In recent years, there has been a growing interest in the use of biologic therapies for osteoarthritis and musculoskeletal injuries, such as platelet-rich plasma (PRP), microfragmented adipose tissue (MFAT) and bone marrow aspirate concentrate (BMAC). These therapies are based on the injection of autologous (from the same person) cells or substances that have regenerative and anti-inflammatory properties. Among these, BMAC has shown promising results in preclinical and clinical studies for the treatment of OA and other musculoskeletal problems.

 

Experimental data has shown that doctors can increase the amount of stem cells obtained in a bone marrow harvest by drawing smaller volumes from multiple sites. Typically we use 1 harvest sites at multiple depths and 10cc or less volume draws in order to maximize the number of stem cells we obtain in our same day procedures. Out technique has been peer reviewed, published, and separately validated.

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What is BMAC?

BMAC is a product obtained from the patient's own bone marrow, which is a rich source of stem cells and growth factors. Bone marrow is harvested from the iliac crest (hip bone) or the tibia (shin bone) using a special needle under local anesthesia. The bone marrow is then processed in a centrifuge to separate and concentrate the desired components, such as mesenchymal stem cells (MSCs), platelets, leukocytes, growth factors and plasma. The resulting BMAC is then injected into the affected joint or tissue under ultrasound or fluoroscopic guidance.

 

How does BMAC work?

BMAC has multiple mechanisms of action that can benefit patients with OA and musculoskeletal problems. One of the main components of BMAC is MSCs, which are multipotent stem cells that were thought to differentiate into various types of cells, such as cartilage, bone, muscle and tendon. However, it is now known that MSCs can also secrete anti-inflammatory and immunomodulatory molecules that can reduce pain and swelling in the joints, and co-ordinate anti-inflammatory processes in the body. Moreover, MSCs can stimulate the resident stem cells in the joint to enhance tissue repair and regeneration.

 

Another important component of BMAC is platelets, which are blood cells that contain numerous growth factors, such as platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-beta), vascular endothelial growth factor (VEGF) and insulin-like growth factor 1 (IGF-1). These growth factors can promote angiogenesis (new blood vessel formation), cell proliferation, migration and differentiation, matrix synthesis and remodeling, and wound healing.

 

Additionally, BMAC contains leukocytes (white blood cells) and plasma, which can provide antimicrobial and immunological protection to the joint. BMAC also contains a high concentration of interleukin-1 receptor antagonist (IL-1Ra), which is a natural inhibitor of interleukin-1 (IL-1), a pro-inflammatory cytokine that plays a key role in OA pathogenesis. IL-1Ra can block the binding of IL-1 to its receptor and prevent its deleterious effects on cartilage degradation, inflammation and pain.

 

The Role of Mesenchymal Stem Cells

MSCs are pivotal to the regenerative capabilities of BMAC. These cells are multipotent stromal cells that can differentiate into a variety of cell types, including bone cells (osteoblasts), cartilage cells (chondrocytes), and fat cells (adipocytes). What makes MSCs particularly valuable in regenerative medicine is their ability to self-renew and exhibit multi-lineage differentiation.

 

Dr. Arnold Caplan's Contributions

Dr. Arnold Caplan, often referred to as the "Father of Mesenchymal Stem Cells," made significant contributions to our understanding of MSCs. He coined the term "medicinal signaling cells" to highlight their role in modulating the immune system, inhibiting scar formation, and promoting tissue regeneration. His work laid the foundation for the therapeutic use of MSCs in treating a wide range of conditions, from osteoarthritis to spinal cord injuries.

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What are the benefits of BMAC?

BMAC has several advantages over other biologic therapies for OA and musculoskeletal problems. First, BMAC is autologous, meaning that it comes from the patient's own body, which reduces the risk of infection, rejection or allergic reaction. Second, BMAC is minimally invasive, requiring only a small amount of bone marrow aspiration and a single injection into the joint or tissue. Third, BMAC is cost-effective, as it does not require expensive laboratory processing or storage. Fourth, BMAC is versatile, as it can be used for various joints (knee, hip, shoulder, ankle) and tissues (tendon, ligament, muscle). Additionally, BMAC can be used as the source for intravenous (IV) stem cell therapy t aid in managing inflammatory conditions such as Rheumatoid arthritis and chronic inflammatory pain syndromes.

 

What are the evidence for BMAC?

Several preclinical studies have demonstrated the safety and efficacy of BMAC in animal models of OA and musculoskeletal injuries. For instance, BMAC injection improved cartilage regeneration , reduced synovial inflammation , increased tendon strength  and enhanced muscle healing  in different animal models.

 

Clinical studies have also shown positive results for BMAC in patients with OA and musculoskeletal problems. A recent systematic review  included 18 clinical studies with a total of 4626 patients who received intra-articular or subchondral injections of BMAC for OA or musculoskeletal disorders. The review found that BMAC was safe and effective in improving pain and function in most of the studies. However, the review highlighted the need for more rigorous and large-scale trials to confirm the benefits of BMAC.

 

One of the most recent and well-designed studies compared the outcomes of BMAC versus PRP injections in 39 patients with knee OA. The study found that BMAC was superior to PRP in reducing pain and improving function and quality of life at 12 months follow-up. The study also reported that BMAC induced a significant increase in IL-1Ra levels in the joint fluid, suggesting a possible mechanism of action for BMAC.

 

Conclusion

BMAC is a promising therapy for OA and musculoskeletal conditions, as it can harness the regenerative and anti-inflammatory potential of the patient's own bone marrow. BMAC has shown safety and effectiveness in preclinical and clinical studies, but more research is needed to optimize its use and compare it with other biologic therapies.

 

How to get started with BMAC therapy?

 

If you are interested in our BMAC therapy and want to find out if you are a good candidate, you can contact OrthoRegen® to schedule a consultation.  You can also visit our CONTACT PAGE to complete the new patient documentation, which will be reviewed by Dr Schiavo to see if we can help treat your condition.  OrthoRegen® will provide you with a comprehensive assessment and a personalised treatment plan that will help you achieve your health and wellness goals. 

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For further information on other services and treatments we provide, please head to OUR SERVICES page.