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Bone Marrow as a Source of Cells for Musculoskeletal Cellular Therapies

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Abstract

Bone marrow provides an invaluable source of cells for cell-based therapies in the orthopedic setting. Bone marrow aspirates (BMAs) contain a diversity of stem and progenitor cell systems, including connective tissue progenitors (CTPs), hematopoietic stem and progenitor cells (HSCs), and progenitors of vascular endothelium (EPCs). Bone marrow can be harvested by percutaneous minimally invasive aspiration or excavation with minimal morbidity. With appropriate anticoagulation, this provides a cell suspension that can be readily processed through a variety of methods.

BMA has a long clinical history as a means of supplementing areas of bone healing as a form of autologous bone grafts, with or without processing, presumably repeating deficient populations of osteoblastic connective tissue progenitors. Processed marrow can be provided as a point of care product. However, the specific indications and optimal processing methods and composition for bone marrow-derived cells for specific indications have yet to be determined. Processed marrow can also provide the starting materials needed for in vitro culture expansion and fabrication of a diversity of cellular and cell-derived products.

BMA is most frequently performed from the iliac crest. Yield of CTPs and other marrow-derived cells can be strongly influenced by patient selection, aspiration site, aspiration technique, and subsequent processing. Various processing methods have been developed for the concentration of BMA including density separation, selective retention, magnetic separation, and fluorescence-activated cell sorting (FACS).

Consensus standards are needed for analysis and reporting on BMA and BMA-derived product composition and the efficacy of processing methods (yield, concentration, prevalence, etc.) and will accelerate the development and comparison of novel treatments. Linking clinical data (demographics, diagnosis, disease stage, comorbidities, and functional status) and BMA harvest and composition data, together with rigorously documented clinical outcomes, is a key step in this process.

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Authors and Affiliations

  1. Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    George F. Muschler & Nicolas S. Piuzzi

  2. Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    Hannah Simmons & Venkata Mantripragada

Authors
  1. George F. Muschler
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  2. Hannah Simmons
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  3. Venkata Mantripragada
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  4. Nicolas S. Piuzzi
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Corresponding author

Correspondence to George F. Muschler .

Editor information

Editors and Affiliations

  1. Rizzoli Orthopaedic Institute, Bologna, Italy

    Giuseppe Filardo

  2. Orthopaedic & Sports Medicine Group, Santa Monica Orthopaedic & Sports Medicine, Santa Monica, CA, USA

    Bert R. Mandelbaum

  3. Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    George F. Muschler

  4. Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

  5. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

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Muschler, G.F., Simmons, H., Mantripragada, V., Piuzzi, N.S. (2022). Bone Marrow as a Source of Cells for Musculoskeletal Cellular Therapies. In: Filardo, G., Mandelbaum, B.R., Muschler, G.F., Rodeo, S.A., Nakamura, N. (eds) Orthobiologics. Springer, Cham. https://doi.org/10.1007/978-3-030-84744-9_2

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  • DOI: https://doi.org/10.1007/978-3-030-84744-9_2

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