At present, it is well known that populations of human bone marrow stromal cells (HBMSCs) can differentiate into osteoblasts and produce bone. However, the amount of cells with osteogenic potential that is ultimately obtained will still be dependent on both patient physiological status and culture system. In addition, to use a cell therapy approach in orthopedics, large cell numbers will be required and, as a result, knowledge of the factors affecting the growth kinetics of these cells is needed. In the present study we investigated the effect of dexamethasone stimulation on the in vivo osteogenic potential of HBMSCs. After a proliferation step, the cells were seeded and cultured on porous calcium phosphate scaffolds for 1 week, and then subcutaneously implanted in nude mice for 6 weeks, in order to evaluate their in vivo bone-forming ability. Furthermore, the effect of donor age on the proliferation rate of the cultures and their ability to induce in vivo bone formation was studied. In 67% of the assayed patients (8 of 12), the presence of dexamethasone in culture was not required to obtain in vivo bone tissue formation. However, in cultures without bone-forming ability or with a low degree of osteogenesis, dexamethasone increased the bone-forming capacity of the cells. During cellular proliferation, a significant age-related decrease was observed in the growth rate of cells from donors older than 50 years as compared with younger donors. With regard to the effect of donor age on in vivo bone formation, HBMSCs from several donors in all age groups proved to possess in vivo osteogenic potential, indicating that the use of cell therapy in the repair of bone defects can be applicable irrespective of patient age. However, the increase in donor age significantly decreased the frequency of cases in which bone formation was observed.

The use of cell therapies in bone reconstruction has been the subject of extensive research. It is known that human bone marrow stromal cell (HBMSC) cultures contain a population of progenitor cells capable of differentiation towards the osteogenic lineage. In the present study, the correlation between the in vitro osteogenic potential of HBMSC cultures and their capacity to form bone in vivo was investigated. HBMSC cultures were established from 14 different donors. Fourth passage cells were examined for the expression of alkaline phosphatase (ALP), procollagen I (PCI) and osteopontin (OP), through flow cytometry and the effect of the osteogenic differentiation factor dexamethasone (Dex) on this expression was evaluated. In addition, the capacity of the cultures to induce in vivo bone formation was analysed by culturing the cells on porous hydroxyapatite (HA) scaffolds followed by subcutaneous implantation of these constructs in nude mice. Results showed expression of PCI, OP and ALP in all cultures, irrespective of the presence of Dex in the culture medium. Dex failed to have a significant effect on the expression of PCI and OP but it induced a consistent increase in the relative amount of cells expressing ALP. Nevertheless, although in vitro testing clearly indicated osteogenic potential in all cultures, HBMSC from six of the 14 tested donors did not form bone in vivo. The results, therefore, demonstrate that neither the expression of PCI, OP and ALP nor the absolute increase in Dex-stimulated ALP expression can as yet be used as predictive markers for in vivo bone formation by HBMSC. However, preliminary data indicate that not the absolute, but the relative increase in the percentage of ALP expressing cells caused by Dex stimulation may be related to the ability of the HBMSC to form bone.