Bone Marrow Concentrate Therapy
Bone marrow concentrate has been used in surgery and wound care for the last 30 years in order to enhance healing of wounds and solidify fractures and spine fusions. Based on extensive research, there is scientific evidence supporting the presence of specific cells which are the precursors to bone, muscle, tendon, cartilage, etc. In the past, scientists had the point of view that a person was born with a finite number of cells. Due to the scientific process, we now accept that we can plant precursor cells in areas with the intention of growing new cells in that area. These cells are committed to regenerative repair and can even change the immune system. The cell is called Mesenchymal Stem Cell (MSC).
How do these cells help injury?
Mesenchymal stem cells (MSC) become activated around injured tissue, until then they lay dormant. MSC secrete a large number of biologic agents that will inhibit the over active immune system, inhibit cell death, inhibit scar formation, and release a large number of immune modulators which assist in the repair process.
1. Anitua E Plasma rich in growth factors: Preliminary results of use in the preparation of future sites for implants. Int J Oral Maxillofac Implants 1999; 14:529-535.
2. Connnolly JF, Guse R, Tiedeman J, Dehne R. Autologous marrow injection as a substitute for operative grafting of tibial nonunions. Clin Orthop Relat Res 1991;266:259-270
3. Connolly JF,Clinical useof marrow osteoprogenitor cells to stimulate osteogenesis. Clin Orthop Relat Res 1998;355(suppl):S257-S266.
Why use bone marrow cells?
Most people who are interested in stem cell therapy have already had some exposure. The natural question is why should we use bone marrow instead of the pre-prepared solutions which are readily available in the biologic market? After careful consideration for sterility and effectiveness, Dr. Bhandari has chosen to continue the use of bone marrow concentrate as the source of MSC.
Many studies have been performed to evaluate the number of MSC in various tissues. The table below illustrates that the largest amount of MSC per milliliter of fluid or tissue is in fat cells. Unfortunately, due to unscrupulous behavior of some stem cell clinics, the ability to harvest these cells from fat has been deemed illegal. The next highest supply of MSC is in fact the bone marrow.
Another concern of stem cell is the underlying risk of cancer. Each person has their own genetic code and we have the ability to start and stop the replication of cells. In short, your body knows when and how to stop the replication process. The long term effect of injecting another person's cells and growth factors are unknown. Dr. Bhandari believes in the hippocratic oath and firmly believes that injecting the person's own cells is a safe and effective method.
How are these cells obtained and processed?
Since MSC injections are considered experimental and not classified as a drug, it is vital as a consumer of this procedure to know how these cells are obtained. The drugs which you consume are guaranteed by the manufacturer to have a minimum and maximum of active ingredient so that whether you take a tablet from one container or another, the effect should be the same. This is not true of any biologic substance whether obtained from your body or from a lab. So Dr. Bhandari feels that it is imperative to follow established guidelines when harvesting MSC from bone marrow so that the maximum number of MSC are obtained. At our center, Dr. Bhandari follows the same method of harvesting as the father of regenerative medicine, Dr. Hernigou.
Another fact, often over looked by the consumer, is the method of concentration of the bone marrow aspirate. Scientific evidence agrees that it is not the quality of the cells which is important as much as the number of cells obtained. As we age, the quality and over all number of MSCs decrease. However, studies show that by delivering a high concentration of MSCs to the tissue, we can rectify this shortfall. Dr. Bhandari uses harvesting kits from companies who are committed to regenerative medicine and who are able to provide reliable studies which prove high concentration of cells in the final solution.
GO FOR EVENING WALKS AGAIN
The patient presented with chronic knee pain which had not improved despite weight loss, anti-inflammatory medication, physical therapy, and numerous injections. She could not stand or walk for long periods of time. The MRI showed significant deterioration of the cartilage of the knee. The patient underwent a bone marrow injection into the knee and now reports almost 100% relief in pain and complete return to function.
A Morning Without Pain
The patient reported pain with standing and walking. His pain would worsen if he would sit for long periods of time. The MRI of the spine showed degenerative disc disease along with arthritis. With a combination of regenerative medicine and treatment for arthritis, he was able to almost eliminate his back pain.