Repair of long-bone pseudoarthrosis with autologous bone marrow mononuclear cells combined with allogenic bone graft

Mesenchymal stem cells derived from vertebrae (vMSCs) show best biological properties

“…Preclinical and clinical results show that, independently from the method used to deliver MSCs into the musculoskeletal system, the direct application of these cells on a loss of bone substance stimulates bone regeneration [4]. Recently, FernandezBances et al [18] treated seven patients with pseudoarthrosis of a long bone through introduction of MSCs derived from iliac crest bone marrow of the same patient supported by allogenic cancellous bone graft (from the local bone bank), obtaining consolidation in all the cases.…”

Inflammation, fracture and bone repair

“…One novel approach is to modulate macrophage phenotypes in the healing tissues, thereby affecting the pro-inflammatory and healing events of bone repair. Several reports have studied the use of autologous bone marrow concentrate of mononuclear cells to facilitate fracture healing [152, 153]. Besides the transference of MSCs and endothelial stem cells (ESCs), this concentrate includes the transference of multi-potent and self-renewal HSCs, capable of differentiating into all hematopoietic cell types, including macrophage precursors [152–154].…”

“…Several reports have studied the use of autologous bone marrow concentrate of mononuclear cells to facilitate fracture healing [152, 153]. Besides the transference of MSCs and endothelial stem cells (ESCs), this concentrate includes the transference of multi-potent and self-renewal HSCs, capable of differentiating into all hematopoietic cell types, including macrophage precursors [152–154]. Thus, bone marrow concentrate optimizes two of the most desirable clinical outcomes regarding the treatment of non-union fractures: neo-osteogenesis and neo-angiogenesis [155, 156].…”

“…Moreover, MSCs exhibit immunomodulatory effects, promoting the alternative activation of macrophages toward the pro-remodeling M2-subset [115, 188]. The use of concentrate of bone marrow mononuclear cells associated with biomaterials to treat pseudoarthroses and optimize bone repair has been reported [152]. Cell based therapies using ex-vivo polarized M2-macrophages to promote tissue repair has shown promise in models of ischemia and multiple sclerosis [189].…”

Application of stem cells in orthopaedic conditions: what is the current evidence?

“…The application by these investigators has been on non-union of long bones especially tibia and also for diagnosed cases of pseudoarthrosis. Fernandez et al 21 studied the effects of autologous bone marrow mononuclear cells combined with allogenic bone graft for repair of pseudo-arthrosis of long bones. Bone marrow mononuclear cells (BMMNCs) comprise of progenitor and stem cells with pro-angiogenic and pro-osteogenic properties.…”