Clinical outcome of autologous bone marrow aspirates concentrate (BMAC) injection in degenerative arthritis of the knee

Kim, Jae-Do; Lee, Gun Woo; Jung, Gu Hee; Kim, Cheung Kue; Kim, Tae-Hun; Park, Jin Hyung; Sook, Seong; You, Young-Bin

doi:10.1007/s00590-013-1393-9

Cited by 163 publications

(156 citation statements)

References 26 publications

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“…[15][16][17][18] However, other studies have reported using volumes as low as 30 mL 19,20 and as high as 120 mL. 21 In the present Technical Note, 60 mL of BMAC was aspirated and later processed. In regard to BMAC processing, studies have used centrifugation, followed by BMAC activation with batroxobin enzyme.…”

Section: Application Of Bmacmentioning

confidence: 91%

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Chahla

Mannava

Cinque

et al. 2017

Arthroscopy Techniques

138

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Bone marrow obtained by iliac crest aspiration is a common source for harvesting mesenchymal stem cells, other progenitor cells, and associated cytokine/growth factors. Recent studies have reported good to excellent outcomes with the use of bone marrow aspirate concentrate (BMAC) for pain relief in the treatment of focal chondral lesions and osteoarthritis of the knee. However, the harvesting and processing technique are crucial to achieve satisfactory results. Several studies have examined outcomes after BMAC injection, with encouraging results, but there is a lack of consensus in terms of the frequency of injection, the amount of BMAC that is injected, and the timing of BMAC injections. The purpose of this Technical Note was to describe a standardized bone marrow aspiration harvesting technique and processing method. Bone marrow obtained by iliac crest aspiration is a common source for harvesting mesenchymal stem cells, other progenitor cells, and associated cytokine/ growth factors. Because the use of bone marrow aspirate concentrate (BMAC) is currently approved by the United States Food and Drug Administration, it represents one of the few means for acquiring progenitor cells and growth factors for subsequent injection.

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Section: Application Of Bmacmentioning

confidence: 91%

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Chahla

Mannava

Cinque

et al. 2017

Arthroscopy Techniques

138

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“…Application of marrow concentrates as a practical, singlestep approach to treat articular cartilage lesions is clinical reality to provide options that are less complex and invasive than those based on the implantation of isolated progenitor cells, 10,11,43 but the quality of the repair tissue generated with such treatments still remains inferior to that of the original hyaline cartilage. This issue might be addressed by genetically modifying the concentrates to improve their chondroregenerative capabilities.…”

Section: Discussionmentioning

confidence: 99%

“…Several therapeutic options are available to treat articular cartilage defects, including autologous chondrocyte implantation and marrow-stimulating techniques, 2-5 but these procedures generally lead to the production of a fibrocartilaginous repair tissue (type-I collagen) of lesser quality than the natural hyaline cartilage (type-II collagen, proteoglycans) that does not integrate well with the surrounding unaffected cartilage, and cannot withstand mechanical stress. [5][6][7] Such issues have been addressed, at least in part, by elaborating progenitor cell-based therapies for cartilage repair by the administration of isolated chondroregenerative cells like bone marrow-derived mesenchymal stem cells (MSCs) 5,8,9 or of marrow concentrates containing MSCs among various cell subpopulations (hematopoietic cells, fibroblasts) as a single-step, convenient therapeutic procedure [10][11][12] due to the extensive, specific ability of MSCs to undergo competent chondrogenic differentiation in this environment. [13][14][15] Nevertheless, even though the clinical outcomes of such trials have been encouraging, complete reconstruction of an original cartilaginous surface in treated patients has not been reported to date, demonstrating the clear need for improved protocols.…”

Section: Introductionmentioning

confidence: 99%

Chondrogenic Differentiation Processes in Human Bone Marrow Aspirates upon rAAV-Mediated Gene Transfer and Overexpression of the Insulin-Like Growth Factor I

