 10, or 14 days after lengthening began) by sorting circulating MSCs and measuring serum levels of stromal cell-derived factor 1 (SDF-1) and interleukin 1β. Then, 40 rats were used for cell therapy study. A single dose of 5 × 105 allogeneic MSCs was locally injected at the lengthening site on day 3, 6, or 10 after lengthening began, or 3 doses of MSCs were injected at the three time points. Sequential X-ray radiographs were taken weekly. Endpoint examinations included micro-computed tomography analysis, mechanical testing, histomorphometry, and histology. RESULTS The number of circulating MSCs and serum level of SDF-1 were significantly increased during lengthening, and then decreased afterwards. Single injection of MSCs during lengthening phase (on day 3, but not day 6 or 10) significantly increased bone volume fraction, mechanical maximum loading, and bone mineralization of the regenerate. Triple injections of MSCs at three time points also significantly increased bone volume and maximum loading of the regenerates. CONCLUSION This study demonstrated that bone consolidation could be accelerated by a single injection of MSCs during lengthening when the ratio of peripheral MSCs to mononuclear cells and the serum SDF-1 presented at peak levels concurrently, suggesting that day 3 after lengthening began may be the optimal time point for cell therapy to promote early bone consolidation.
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Affiliation(s)
- Yanhua Yang
- Department of Central Laboratory, Changzhou Seventh People's Hospital, Changzhou, China.,Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Qi Pan
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Kaijie Zou
- Department of Central Laboratory, Changzhou Seventh People's Hospital, Changzhou, China.,Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Haixing Wang
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Xiaoting Zhang
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Zhengmeng Yang
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Wayne Yuk Wai Lee
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Bo Wei
- Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Weidong Gu
- Department of Central Laboratory, Changzhou Seventh People's Hospital, Changzhou, China
| | - Yunzhi Peter Yang
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, USA.,Department of Materials Science and Engineering, School of Engineering, Stanford University, Stanford, USA.,Department of Bioengineering, School of Medicine, Stanford University, Stanford, USA
| | - Sien Lin
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. .,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. .,Orthopaedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China. .,Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, USA.
| | - Gang Li
- Department of Orthopaedic and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. .,Stem Cells and Regenerative Medicine Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. .,The CUHK-ACC Space Medicine Centre on Health Maintenance of Musculoskeletal System, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China. .,Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Kingery MT, Manjunath AK, Anil U, Strauss EJ. Bone Marrow Mesenchymal Stem Cell Therapy and Related Bone Marrow-Derived Orthobiologic Therapeutics. Curr Rev Musculoskelet Med 2019; 12:451-459. [PMID: 31749105 DOI: 10.1007/s12178-019-09583-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The purpose of the current article is to review the available literature related to bone marrow-derived mesenchymal stem cell therapy in the management of musculoskeletal pathologies and demonstrate the critical need for additional well-designed clinical studies. RECENT FINDINGS In recent years, there has been a rapid increase in interest regarding the use of bone marrow-derived mesenchymal stem cells in the treatment of musculoskeletal injury and disease. The clinical use of BM-MSCs and other forms of stem cell therapy has far outpaced the basic and translational science evidence required to elucidate the potential efficacy of this orthobiologic treatment approach. Early studies have demonstrated potential clinical benefit of utilizing bone marrow-derived mesenchymal stem cell therapy in the management of knee osteoarthritis, focal chondral lesions, shoulder pathology including rotator cuff tears and glenohumeral arthritis, and degenerative disk disease in the spine. To date, most published studies are small case series often lacking a control group or a standardized method of treatment. Bone marrow-derived mesenchymal stem cell therapy is becoming an increasingly common treatment for musculoskeletal injuries and disease. Although early clinical studies have shown promising outcomes, methodological flaws and lack of standardization among trials have limited the conclusions that can be drawn from the existing literature. A better understanding of the underlying mechanism of action and more carefully designed clinical trials will help reveal the efficacy and utility of BM-MSCs as a treatment modality for various orthopedic pathologies.
