Dataset Information

Bone Marrow-Derived Cell Therapies to Heal Long-Bone Nonunions: A Systematic Review and Meta-Analysis-Which Is the Best Available Treatment?

ABSTRACT: Nonunions represent one of the major indications for clinical settings with stem cell-based therapies. The objective of this research was to systematically assess the current evidence for the efficacy of bone marrow-derived cell-based approaches associated or not with bone scaffolds for the treatment of nonunions. We searched MEDLINE (PubMed) and CENTRAL up to July 2019 for clinical studies focused on the use of cell-based therapies and bone marrow derivatives to treat bone nonunions. Three investigators independently extracted the data and appraised the risk of bias. We analysed 27 studies including a total number of 347 participants exposed to four interventions: bone marrow concentrate (BMAC), BMAC combined with scaffold (BMAC/Scaffold), bone marrow-derived mesenchymal stromal cells (BMSCs), and BMSC combined with scaffold (BMSC/Scaffold). Two controlled studies showed a positive trend in bone healing in favour of BMAC/Scaffold or BMSC/Scaffold treatment against bone autograft, although the difference was not statistically significant (RR 0.11, 95% CI -0.05; 0.28). Among single cohort studies, the highest mean pooled proportion of healing rate was reported for BMAC (77%; 95% CI 63%-89%; 107 cases, n = 8) and BMAC/Scaffold treatments with (71%; 95% CI 50%-89%; 117 cases, n = 8) at 6 months of follow-up. At 12 months of follow-up, an increasing proportion of bone healing was observed in all the treatment groups, ranging from 81% to 100%. These results indicate that BMAC or BMAC/Scaffold might be considered as the primary choice to treat nonunions with a successful healing rate at a midterm follow-up. Moreover, this meta-analysis highlighted that the presence of a scaffold positively influences the healing rate at a long-term follow-up. More case-control studies are still needed to support the clinical improvement of cell-based therapies against autografts, up to now considered as the gold standard for the treatment of nonunions.

SUBMITTER: Palombella S

PROVIDER: S-EPMC6948316 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Bone Marrow-Derived Cell Therapies to Heal Long-Bone Nonunions: A Systematic Review and Meta-Analysis-Which Is the Best Available Treatment?

Palombella Silvia S Lopa Silvia S Gianola Silvia S Zagra Luigi L Moretti Matteo M Lovati Arianna B AB

Stem cells international 20191227

Nonunions represent one of the major indications for clinical settings with stem cell-based therapies. The objective of this research was to systematically assess the current evidence for the efficacy of bone marrow-derived cell-based approaches associated or not with bone scaffolds for the treatment of nonunions. We searched MEDLINE (PubMed) and CENTRAL up to July 2019 for clinical studies focused on the use of cell-based therapies and bone marrow derivatives to treat bone nonunions. Three inve ...[more]

PMID: 31949437

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Project description:AimThe aim of this study was to investigate safety of treating diabetic foot ulcers with a topically administered mesenchymal stem cell product.MethodIndividuals with diabetes, peripheral neuropathy, toe blood pressure > 39 mmHg and non-infected foot ulcers with duration of four to fifty-two weeks were screened. Participants were treated with a one-time application of a topically applied allogeneic cellular product containing CD362 enriched mesenchymal stem cells suspended in a collagen solution. Participants were subsequently followed for seven months to gather information on adverse event and serious adverse events.Results/discussionA total of sixteen individuals were screened, of whom two were included. The included participants incurred a total of seven adverse events and one serious adverse event. Increased exudation from the treated diabetic foot ulcer was observed for both participants and a connection to investigational medicinal product was suspected. The increased exudation was resolved within one week after application of investigational medicinal product, without any further complications. The serious adverse event consisted of a hospital admission due to neurological symptoms, which were assumed to be caused by hypoglycemia, with no suspected correlation to the investigational medicinal product. None of the other observed adverse events were suspected to be associated with the investigational medicinal product.ConclusionThis study presents data from two individuals with a diabetic foot ulcer treated with a novel topical mesenchymal stem cell product. An adverse event observed for both participants was suspected to be associated to the investigational medicinal product, i.e., increased exudation, which was resolved within one week, did not lead to further complications and can easily be remedied by choosing bandages with higher absorption capacity or increasing frequency of bandage changes. This study lays the groundwork for further large scale randomized clinical studies.Trial registrationEudraCT number 2015-005580-16. Registered 12/06-2018.

Project description:In archaeological assemblages the presence of percussion marks, on the surface of long bones, is an indicator of long bone marrow extraction. The form, quantity and distribution of percussion marks are analysed to gain a better understanding of the marrow extraction process. Patterns of bone percussion damage in archaeological assemblages may highlight standardized actions, possibly related to butchery traditions. However, additional factors could underlie these patterns and should also be considered. In this article we test intuitiveness as a factor in appearance of percussion mark patterns, to see if patterns can appear when bones are being fractured without prior experience with bone fracture properties. To test this hypothesis, for this study we selected a sample of 40 cattle (Bos taurus) long limb bones from a large bone breakage experiment (400 long limb bones), where participants had no previous experience in bone breakage and may thus have broken bones intuitively. We used Geographic Information System (GIS) software to analyse the distribution of percussion marks. Using ArcGIS Spatial Analysts tools, we identified and quantified significant concentrations of percussion marks. Results show that percussion mark patterns emerge for the same bone element, and that specific sides and zones were recurrently selected by experimenters. The distribution of patterns varies among the different long bone elements, and we attribute this variance to an adjustment to bone morphology. In addition, we calculated and identified bone damage patterns resulting from hammerstone percussion. Crossing bone survivorship with percussion mark patterns enabled us to recognise and evaluate the effects of fragmentation and surface visibility in controlled experimental conditions. The GIS method facilitates comparisons between different variables and provides a sophisticated visual representation of results. Enlarging the sample will allow to constitute a more substantial analogous model for fossil assemblages.

Dataset Information

Bone Marrow-Derived Cell Therapies to Heal Long-Bone Nonunions: A Systematic Review and Meta-Analysis-Which Is the Best Available Treatment?

Publications

Bone Marrow-Derived Cell Therapies to Heal Long-Bone Nonunions: A Systematic Review and Meta-Analysis-Which Is the Best Available Treatment?

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