Abstract
Use of mesenchymal stem cells from bone marrow has gained significant popularity. The iliac crest has been determined to be an effective site for harvesting mesenchymal stem cells. Review of the literature revealed that multiple techniques are used to harvest bone marrow aspirate from the iliac crest, but the descriptions are based on the experience of various authors as opposed to studied anatomy. A safe, reliable, and reproducible method for aspiration has yet to be studied and described.
Connective tissue progenitors (CTPs) from native bone marrow (BM) or their culture-expanded progeny, often referred to as mesenchymal stem/stromal cells, represent a promising strategy for treatment of cartilage injuries and other problems of bone consolidation. However, the cartilage regeneration capacity of these cells remains unpredictable because of cell heterogeneity.
Our experience concerning the aspiration of mesenchymal stem cells from the iliac crest and their use in patients suffering from chondropathy has given good results, with the use of the sepax2 method for processing and preparation of mesenchymal stem cells extracted from the iliac crest.
Similar content being viewed by others
Bibliografia
Connolly JF, Shindell R (1986) Percutaneous marrow injection for an ununited tibia. Nebr Med J 71(4):105–107
Connolly JF, Guse R, Tiedeman J, Dehne R (1989) Autologous marrow injection for delayed unions of the tibia: a preliminary report. J Orthop Trauma 3(4):276–282
Connolly JF, Guse R, Tiedeman J, Dehne R (1991) Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res 266:259–270
Fayaz HC, Giannoudis PV, Vrahas MS et al. (2011) The role of stem cells in fracture healing and nonunion. Int Orthop 35(11):1587–1597
Akram M, Irshad M, Farooqi FM et al. (2014) Role of injecting bone marrow aspiration injection in treating delayed union and non-union. J Pak Med Assoc 64(12 Suppl. 2):S154–S158
Connolly JF (1995) Injectable bone marrow preparations to stimulate osteogenic repair. Clin Orthop Relat Res 313:8–18
Connolly JF (1998) Clinical use of marrow osteoprogenitor cells to stimulate osteogenesis. Clin Orthop Relat Res 355(Suppl):S257–S266
Gurkan UA, Akkus O (2008) The mechanical environment of bone marrow: a review. Ann Biomed Eng 36(12):1978–1991
Hernigou P, Beaujean F (2002) Treatment of osteonecrosis with autologous bone marrow grafting. Clin Orthop Relat Res 405:14–23
Gangji V, Hauzeur JP (2005) Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. Surgical technique. J Bone Jt Surg, Am 87(Pt 1 Suppl 1):106–112
Juopperi TA, Schuler W, Yuan X et al. (2007) Isolation of bone marrow-derived stem cells using density-gradient separation. Exp Hematol 35(2):335–341
Sakai S, Mishima H, Ishii T et al. (2008) Concentration of bone marrow aspirate for osteogenic repair using simple centrifugal methods. Acta Orthop 79(3):445–448
Ahmadbeigi N, Soleimani M, Babaeijandaghi F et al. (2012) The aggregate nature of human mesenchymal stromal cells in native bone marrow. Cytotherapy 14(8):917–924
Caplan AI (2007) Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Physiol 213(2):341–347
Hernigou P, Trousselier M, Roubineau F et al. (2016) Stem cell therapy for the treatment of hip osteonecrosis: a 30-year review of progress. Clin Orthop Surg 8(1):1–8
Harrell DB, Caradonna E, Mazzucco L et al. (2015) Non-hematopoietic essential functions of bone marrow cells: a review of scientific and clinical literature and rationale for treating bone defects. Orthop Rev 7(4):5691
Milligan DW, Howard MR, Judd A (1987) Premedication with lorazepam before bone marrow biopsy. J Clin Pathol 40(6):696–698
Tanasale B, Kits J, Kluin PM et al. (2013) Pain and anxiety during bone marrow biopsy. Pain Manag Nurs 14(4):310–317
Vanhelleputte P, Nijs K, Delforge M et al. (2003) Pain during bone marrow aspiration: prevalence and prevention. J Pain Symptom Manage 26(3):860–866
Malempati S, Joshi S, Lai S et al. (2009) Videos in clinical medicine. Bone marrow aspiration and biopsy. N Engl J Med 361(15):e28