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Affiliation(s)
- Matthew T Kingery
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Amit K Manjunath
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Utkarsh Anil
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA. .,NYU Langone Orthopedics, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA.
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The Effect of Bone Marrow Aspirate Concentrate Application on Distracted Bone Biomechanical Properties. J Craniofac Surg 2019; 30:2650-2655. [DOI: 10.1097/scs.0000000000005998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Schäfer R, DeBaun MR, Fleck E, Centeno CJ, Kraft D, Leibacher J, Bieback K, Seifried E, Dragoo JL. Quantitation of progenitor cell populations and growth factors after bone marrow aspirate concentration. J Transl Med 2019; 17:115. [PMID: 30961655 PMCID: PMC6454687 DOI: 10.1186/s12967-019-1866-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/28/2019] [Indexed: 12/15/2022] Open
Abstract
Background The number of Mesenchymal Stem/Stromal Cells (MSCs) in the human bone marrow (BM) is small compared to other cell types. BM aspirate concentration (BMAC) may be used to increase numbers of MSCs, but the composition of MSC subpopulations and growth factors after processing are unknown. The purpose of this study was to assess the enrichment of stem/progenitor cells and growth factors in BM aspirate by two different commercial concentration devices versus standard BM aspiration. Methods 120 mL of BM was aspirated from the iliac crest of 10 male donors. Each sample was processed simultaneously by either Emcyte GenesisCS® (Emcyte) or Harvest SmartPReP2 BMAC (Harvest) devices and compared to untreated BM aspirate. Samples were analyzed with multicolor flow cytometry for cellular viability and expression of stem/progenitor cells markers. Stem/progenitor cell content was verified by quantification of colony forming unit-fibroblasts (CFU-F). Platelet, red blood cell and total nucleated cell (TNC) content were determined using an automated hematology analyzer. Growth factors contents were analyzed with protein quantification assays. Statistical analyses were performed by ANOVA analysis of variance followed by Tukey’s multiple comparison test or Wilcoxon matched-pairs signed rank test with p < 0.05 for significance. Results Cell viability after processing was approximately 90% in all groups. Compared to control, both devices significantly enriched TNCs and platelets, as well as the CD45−CD73+ and CD45−CD73+CD90+ cell populations. Further, Harvest significantly concentrated CD45−CD10+, CD45−CD29+, CD45−CD90+, CD45−CD105+, CD45−CD119+ cells, and CD45dimCD90+CD271+ MSCs, whereas Emcyte significantly enriched CD45dimCD44+CD271+ MSCs. BM concentration also increased the numbers of CFU-F, platelet-derived growth factor, vascular endothelial growth factor, macrophage colony-stimulating factor, interleukin-1b, VCAM-1 and total protein. Neither system concentrated red blood cells, hematopoietic stem cells or bone morphogenetic proteins. Conclusion This data could contribute to the development of BMAC quality control assays as both BMAC systems concentrated platelets, growth factors and non-hematopoietic stem cell subpopulations with distinct phenotypes without loss of cell viability when compared to unprocessed BM. Electronic supplementary material The online version of this article (10.1186/s12967-019-1866-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard Schäfer
- Institute for Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Frankfurt Am Main, Germany
| | - Malcolm R DeBaun
- Department of Orthopedic Surgery, Stanford University School of Medicine, 450 Broadway, Redwood City, CA, 94063, USA
| | - Erika Fleck
- Institute for Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Frankfurt Am Main, Germany
| | | | - Daniela Kraft
- Institute for Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Frankfurt Am Main, Germany
| | - Johannes Leibacher
- Institute for Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Frankfurt Am Main, Germany
| | - Karen Bieback
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Mannheim, Germany
| | - Erhard Seifried
- Institute for Transfusion Medicine and Immunohematology, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Frankfurt Am Main, Germany
| | - Jason L Dragoo
- Department of Orthopedic Surgery, Stanford University School of Medicine, 450 Broadway, Redwood City, CA, 94063, USA.
