Bone Marrow Concentrate: a novel tool for bone repair!

Abstract

Background: Recently controversy has arisen regarding the role of mesenchymal stem cell (MSC) in orthopaedic surgery with their potential clinical application in cartilage and bone regeneration. Although autologous bone grafting is still the “gold standard” to heal critical size bony defects, it is associated with significant donor site morbidity. We present clinical and experimental data of autologous bone marrow aspiration concentrate (BMAC) in patients with local bone defects. Materials and Methods: Clinical trial: 44 patients with pseudarthrosis or local bone defects (bone cysts, benign bone tumors, revision endoprosthetic surgery) underwent Jamshidi vacuum aspiration (posterior iliac crest) followed by bone marrow concentration via density gradient centrifugation (Smart prep2®, Harvest Technologies). BMAC was incubated with bovine hydroxyapatite (HA) carrier (Orthoss®, Geistlich) or a collagen membrane (Gelaspon®, Chauvin Ankerpharm). Bone defects were treated with cancellous bone grafting supplemented by BMAC/biomaterial-composit. Bone regeneration was determined by clinical and radiological examinations. Experimental data: Mononuclear cells were counted and colony forming units (CFU-F/-ALP) determined. In addition, cellular adherence and proliferation on scaffolds was analyzed and the osteogenic potential of BMAC evaluated. Results: All of the 44 patients showed new bone formation/healing during follow up. There was no servere perioperative complication. However, one patient showed persisting hematoma, and three other individuals had prolonged wound secretions (three required revision surgery). The average concentration factor for BMAC was 5.7 (SD: 1.01). In vitro CFU appeared earlier and were larger suggesting a higher regenerative potential in BMAC. It was shown that BMACells adhered on the scaffold, proliferated and displayed osteogenic differentiation with and without DAG supplementation. Conclusion: Our interim data showed that application of BMAC is easy to handle, a safe procedure and successful in treatment of local bone defects. However, additional supplements (growth factors e.g. BMPs) might be able to improve the clinical outcome of BMAC.