Salem P, Wolverson MK, Reimers HJ, Kudva GC (2003) Complications of bone marrow biopsy. Br J Haematol 121(6):821
Kahn B (1979) Superior gluteal artery laceration, a complication of iliac bone graft surgery. Clin Orthop Relat Res 140:204–207
Massey EW (1980) Meralgia paresthetica secondary to trauma of bone graft. J Trauma 20(4):342–343
Smith SE, Delee JC, Ramamurthy S (1984) Ilioinguinal neuralgia following iliac bone-grafting. Report of two cases and review of the literature. J Bone Jt Surg, Am 66(8):1306–1308
Weikel AM, Habal MB (1977) Meralgia paresthetica: a complication of iliac bone procurement. Plast Reconstr Surg 60(4):572–574
Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Jt Surg, Am 46:1615–1646
Hernigou P, Poignard A, Manicom O et al. (2005) The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone. J Bone Jt Surg, Br 87(7):896–902
Okumachi E, Lee SY, Niikura T et al. (2015) Comparative analysis of rat mesenchymal stem cells derived from slow and fast skeletal muscle in vitro. Int Orthop 39:569–576
De Bari C, Dell’Accio F, Luyten FP (2001) Human periosteum-derived cells maintain phenotypic stability and chondrogenic potential throughout expansion regardless of donor age. Arthritis Rheum 44:85–95
De Bari C, Dell’Accio F, Vandenabeele F et al. (2003) Skeletal muscle repair by adult human mesenchymal stem cells from synovial membrane. J Cell Biol 160:909–918
Volarevic V, Ljujic B, Stojkovic P et al. (2011) Human stem cell research and regenerative medicine present and future. Br Med Bull 99:155–168
Volarevic V, Al-Qahtani A, Arsenijevic N et al. (2010) Interleukin-1 receptor antagonist (IL-1Ra) and IL-1Ra producing mesenchymal stem cells as modulators of diabetogenesis. Autoimmunity 43:255–263
Dominici M, Le Blanc K, Mueller I et al. (2006) Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy 8:315–317
Kim JE, Lee SM, Kim SH et al. (2014) Effect of self-assembled peptide-mesenchymal stem cell complex on the progression of osteoarthritis in a rat model. Int J Nanomed 9:141–157
Murphy JM, Fink DJ, Hunziker EB, Barry FP (2003) Stem cell therapy in a caprine model of osteoarthritis. Arthritis Rheum 48:3464–3474
Li M, Luo X, Lv X et al. (2016) In vivo human adipose-derived mesenchymal stem cell tracking after intra-articular delivery in a rat osteoarthritis model. Stem Cell Res Ther 7:160
Lee KB, Hui JH, Song IC et al. (2007) Injectable mesenchymal stem cell therapy for large cartilage defects—a porcine model. Stem Cells 25:2964–2971
Frisbie DD, Stewart MC (2011) Cell-based therapies for equine joint disease. Vet Clin North Am Equine Pract 27:335–349
Black LL, Gaynor J, Gahring D et al. (2007) Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: a randomized, double-blinded, multicenter, controlled trial. Vet Ther 8:272–284
Black LL, Gaynor J, Adams C et al. (2008) Effect of intraarticular injection of autologous adipose-derived mesenchymal stem and regenerative cells on clinical signs of chronic osteoarthritis of the elbow joint in dogs. Vet Ther 9:192–200
Mokbel AN, El Tookhy OS, Shamaa AA et al. (2011) Homing and reparative effect of intra-articular injection of autologous mesenchymal stem cells in osteoarthritic animal model. BMC Musculoskelet Disord 12:259
Murakami S, Lefebvre V, de Crombrugghe B (2000) Potent inhibition of the master chondrogenic factor Sox9 gene by interleukin-1 and tumor necrosis factor-alpha. J Biol Chem 275:3687–3692
Orozco L, Munar A, Soler R et al. (2013) Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation 95:1535–1541
Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B (2016) Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients. Int J Rheum Dis 19:219–225
Centeno CJ, Al-Sayegh H, Freeman MD et al. (2016) A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. Int Orthop 40:1755–1765
Jo CH, Chai JW, Jeong EC et al. (2017) Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a 2-year follow-up study. Am J Sports Med 45(12):2774–2783