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El-Said MM, Emile SH. Cellular therapy: A promising tool in the future of colorectal surgery. World J Gastroenterol 2019; 25:1560-1565. [PMID: 30983816 PMCID: PMC6452228 DOI: 10.3748/wjg.v25.i13.1560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/28/2019] [Accepted: 03/02/2019] [Indexed: 02/06/2023] Open
Abstract
Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer (CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells (MSCs) and bone marrow-mononuclear cells (BM-MNCs) therapy. These cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.
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Affiliation(s)
- Mohammed Mohammed El-Said
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura 35516, Egypt
| | - Sameh Hany Emile
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura 35516, Egypt
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15
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Blanco JF, Villarón EM, Pescador D, da Casa C, Gómez V, Redondo AM, López-Villar O, López-Parra M, Muntión S, Sánchez-Guijo F. Autologous mesenchymal stromal cells embedded in tricalcium phosphate for posterolateral spinal fusion: results of a prospective phase I/II clinical trial with long-term follow-up. Stem Cell Res Ther 2019; 10:63. [PMID: 30795797 PMCID: PMC6387529 DOI: 10.1186/s13287-019-1166-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Posterolateral spinal fusion with autologous bone graft is considered the "gold standard" for lumbar degenerative disc disease (DDD) when surgical treatment is indicated. The potential role of mesenchymal stromal cells (MSCs) to replace the bone graft in this setting has not been fully addressed. OBJECTIVE To analyze the safety, feasibility and potential clinical efficacy of the implantation of autologous MSCs embedded with tricalcium phosphate as a therapeutic alternative to bone graft in patients with DDD during posterolateral spine fusion. STUDY DESIGN Phase I/II single-arm prospective clinical trial. METHODS Eleven patients with monosegmental DDD at L4-L5 or L5-S1 level were included. Autologous bone marrow-derived MSC were expanded in our Good Manufacturing Practice (GMP) Facility and implanted during spinal surgery embedded in a tricalcium phosphate carrier. Monitoring of patients included a postoperative period of 12 months with four visits (after the 1st, 3rd, 6th, and 12th month), with clinical and radiological assessment that included the visual analog scale (VAS), the Oswestry disability index (ODI), the Short-Form Health Survey (SF-36), the vertebral fusion grade observed through a simple Rx, and the evaluation of possible complications or adverse reactions. In addition, all patients were further followed up to 5 years for outcome. RESULTS Median age of patients included was 44 years (range 30-58 years), and male/female ratio was (6/5) L4-L5 and L5-S1 DDD was present five and six patients, respectively. Autologous MSCs were expanded in all cases. There were no adverse effects related to cell implantation. Regarding efficacy, both VAS and ODI scores improved after surgery. Radiologically, 80% of patients achieved lumbar fusion at the end of the follow-up. No adverse effects related to the procedure were recorded. CONCLUSIONS The use of autologous MSCs for spine fusion in patients with monosegmental degenerative disc disease is feasible, safe, and potentially effective. TRIAL REGISTRATION no. EudraCT: 2010-018335-17 ; code Identifier: NCT01513694 ( clinicaltrials.gov ).
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Affiliation(s)
- Juan F Blanco
- Trauma and Orthopedics Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain. .,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain. .,Trauma and Orthopedics Department, IBSAL - University Hospital of Salamanca, Paseo de San Vicente 58-182, 37007, Salamanca, Spain.
