There are approximately 2,500 Adult Mesenchymal Stem Cells per mL of Bone Marrow Concentrate on average according to the work of Dr. Phillipe Hernigou in Paris. It leads me to conclude that unconcentrated bone marrow aspirate doesn’t have enough MSCs per unit volume to contribute to a therapeutic potential in a consistent manner. The way MSC counts are done is by assaying Colony Forming Unit-Fibroblasts (CFU-F) from samples taken from the BMC at the time of an arthritic intervention. This is a retrospective look as the CFU-F assay is done by culturing for seven to ten days with a sample of the injectate at the time the intervention with concentrated bone marrow is completed.
Is this too much information? Many patients ask me relevant questions so I thought I would try to clarify. Why don’t I just inject bone marrow concentrate into a vein? Mice were injected in a laboratory using both a vein or an artery and the cells were tracked over time. When using a vein, a significant entrapment of cells was found in the lungs. When using an artery, the entrapment of cells was at a site of injury or disease but not in a joint. Finally, delivering cells directly to the arthritic joint kick starts the repair process offering the best possible outcome.
Why don’t I use or even recommend cultured cells? If cultured cells are used, this procedure goes beyond the realm of minimal manipulation and proves contrary to FDA guidelines. In addition, culturing cells can potentially alter the properties of the cells. It is also important to remember that Mesenchymal Stem Cells have better homing capabilities, compared to their culture-expanded counterparts.
Why is Bone Marrow Concentrate so much more effective than Platelet Rich Plasma? Recent publications have documented that interleukin 1 receptor antagonist protein (IL1-ra), an anti-inflammatory protein is over 22 times higher in BMC than PRP. Additionally, the immune capacity of bone marrow is such that infection is rare when Bone Marrow Concentrate is used.
We are dedicated to providing patients the best possible care in regenerative medicine. The laboratory I use is registered with the FDA. The process I employ has cleared two FDA audits with no issues. Based on the platform I employ, we offer our patients customized interventions, since each preparation is analyzed for platelets, red blood cells and white blood cells (among 27 parameters) which I review prior to injection. The knowledge allows me to make adjustments based on almost five years of experience in Interventional Orthopedics and 37 years as a joint replacement surgeon. No other Regenerative Medical program or practice may make this claim.
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