Adult stem cells are available from three principal sources: bone marrow, adipose and blood.
Bone marrow is obtained by placing a needle into a large, readily accessible bone and aspirating (withdrawing) marrow. Hence the term bone marrow aspirate.
The use of x-ray during bone marrow aspirate ensures correct placement of the needle, minimizes time required, maximizes patient comfort and avoids complications such as puncture of blood vessels and organs. X-ray guidance during bone marrow aspirate is the standard of care at the Centeno-Schultz Clinic. We have had no complications and the procedure is performed in 20 minutes or less.
After the bone marrow is obtained the stem cell rich cells ( the nucleated cells) need to be separated and concentrated. Hence the term bone marrow aspirate concentrate: BMAC.
Most clinics use a bed side centrifuge whereas Regenexx has a state of the art lab.
Does it make a difference?
When compared to bedside centrifuges, the Regenexx lab produced a concentrate that had a 3 times the number nucleated cells. This is illustrated in the graph below. The greater the number of nucleated cells the better since studies have demonstrated that placement and number of cells injected can translate to better clinical outcome.
Autologous, adult mesenchymal stem cells have proven to be an effective therapy for patients who have orthopedic injuries. Specifically, autologous, adult mesenchymal stem cell therapy has regenerated cartilage in knees, hips and thumbs, repaired tendon injuries, reduced the size of protrusions in the lumbar spine and healed long bone non-union fractures.
Regenexx isolates a patients own mesenchymal stem cells in a state of the art cell culture laboratory. Then, in an effort to provide maximal clinical results, it expands the stem cells by a factor of 1,000X. The process takes 12-14 days and typically yields a mesenchymal stem cell count of 5-10 million cells. The stem cells are expanded through the use of the patient’s own blood products. No growth hormone or exogenous stimulates are utilized. The patented process is unique in its ability to yield such a large number of autologous, mesenchymal stem cells.
In a previous blog, I discussed BMAC: Bone Marrow Aspirate Concentrate. The therapy involves taking a patients bone marrow, concentrating it via a centrifuge and re-injecting the concentrate into the area of damaged tissue. The entire process is conducted in a single setting. There is no isolation or culture expansion of the stem cells. BMAC differs significantly from the Regenexx procedure in the type and absolute number of stem cells injected. BMAC yields a high concentration of hemapoetic stem cells which will differentiate into blood products. The important repair stem cell, mesenchymal stem cells, are in very low concentrations.
The bone marrow is rich in stem cells. These cells are typcially obtained by a technique referred to as a bone marrow aspirate where a needle is placed into the iliac crest and cells are withdrawn through a syringe.
Bone Marrow Aspirate Concentrate Unit
Withdrawing cells in this fashion is called aspiration. Bone marrow aspiration is a common practice for obtaining stem cells. A popular technique is to take the bone marrow aspirate ( the cells obained from the bone marrow aspiration) and spin it down in a centrifuge thereby creating a concentrate of bone marrow nucleated cells. This technique is called BMAC: Bone Marrow Aspirate Concentration. The concentrated bone marrow aspirate contains stem cells and has been termed and advertised as ‘stem cell concentrate.” There are several units commercially-available.
There are many different types of stem cells in bone marrow. Stem cells that are crticial for regeneration of cartilage, tendon and ligament are very specific and are called mesenchymal stem cells.
A crtical question which has recently been studied is what is the concentration of mesenchymal stem cells from commerically available units. Equally important, is the question of whether or not the concentration of stem cells from BMAC can made a difference clinically.XXXX demonstrated that bedside bone marrow concentrate machines utilizing a 60cc bone marrow aspirate can produce between 70,000-90,000 mesenchymal stem cells. What does this mean? Animal research and data collected at Regenexx suggests that millions of mesenchyml stem cells are required to repair cartilage, tendon and muscle injuries. Furthermore unlike the BMAC units, Regenexx expands the number of mesenchymal stems stem to approximately 100-1,000 times the number obtained from BMAC. So in considering stem cell therapy it is essential to understand both the type and absolute number of stem cells injected since both will play a critical role in the success of a procedure.