| | - Eva M Villarón
- Hematology Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - David Pescador
- Trauma and Orthopedics Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Carmen da Casa
- Trauma and Orthopedics Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain
| | - Victoria Gómez
- Trauma and Orthopedics Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Alba M Redondo
- Hematology Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Olga López-Villar
- Hematology Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Miriam López-Parra
- Hematology Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Sandra Muntión
- Hematology Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
| | - Fermín Sánchez-Guijo
- Hematology Service, IBSAL - University Hospital of Salamanca, Salamanca, Spain.,Network Center in Regenerative Medicine and Cellular Therapy of Castilla y León, Salamanca, Spain
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16
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Piuzzi NS, Mantripragada VP, Sumski A, Selvam S, Boehm C, Muschler GF. Bone Marrow-Derived Cellular Therapies in Orthopaedics. JBJS Rev 2018; 6:e4. [DOI: 10.2106/jbjs.rvw.18.00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Verboket R, Leiblein M, Seebach C, Nau C, Janko M, Bellen M, Bönig H, Henrich D, Marzi I. Autologous cell-based therapy for treatment of large bone defects: from bench to bedside. Eur J Trauma Emerg Surg 2018; 44:649-665. [PMID: 29352347 PMCID: PMC6182650 DOI: 10.1007/s00068-018-0906-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/08/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Reconstruction of long segmental bone defects is demanding for patients and surgeons, and associated with long-term treatment periods and substantial complication rates in addition to high costs. While defects up to 4-5 cm length might be filled up with autologous bone graft, heterologous bone from cadavers, or artificial bone graft substitutes, current options to reconstruct bone defects greater than 5 cm consist of either vascularized free bone transfers, the Masquelet technique or the Ilizarov distraction osteogenesis. Alternatively, autologous cell transplantation is an encouraging treatment option for large bone defects as it eliminates problems such as limited autologous bone availability, allogenic bone immunogenicity, and donor-site morbidity, and might be used for stabilizing loose alloplastic implants. METHODS The authors show different cell therapies without expansion in culture, with ex vivo expansion and cell therapy in local bone defects, bone healing and osteonecrosis. Different kinds of cells and scaffolds investigated in our group as well as in vivo transfer studies and BMC used in clinical phase I and IIa clinical trials of our group are shown. RESULTS Our research history demonstrated the great potential of various stem cell species to support bone defect healing. It was clearly shown that the combination of different cell types is superior to approaches using single cell types. We further demonstrate that it is feasible to translate preclinically developed protocols from in vitro to in vivo experiments and follow positive convincing results into a clinical setting to use autologous stem cells to support bone healing.
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Affiliation(s)
- R. Verboket
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M. Leiblein
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - C. Seebach
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - C. Nau
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M. Janko
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M. Bellen
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - H. Bönig
- Department of Transfusion Medicine and Immune Hematology, University Hospital Frankfurt and DRK Blood Donor Service Baden-Württemberg-Hessen, Frankfurt, Germany
| | - D. Henrich
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - I. Marzi
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
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18
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Rausch V, Seybold D, Königshausen M, Köller M, Schildhauer TA, Geßmann J. [Basic principles of fracture healing]. DER ORTHOPADE 2018; 46:640-647. [PMID: 28718007 DOI: 10.1007/s00132-017-3449-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In contrast to other tissues, bone has the remarkable ability to heal without scarring. After union of the fracture, the remodeled bone ideally does not differ from the original bone, especially in terms of biomechanical properties. The healing of a fracture resembles the embryonic development of bone. Depending on the biomechanical properties of the fracture, bone heals directly or indirectly, which refers to the formation of cartilage as a step before new bone appears. Currently, treatment of the patient is often limited to anatomical reduction and optimization of the fracture environment with respect to biomechanics. PROSPECTS Future treatment strategies, however, could include systemic medication that could be especially beneficial for patients at risk of complications in fracture healing. The aim of this review is to provide an overview on the process of fracture healing and to depict possibilities for current and future treatment strategies.