Frisch

Rey‐Rico

Venkatesan

et al. 2015

Tissue Engineering Part A

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Direct therapeutic gene transfer in marrow concentrates is an attractive strategy to conveniently enhance the chondrogenic differentiation processes as a means to improve the healing response of damaged articular cartilage upon reimplantation in sites of injury. In the present study, we evaluated the ability of the clinically adapted recombinant adeno-associated virus (rAAV) vectors to mediate overexpression of the insulin-like growth factor I (IGF-I) in human bone marrow aspirates that may modulate the proliferative, anabolic activities, and chondrogenic differentiation potential in such samples in vitro. The results demonstrate that successful, significant rAAV-mediated IGF-I gene transfer and expression were achieved in transduced aspirates (up to 105.9 -35.1 pg rhIGF-I/mg total proteins) over time (21 days) at very high levels (*80% of cells expressing the candidate IGF-I transgene), leading to increased levels of proliferation, matrix synthesis, and chondrogenic differentiation over time compared with the control (lacZ) condition. Treatment with the candidate IGF-I vector also stimulated the hypertrophic and osteogenic differentiation processes in the aspirates, suggesting that the regulation of IGF-I expression through rAAV will be a prerequisite for future translation of the approach in vivo. However, these findings show the possible benefits of this vector class to directly modify marrow concentrates as a convenient tool for strategies that aim at improving the repair of articular cartilage lesions.

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“…Four systematic reviews (35)(36)(37)(38) were also excluded. An assessment of the remaining 18 studies revealed that 10 used a single-arm prospective design (18)(19)(20)(39)(40)(41)(42)(43)(44)(45), four used quasi-experimental trials (46)(47)(48)(49) and four used RCT (50-53) (Table I). A total of 565 participants (226 males and 339 females) were included from the 18 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis

Cui

Wang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. To assess the clinical efficacy and safety of mesenchymal stem cell (MSC) treatment for osteoarthritis of the knee (KOA), a systematic electronic literature search was performed on PubMed, EMBASE and Web of Science. Studies published in English from the earliest record to December 2014 were searched using the following keywords: Cartilage defect, cartilage repair, osteoarthritis, KOA, stem cells, MSCs, bone marrow concentrate (BMC), adipose-derived mesenchymal stem cells, synovial-derived mesenchymal stem cells and peripheral blood-derived mesenchymal stem cells. The effect sizes of selected studies were determined by extracting pain scores from the visual analog scale and functional changes from International Knee Documentation Committee and Lysholm and Western Ontario and McMaster Universities Osteoarthritis Index before and after MSCs or reference treatments at 3, 6, 12, and 24 months. The factors were analyzed and the outcomes were modified after comparing the MSC group pooled values with the pretreatment baseline or between different treatment arms. A systematic search identified 18 clinical trials on this topic, including 10 single-arm prospective studies, four quasi-experimental studies and four randomized controlled trials that used BMCs to treat 565 patients with KOA in total. MSC treatment in patients with KOA showed continual efficacy for 24 months compared with their pretreatment condition. Effectiveness of MSCs was improved at 12 and 24 months post-treatment, compared with at 3 and 6 months. No dose-responsive association in the MSCs numbers was demonstrated. However, patients with arthroscopic debridement, activation agent or lower degrees of Kellgren-Lawrence grade achieved improved outcomes. MSC application ameliorated the overall outcomes of patients with KOA, including pain relief and functional improvement from basal evaluations, particularly at 12 and 24 months after follow-up.

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Clinical outcome of autologous bone marrow aspirates concentrate (BMAC) injection in degenerative arthritis of the knee

Abstract: BMAC injection significantly improved both knee pain and functions in the patients with degenerative arthritis of knee. Also, the injection would be more effective in early to moderate phases.

Cited by 163 publications

References 26 publications

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Bone Marrow Aspirate Concentrate Harvesting and Processing Technique

Chondrogenic Differentiation Processes in Human Bone Marrow Aspirates upon rAAV-Mediated Gene Transfer and Overexpression of the Insulin-Like Growth Factor I

Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis

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