Lamo-Espinosa JM, Mora G, Blanco JF et al. (2018) Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: long-term follow up of a multicenter randomized controlled clinical trial (phase I/II). J Transl Me 16:213
Bastos R, Mathias M, Andrade R et al. (2018) Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 26(11):3342–3350
Al-Najar M, Khalil H, Al-Ajlouni J et al. (2017) Intra-articular injection of expanded autologous bone marrow mesenchymal cells in moderate and severe knee osteoarthritis is safe: a phase I/II study. J Orthop Surg Res 12(1):190
Iijima H, Isho T, Kuroki H et al. (2018) Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: a meta-analysis toward the establishment of effective regenerative rehabilitation. NPJ Regen Med 3:15
Kim SH, Ha CW, Park YB et al. (2019) Intra-articular injection of mesenchymal stem cells for clinical outcomes and cartilage repair in osteoarthritis of the knee: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 139(7):971–980
Lopa S, Colombini A, Moretti M, De Girolamo L (2018) Injective mesenchymal stem cell-based treatments for knee osteoarthritis: from mechanisms of action to current clinical evidences. Knee Surg Sports Traumatol Arthrosc 27(6):2003–2020
Shin YS, Yoon JR, Kim HS, Lee SH (2018) Intra-articular injection of bone marrow-derived mesenchymal stem cells leading to better clinical outcomes without difference in MRI outcomes from baseline in patients with knee osteoarthritis. Knee Surg Relat Res 30(3):206–214
Hikita A (2018) Cartilage/chondrocyte research and osteoarthritis. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis. Clin Calcium 28(6):825–831
Cotter EJ, Wang KC, Yanke AB, Chubinskaya S (2018) Bone marrow aspirate concentrate for cartilage defects of the knee: from bench to bedside evidence. Cartilage 9(2):161–170
Chahla J, Mannava S, Cinque ME et al. (2017) Bone marrow aspirate concentrate harvesting and processing technique. Arthrosc Tech 6(2):e441–e445
Hernigou J, Alves A, Homma Y et al. (2014) Anatomy of theilium for bone marrow aspiration: map of sectors and implication for safe trocar placement. Int Orthop 38(12):2585–2590
Hernigou J, Picard L, Alves A et al. (2014) Understanding bone safety zones during bone marrow aspiration from the iliac crest: the sector rule. Int Orthop 38(11):2377–2384
Pierini M, Di Bella C, Dozza B et al. (2013) The posterior iliac crest outperforms the anterior iliac crest when obtaining mesenchymal stem-cells from bone marrow. J Bone Jt Surg, Am 95(12):1101–1107
Shapiro SA, Arthurs JR (2017) Bone marrow aspiration for regenerative orthopedic intervention: technique with ultrasound guidance for needle placement. Regen Med 12(8):917–928
Oliver K, Awan T, Bayes M (2017) Single-versus multiple-site harvesting techniques for bone marrow concentrate: evaluation of aspirate quality and pain. Orthop J Sports Med 5(8):2325967117724398
Berumen-Nafarrate E, Vega-Najera C, Leal-Contreras C, Leal-Berumen I (2013) Gluteal compartment syndrome following an iliac bone marrow aspiration. Case Rep Orthop 2013:812172
Rahyussalim AJ, Kurniawati T, Rukmana A (2016) Mycobacterium tuberculosis contaminant risk on bone marrow aspiration material from iliac bone patients with active tuberculous spondylitis. BioMed Res Int 2016:3852940
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflitto di interesse
Gli autori A. Pellegrino, N. Tammaro, M. Conte, L. Romano e S. Misso dichiarano di non aver alcun conflitto d’interesse.
Consenso informato e conformità agli standard etici
Tutte le procedure descritte nello studio e che hanno coinvolto essere umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.
Human and animal rights
L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.
Rights and permissions
About this article
Cite this article
Pellegrino, A., Tammaro, N., Conte, M. et al. Il prelievo delle cellule staminali mesenchimali dalla cresta iliaca. LO SCALPELLO 33, 243–252 (2019). https://doi.org/10.1007/s11639-019-00335-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11639-019-00335-x