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Affiliation(s)
- Valentin Rausch
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Dominik Seybold
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - Matthias Königshausen
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Manfred Köller
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Thomas A Schildhauer
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Jan Geßmann
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
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19
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Piuzzi NS, Hussain ZB, Chahla J, Cinque ME, Moatshe G, Mantripragada VP, Muschler GF, LaPrade RF. Variability in the Preparation, Reporting, and Use of Bone Marrow Aspirate Concentrate in Musculoskeletal Disorders: A Systematic Review of the Clinical Orthopaedic Literature. J Bone Joint Surg Am 2018; 100:517-525. [PMID: 29557869 DOI: 10.2106/jbjs.17.00451] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Interest in the therapeutic potential of bone marrow aspirate concentrate (BMAC) has grown exponentially. However, comparisons among studies and their processing methods are challenging because of inconsistent reporting of protocols, as well as poor characterization of the composition of the initial bone marrow aspirate and of the final products delivered. The purpose of this study was to perform a systematic review of the literature to evaluate the level of reporting related to the protocols used for BMAC preparation and the composition of BMAC utilized in the treatment of musculoskeletal diseases in published clinical studies. METHODS A systematic review of the literature was performed by searching PubMed, MEDLINE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials from 1980 to 2016. Inclusion criteria were human clinical trials, English language, and manuscripts that reported on the use of BMAC in musculoskeletal conditions. RESULTS After a comprehensive review of the 986 identified articles, 46 articles met the inclusion criteria for analysis. No study provided comprehensive reporting that included a clear description of the preparation protocol that could be used by subsequent investigators to repeat the method. Only 14 (30%) of the studies provided quantitative metrics of the composition of the BMAC final product. CONCLUSIONS The reporting of BMAC preparation protocols in clinical studies was highly inconsistent and studies did not provide sufficient information to allow the protocol to be reproduced. Moreover, comparison of the efficacy and yield of BMAC products is precluded by deficiencies in the reporting of preparation methods and composition. Future studies should contain standardized and stepwise descriptions of the BMAC preparation protocol, and the composition of the BMAC delivered, to permit validating and rationally optimizing the role of BMAC in musculoskeletal care.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery and Bioengineering, Cleveland Clinic, Cleveland, Ohio.,Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado
| | - Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado.,Oslo University Hospital, University of Oslo, Oslo, Norway.,OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway
| | | | - George F Muschler
- Department of Orthopaedic Surgery and Bioengineering, Cleveland Clinic, Cleveland, Ohio
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
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20
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The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect. Injury 2017; 48:2842-2846. [PMID: 29122280 DOI: 10.1016/j.injury.2017.10.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. MATERIALS AND METHODS The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). RESULTS The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). CONCLUSIONS Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe.
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21
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Yang Y, Lin S, Wang B, Gu W, Li G. Stem cell therapy for enhancement of bone consolidation in distraction osteogenesis: A contemporary review of experimental studies. Bone Joint Res 2017. [PMID: 28634158 PMCID: PMC5492338 DOI: 10.1302/2046-3758.66.bjr-2017-0023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objectives Distraction osteogenesis (DO) mobilises bone regenerative potential and avoids the complications of other treatments such as bone graft. The major disadvantage of DO is the length of time required for bone consolidation. Mesenchymal stem cells (MSCs) have been used to promote bone formation with some good results. Methods We hereby review the published literature on the use of MSCs in promoting bone consolidation during DO. Results Studies differed in animal type (mice, rabbit, dog, sheep), bone type (femur, tibia, skull), DO protocols and cell transplantation methods. Conclusion The majority of studies reported that the transplantation of MSCs enhanced bone consolidation or formation in DO. Many questions relating to animal model, DO protocol and cell transplantation regime remain to be further investigated. Clinical trials are needed to test and confirm these findings from animal studies. Cite this article: Y. Yang, S. Lin, B. Wang, W. Gu, G. Li. Stem cell therapy for enhancement of bone consolidation in distraction osteogenesis: A contemporary review of experimental studies. Bone Joint Res 2017;6:385–390. DOI: 10.1302/2046-3758.66.BJR-2017-0023.
