Mesenchymal stem cell implantation in atrophic nonunion of the long bones

Abstract

ObjectivesTo explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone.MethodsTen patients with an atrophic nonunion of a long bone fracture were selectively divided into two groups. Five subjects in the treatment group were treated with the combination of 15 million autologous BM-MSCs, 5g/cm3 (HA) granules and internal fixation. Control subjects were treated with iliac crest autograft, 5g/cm3 HA granules and internal fixation. The outcomes measured were post-operative pain (visual analogue scale), level of functionality (LEFS and DASH), and radiograph assessment.ResultsPost-operative pain evaluation showed no significant differences between the two groups. The treatment group demonstrated faster initial radiographic and functional improvements. Statistically significant differences in functional scores were present during the first (p = 0.002), second (p = 0.005) and third (p = 0.01) month. Both groups achieved similar outcomes by the end of one-year follow-up. No immunologic or neoplastic side effects were reported.ConclusionsAll cases of nonunion of a long bone presented in this study were successfully treated using autologous BM-MSCs. The combination of autologous BM-MSCs and HA granules is a safe method for treating nonunion. Patients treated with BM-MSCs had faster initial radiographic and functional improvements. By the end of 12 months, both groups had similar outcomes.Cite this article: H.D. Ismail, P. Phedy, E. Kholinne, Y. P. Djaja, Y. Kusnadi, M. Merlina, N. D. Yulisa. Mesenchymal stem cell implantation in atrophic nonunion of the long bones: A translational study. Bone Joint Res 2016;5:287–293. DOI: 10.1302/2046-3758.57.2000587.

Combined treatment with extracorporeal shock‑wave therapy and bone marrow mesenchymal stem cell transplantation improves bone repair in a rabbit model of bone nonunion

“…Fracture and bone tissue damage are common and serious problems in the clinical setting (6). With the population aging, this type of problem is becoming increasingly prominent (23).…”

“…During the treatment process, many studies have detected that the majority of hypertrophic nonunion cases achieve bony union through compressive fixation; and atrophic nonunion is generally accompanied by bone defects (5). Bone marrow mesenchymal stem cell (BMMSC) implantation is not exposed and some bone nonunion can be healed (6). However, the mechanism underlying the reason that bone nonunion may be healed without direct treatment of the fracture site remains unclear.…”

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

“…The current literature demonstrates faster healing with greater than 94% union rate when using cBMA combined with allograft compared with conventional autologous cancellous bone graft[33]. Ismail et al[31] reported similar union rates and outcomes when comparing cBMA and iliac crest autograft. The benefits of cBMA as an adjunctive therapy has also been demonstrated in the treatment of upper extremity long bone nonunion.…”

Stammzellen in der Regenerativen Medizin – Translationale Hürden und Möglichkeiten zur Überwindung

“…Als neuer und vielversprechender Ansatz gilt das mechanische Anfrischen der Pseudarthrose und die anschließende Behandlung mit MSCs. Diese werden mit Trägersubstanzen wie Chitosan-oder Hydroxyapatit-fragmenten vermengt und in die Frakturregion eingebracht [81,82].…”