Abstract
BackgroundDuring joint replacement, surgical vacuum suction guarantees a sufficient overview on the situs. We assume high concentrations of mesenchymal stromal cells (MSCs) on surgical vacuum filters.We compared the in vitro proliferative and differentiation potency of cells from the following: (i) bone marrow (BM), (ii) cancellous bone (CB), (iii) vacuum filter (VF), and (iv) cell saver filtrate reservoir (SF) in 32 patients undergoing elective total hip replacement.MethodsMononuclear cells (MNC) were isolated, and cell proliferation and colony-forming units (CFU) were measured. Adherent cells were characterized by flow cytometry for MSC surface markers. Cells were incubated with osteogenic, adipogenic, and chondrogenic stimuli. Cells were cytochemically stained and osteoblastic expression (RUNX-2, ALP, and BMP-2) investigated via qPCR.ResultsDependent on the source, initial MNC amount as well as CFU number was significantly different whereas generation time did not vary significantly. CFU numbers from VF were superior to those from SR, BM, and CB. The resulting amount of MSC from the respective source was highest in the vacuum filter followed by reservoir, aspirate, and cancellous bone. Cells from all groups could be differentiated into the three mesenchymal lines demonstrating their stemness nature. However, gene expression of osteoblastic markers did not differ significantly between the groups.ConclusionWe conclude that surgical vacuum filters are able to concentrate tissue with relevant amounts of MSCs. A new potent source of autologous regeneration material with clinical significance is identified. Further clinical studies have to elucidate the regenerative potential of this material in an autologous setting.
Highlights
During joint replacement, surgical vacuum suction guarantees a sufficient overview on the situs
Yield of mononuclear cells The average weight of the different tissue samples harvested in 32 patients was as follows: bone marrow aspirate 3.4 g ± 1.9 g [0.5–9.1], cancellous bone 3.3 g ± 6.6 g [0.3–28.5], surgical vacuum filter clot 14.3 ± 6.0 g [7.8– 31.5], and cell saver reservoir 26.0 ± 14.3 g [9.3–69.1]
Regarding the amount of Mononuclear cells (MNC) per gram tissue, the highest MNC concentration was found in vacuum filter (VF), which was significantly higher than cancellous bone (CB) (p = 0.0096), bone marrow (BM) (p = 0.0007), and SR (p = 0.0005) (Fig. 2b)
Summary
Surgical vacuum suction guarantees a sufficient overview on the situs. We assume high concentrations of mesenchymal stromal cells (MSCs) on surgical vacuum filters. We compared the in vitro proliferative and differentiation potency of cells from the following: (i) bone marrow (BM), (ii) cancellous bone (CB), (iii) vacuum filter (VF), and (iv) cell saver filtrate reservoir (SF) in 32 patients undergoing elective total hip replacement. Besides regulation of the normal skeletal homeostasis including calcium-phosphate metabolism, hematopoiesis, and further immunological functions, the adult human bone marrow contains osteoprogenitor cells that play a crucial role in fracture healing and osteogenesis [1]. Clinical and experimental data suggest several different stimuli orchestrating the complex molecular interactions of bone healing. In total hip replacement, relevant amounts of the bone marrow leave the acetabulum and femoral canal during preparation procedures.
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