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Affiliation(s)
- Y Yang
- Department of Key Laboratory, Changzhou No.7 People's Hospital, No. 288 Yanling East Road, Changzhou, Jiangsu, China
| | - S Lin
- Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - B Wang
- Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | - W Gu
- Department of Traumatology, Changzhou No.7 People's Hospital, No. 288 Yanling East Road, Changzhou, Jiangsu, China
| | - G Li
- Department of Orthopaedics and Traumatology, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
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22
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Improvement of Fat Graft Survival with Autologous Bone Marrow Aspirate and Bone Marrow Concentrate: A One-Step Method. Plast Reconstr Surg 2016; 137:676e-686e. [PMID: 27018695 DOI: 10.1097/prs.0000000000001993] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Stem cells have proven to be beneficial to fat graft survival, but a one-step method of cell-assisted lipotransfer is still missing. In the present work, the authors improved the fat graft survival using bone marrow aspirate and bone marrow concentrate, to ensure that both liposuction and cell-assisted lipotransfer were included in the same procedure. METHODS Bone marrow aspirate was collected from the iliac crest of the rabbits. Bone marrow concentrate was obtained using density gradient centrifugation and labeled with PKH26 fluorescent cell linker. Rabbits were divided into three groups: group A, bone marrow aspirate; group B, bone marrow concentrate; and group C, phosphate-buffered saline buffer as a blank control. The implanted mixture contained 1.5 ml of adipose granule and 1 ml of bone marrow aspirate or bone marrow concentrate. The rabbits were subjected to fluorescence imaging in vivo at four time points. Grafts were harvested and analyzed at 4 weeks and 12 weeks after fat grafting. RESULTS Bone marrow cell fluorescence signals were observed in the rabbits' injection regions during a follow-up of 12 weeks. The fat grafts of group A and B showed a better weight and volume retention, living quality, adipocyte viability, and angiogenesis after transplantation. The results of living tissue imaging also showed that the implanted bone marrow cells could contribute to fat graft survival by multilineage differentiation and could also contribute to adipogenesis and angiogenesis. CONCLUSION Both bone marrow aspirate and bone marrow concentrate improved the survival and angiogenesis of grafted fat tissue.
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Compton J, Fragomen A, Rozbruch SR. Skeletal Repair in Distraction Osteogenesis: Mechanisms and Enhancements. JBJS Rev 2015; 3:01874474-201508000-00002. [PMID: 27490473 DOI: 10.2106/jbjs.rvw.n.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jocelyn Compton
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10031
| | - Austin Fragomen
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - S Robert Rozbruch
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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24
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Dumic-Cule I, Pecina M, Jelic M, Jankolija M, Popek I, Grgurevic L, Vukicevic S. Biological aspects of segmental bone defects management. INTERNATIONAL ORTHOPAEDICS 2015; 39:1005-11. [DOI: 10.1007/s00264-015-2728-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/26/2015] [Indexed: 10/23/2022]
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25
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Fleming ME, Bharmal H, Valerio I. Regenerative medicine applications in combat casualty care. Regen Med 2015; 9:179-90. [PMID: 24750059 DOI: 10.2217/rme.13.96] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this report is to describe regenerative medicine applications in the management of complex injuries sustained by service members injured in support of the wars in Afghanistan and Iraq. Improvements in body armor, resuscitative techniques and faster transport have translated into increased patient survivability and more complex wounds. Combat-related blast injuries have resulted in multiple extremity injuries, significant tissue loss and amputations. Due to the limited availability and morbidity associated with autologous tissue donor sites, the introduction of regenerative medicine has been critical in managing war extremity injuries with composite massive tissue loss. Through case reports and clinical images, this report reviews the application of regenerative medicine modalities employed to manage combat-related injuries. It illustrates that the novel use of hybrid reconstructions combining traditional and regenerative medicine approaches are an effective tool in managing wounds. Lessons learned can be adapted to civilian care.
