Abstract
ObjectivesReconstruction of long segmental bone defects is demanding for patients and surgeons, and associated with long-term treatment periods and substantial complication rates in addition to high costs. While defects up to 4–5 cm length might be filled up with autologous bone graft, heterologous bone from cadavers, or artificial bone graft substitutes, current options to reconstruct bone defects greater than 5 cm consist of either vascularized free bone transfers, the Masquelet technique or the Ilizarov distraction osteogenesis. Alternatively, autologous cell transplantation is an encouraging treatment option for large bone defects as it eliminates problems such as limited autologous bone availability, allogenic bone immunogenicity, and donor-site morbidity, and might be used for stabilizing loose alloplastic implants.MethodsThe authors show different cell therapies without expansion in culture, with ex vivo expansion and cell therapy in local bone defects, bone healing and osteonecrosis. Different kinds of cells and scaffolds investigated in our group as well as in vivo transfer studies and BMC used in clinical phase I and IIa clinical trials of our group are shown.ResultsOur research history demonstrated the great potential of various stem cell species to support bone defect healing. It was clearly shown that the combination of different cell types is superior to approaches using single cell types. We further demonstrate that it is feasible to translate preclinically developed protocols from in vitro to in vivo experiments and follow positive convincing results into a clinical setting to use autologous stem cells to support bone healing.
Highlights
Reconstruction of long segmental bone defects is demanding for patients and surgeons, and associated with longterm treatment periods and substantial complication rates in addition to high costs
Autologous Bone marrow aspiration concentrate (BMAC) were combined with platelet-rich plasma (PRP) injection at the osteotomy site in distraction osteogenesis of the tibia
The treatment group showed faster healing at each cortex and full weight bearing was permitted earlier in the treatment group than in the control group, the effect size was small Percutaneous BMAC injection was combined with either demineralized bone matrix (DBM) and/or rhBMP-2 in delayed union or non-union patients
Summary
Reconstruction of long segmental bone defects is demanding for patients and surgeons, and associated with longterm treatment periods and substantial complication rates in addition to high costs. Large bone defects result from major trauma, surgical excision of tumors, debridement after posttraumatic septic non-unions, osteitis or explantation of endoprothesis. Autologous cell transplantation is an encouraging treatment option for large bone defects as it eliminates problems such as limited autologous bone availability, allogenic bone immunogenicity, and donor-site morbidity, and might be used for stabilizing loose alloplastic implants [4, 5]. Systematic clinical studies applying autologous bone cell transplantation have barely performed. In contrast to the extensive in vitro and animal experiment data, there are only few studies that show clinical results for cell therapy treatments to regenerate bone. There are two clinical application forms of cell therapies to regenerate bone. Various health law-related consequences emerge for the manufacturer and the orthopedic surgeon in attendance
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