The composite of bone marrow concentrate and PRP as an alternative to autologous bone grafting.

Mohssen Hakimi,Ahmad-Reza Hakimi,Patric Kröpil,Martin Sager,Pascal Jungbluth,Jan-Peter Grassmann,Michael Wild,Joachim Windolf,Johannes Schneppendahl,Marcel Betsch,Sebastian Gehrmann,Monika Herten,Luc Malaval

doi:10.1371/journal.pone.0100143

Mohssen Hakimi, Ahmad-Reza Hakimi + Show 11 more

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https://doi.org/10.1371/journal.pone.0100143

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Abstract

One possible alternative to the application of autologous bone grafts represents the use of autologous bone marrow concentrate (BMC). The purpose of our study was to evaluate the potency of autologous platelet-rich plasma (PRP) in combination with BMC. In 32 mini-pigs a metaphyseal critical-size defect was surgically created at the proximal tibia. The animals were allocated to four treatment groups of eight animals each (1. BMC+CPG group, 2. BMC+CPG+PRP group, 3. autograft group, 4. CPG group). In the BMC+CPG group the defect was filled with autologous BMC in combination with calcium phosphate granules (CPG), whereas in the BMC+CPG+PRP group the defect was filled with the composite of autologous BMC, CPG and autologous PRP. In the autograft group the defect was filled with autologous cancellous graft, whereas in the CPG group the defect was filled with CPG solely. After 6 weeks radiological and histomorphometrical analysis showed significantly more new bone formation in the BMC+CPG+PRP group compared to the BMC+CPG group and the CPG group. There were no significant differences between the BMC+CPG+PRP group and the autograft group. In the PRP platelets were enriched significantly about 4.7-fold compared to native blood. In BMC the count of mononuclear cells increased significantly (3.5-fold) compared to the bone marrow aspirate. This study demonstrates that the composite of BMC+CPG+PRP leads to a significantly higher bone regeneration of critical-size defects at the proximal tibia in mini-pigs than the use of BMC+CPG without PRP. Furthermore, within the limits of the present study the composite BMC+CPG+PRP represents a comparable alternative to autologous bone grafting.

Highlights

The autologous cancellous graft represents up to this date the therapeutical gold standard in the treatment of bone defects on long bones [1,2,3]
Histological Results Histomorphometrical analysis revealed that the area of new bone was significantly larger in the autograft group and the bone marrow concentrate (BMC)+ calcium phosphate granules (CPG)+platelet-rich plasma (PRP) group compared to the BMC+CPG group concerning the central area of the defect zone
In the cortical area of the defect zone the autograft and BMC+CPG+PRP group showed a higher new bone formation compared to the BMC+CPG group but the differences were not significant

Summary

Introduction

The autologous cancellous graft represents up to this date the therapeutical gold standard in the treatment of bone defects on long bones [1,2,3]. The combination of an osteoconductive bone substitute with PRP and BMC, could mean a further step in the search of a composite with an osteogenetic potential equivalent to autologous bone grafts In this context Marx et al and Dallari et al were able to show that the growth factors in PRP, when serving as mitogenes, can only stimulate the growth of preexisting vital bone cells or osteogenic cells and have to rely on their local existence [6,11]. The addition of autologous mesenchymal stem cells in the form of BMC could provide an increased presence of osteoprogenitor cells These would be available for the stimulation of the mitogenous growth factors in PRP. Several authors demonstrated that PRP promotes the proliferation of human MSCs as well as rat-derived MSCs and mouse-derived MSCs in vitro [19,20,21,22]

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