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Affiliation(s)
- Mark E Fleming
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA
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Nagata MJ, de Campos N, Messora MR, Santinoni CS, Bomfim SR, Fucini SE, Pola NM, Neves AP, de Almeida JM, Theodoro LH, Ervolino E. Platelet-Rich Plasma Derived From Bone Marrow Aspirate Promotes New Cementum Formation. J Periodontol 2014; 85:1702-11. [DOI: 10.1902/jop.2014.140083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Sununliganon L, Peng L, Singhatanadgit W, Cheung LK. Osteogenic efficacy of bone marrow concentrate in rabbit maxillary sinus grafting. J Craniomaxillofac Surg 2014; 42:1753-65. [PMID: 25052732 DOI: 10.1016/j.jcms.2014.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/29/2014] [Accepted: 06/05/2014] [Indexed: 12/23/2022] Open
Abstract
Maxillary sinus grafting is required to increase bone volume in the atrophic posterior maxilla to facilitate dental implant placement. Grafting with autogenous bone (AB) is ideal, but additional bone harvesting surgery is unpleasant. Alternatively, bone substitutes have been used but they limit new bone formation. The strategy of single-visit clinical stem cell therapy using bone marrow aspirate concentrate (BMAC) to facilitate new bone formation has been proposed. This study aimed to assess bone regeneration capacity of autologous BMAC mixed with bovine bone mineral (BBM) in maxillary sinus grafting. Twenty-four white New Zealand rabbits were used and their maxillary sinuses were randomly assigned for grafting with 4 different materials. Rates of new bone apposition in augmented sinuses were measured and bone histomorphometry were examined. Significant increase in the quantity of nucleated cells and colony forming unit-fibroblasts were confirmed in BMAC. Mesenchymal stem cells in BMAC retained their in vitro multi-differentiation capability. Higher rates of mineral appositions in the early period were detected in BBM + BMAC and AB than BBM alone, though they are not significantly different. Graft volume/tissue volumes in BBM and BBM + BMAC were found to be higher than those in AB and sham.
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Affiliation(s)
- L Sununliganon
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, China; Faculty of Dentistry, Thammasat University, Thailand
| | - L Peng
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, China
| | | | - L K Cheung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, China.
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Wang X, Schröder HC, Grebenjuk V, Diehl-Seifert B, Mailänder V, Steffen R, Schloßmacher U, Müller WEG. The marine sponge-derived inorganic polymers, biosilica and polyphosphate, as morphogenetically active matrices/scaffolds for the differentiation of human multipotent stromal cells: potential application in 3D printing and distraction osteogenesis. Mar Drugs 2014; 12:1131-47. [PMID: 24566262 PMCID: PMC3944534 DOI: 10.3390/md12021131] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/10/2014] [Accepted: 02/17/2014] [Indexed: 01/03/2023] Open
Abstract
The two marine inorganic polymers, biosilica (BS), enzymatically synthesized from ortho-silicate, and polyphosphate (polyP), a likewise enzymatically synthesized polymer consisting of 10 to >100 phosphate residues linked by high-energy phosphoanhydride bonds, have previously been shown to display a morphogenetic effect on osteoblasts. In the present study, the effect of these polymers on the differential differentiation of human multipotent stromal cells (hMSC), mesenchymal stem cells, that had been encapsulated into beads of the biocompatible plant polymer alginate, was studied. The differentiation of the hMSCs in the alginate beads was directed either to the osteogenic cell lineage by exposure to an osteogenic medium (mineralization activation cocktail; differentiation into osteoblasts) or to the chondrogenic cell lineage by incubating in chondrocyte differentiation medium (triggering chondrocyte maturation). Both biosilica and polyP, applied as Ca²⁺ salts, were found to induce an increased mineralization in osteogenic cells; these inorganic polymers display also morphogenetic potential. The effects were substantiated by gene expression studies, which revealed that biosilica and polyP strongly and significantly increase the expression of bone morphogenetic protein 2 (BMP-2) and alkaline phosphatase (ALP) in osteogenic cells, which was significantly more pronounced in osteogenic versus chondrogenic cells. A differential effect of the two polymers was seen on the expression of the two collagen types, I and II. While collagen Type I is highly expressed in osteogenic cells, but not in chondrogenic cells after exposure to biosilica or polyP, the upregulation of the steady-state level of collagen Type II transcripts in chondrogenic cells is comparably stronger than in osteogenic cells. It is concluded that the two polymers, biosilica and polyP, are morphogenetically active additives for the otherwise biologically inert alginate polymer. It is proposed that alginate, supplemented with polyP and/or biosilica, is a suitable biomaterial that promotes the growth and differentiation of hMSCs and might be beneficial for application in 3D tissue printing of hMSCs and for the delivery of hMSCs in fractures, surgically created during distraction osteogenesis.
