|Example of bone marrow aspirate concentrate machine.||Adipose tissue-derived stem cell differentiation.|
Bone marrow has been studied over many years and is known to contain these adult stem cells. Concentration of the bone marrow is an important element of efficacy and there are FDA approved devices which concentrate the bone marrow into what is called “Bone Marrow Aspirate Concentrate” (BMAC). This autologous bone marrow aspirate contains not only mesenchymal stem cells but also accessory cells that support angiogenesis and vasculogenesis by producing growth factors and cytokines. There is increasing evidence that combined use of bone marrow aspirate and PRP show equivalence to autologous bone grafting. BMAC has also been shown to be a safe and effective treatment for tibial nonunion, metatarsal nonunions and Jones fracture, osteonecrosis of the hip, osteochondral defect repair, and limb ischemia. Results of a huge five year study in India for non-reconstructable critical limb ischemia demonstrated that BMAC provided an amputation-free survival of 90%, with pain reduction of over 90%. Other musculoskeletal applications also exist with more studies planned.
Human adipose tissue has been shown to be an abundant and rich source of adult stem cells with a population of cells that possess extensive proliferative capacity, and the ability to differentiate into multiple cell lineages. Most people do not mind giving up a little fat and, in fact, many electively undergo liposuction procedures, which yield large volumes of useable adipose tissue. Adipose-derived stem/stromal cells can differentiate to ligaments, tendon, muscle, cartilage, bone or fat. Fat grafting has been popular in cosmetic procedures for many years and this lipoaspirate is now being used in musculoskeletal medicine-either with or without PRP-to create a gel matrix or bioactive scafford to hold the essential “inflammatory boost” in a joint area. Adipose derived stem/stromal cells are similar but not identical to bone marrow cells.
Adipose derived cells have been used with PRP and/or BMAC in the treatment of many musculoskeletal and vascular disorders. It is believed that the PRP fat graft is inducted by its environment to form the type of cell which surrounds it. For example, if it is placed with muscle cells it was differentiate into muscle and be incorporated there. Because of the increased simplicity of fat harvesting versus bone marrow aspiration, the use of autologous adipose tissue is gaining popularity for office use. Also, the yield of stem cells from adipose tissue is 500 to 1,000 times higher than with bone marrow.
In Biocellular Prolotherapy the formula then is autologous tissue either from adipose (ones’ own fat) and/or bone marrow and/or PRP. If the fat is used, this is called “Lipoaspirate Prolotherapy” because the method used to extract the fat is a type of liposuction. If the bone marrow is the formula, the term used is “Bone Marrow Prolotherapy”. Both are forms of Biocellular Prolotherapy. With Biocellular Prolotherapy cells are not manipulated, and no additives are used. The cells are taken from the same patient and put back in the same patient on the same day in the same procedure.
Advances in Regenerative Medicine
High-Density Platelet Rich Plasma and Stem Cell Prolotherapy for Musculoskeletal Pain
Stem Cell Prolotherapy in Regenerative Medicine
History, Theory and Protocols.
Regenerative Medicine in the Field of Pain Medicine
Prolotherapy, platelet-rich plasma therapy and stem cell therapy - theory and evidence.