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Affiliation(s)
- Xiaohong Wang
- ERC Advanced Investigator Grant Research Group, Institute for Physiological Chemistry, University Medical Center, Johannes Gutenberg University, Duesbergweg 6, D-55128 Mainz, Germany.
| | - Heinz C Schröder
- ERC Advanced Investigator Grant Research Group, Institute for Physiological Chemistry, University Medical Center, Johannes Gutenberg University, Duesbergweg 6, D-55128 Mainz, Germany.
| | - Vladislav Grebenjuk
- ERC Advanced Investigator Grant Research Group, Institute for Physiological Chemistry, University Medical Center, Johannes Gutenberg University, Duesbergweg 6, D-55128 Mainz, Germany.
| | | | - Volker Mailänder
- Max Planck Institute for Polymer Research, Ackermannweg 10, 55129 Mainz, Germany.
| | - Renate Steffen
- ERC Advanced Investigator Grant Research Group, Institute for Physiological Chemistry, University Medical Center, Johannes Gutenberg University, Duesbergweg 6, D-55128 Mainz, Germany.
| | - Ute Schloßmacher
- ERC Advanced Investigator Grant Research Group, Institute for Physiological Chemistry, University Medical Center, Johannes Gutenberg University, Duesbergweg 6, D-55128 Mainz, Germany.
| | - Werner E G Müller
- ERC Advanced Investigator Grant Research Group, Institute for Physiological Chemistry, University Medical Center, Johannes Gutenberg University, Duesbergweg 6, D-55128 Mainz, Germany.
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Petri M, Namazian A, Wilke F, Ettinger M, Stübig T, Brand S, Bengel F, Krettek C, Berding G, Jagodzinski M. Repair of segmental long-bone defects by stem cell concentrate augmented scaffolds: a clinical and positron emission tomography--computed tomography analysis. INTERNATIONAL ORTHOPAEDICS 2013; 37:2231-7. [PMID: 24013459 DOI: 10.1007/s00264-013-2087-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/14/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE Treating segmental long-bone defects remains a major challenge. For defects >3 cm, segmental transport represents the gold standard, even though the method is time consuming and afflicted with several complications. The aim of this study was to evaluate healing of such defects after grafting an osteogenic scaffold previously seeded with stem cell concentrate. METHODS We evaluated five patients with segmental long-bone defects (3-14 cm) treated with bone marrow aspirate concentrates (BMAC) seeded onto a bovine xenogenous scaffold. The healing process was monitored by X-rays and positron emission tomography-computed tomography (PET-CT) three months after surgery. RESULTS Centrifugation led to a concentration of leukocytes by factor 8.1 ± 7.5. Full weight bearing was achieved 11.3 ± 5.0 weeks after surgery. PET analysis showed an increased influx of fluoride by factor 8.3 ± 6.4 compared with the contralateral side (p < 0.01). Bone density in the cortical area was 75 ± 16 % of the contralateral side (p < 0.03). The patient with the largest defect sustained an implant failure in the distal femur and finally accomplished therapy by segmental transport. He also had the lowest uptake of fluoride of the patient collective (2.2-fold increase). CONCLUSION Stem cell concentrates can be an alternative to segmental bone transport. Further studies are needed to compare this method with autologous bone grafting and segmental transport.
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Affiliation(s)
- Maximilian Petri
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany,
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