Background and purpose – The value of core decrompression for treatment of osteonecrosis of the femoral head (ONFH) is unclear. We investigated by a literature review whether implantation of autologous bone marrow aspirate, containing high concentrations of pluripotent mesenchymal stem cells, into the core decompression track would improve the clinical and radiological results compared with the classical method of core decompression alone. The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR). Patients and methods – All randomized and non-randomized control trials comparing simple core decompression with autologous bone marrow cell implantation into the femoral head for the treatment of ONFH were considered eligible for inclusion. The methodological quality of the studies included was assessed independently by 2 reviewers using the Cochrane Collaboration tool for assessing risk of bias in randomized studies. Of 496 relevant citations identified, 7 studies formed the basis of this review. Results – The pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08-0.6; p = 0.02). The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3-1.02; p = 0.06). Interpretation – Our findings suggest that implantation of autologous mesenchymal stem cells (MSCs) into the core decompression track, particularly when employed at early (pre-collapse) stages of ONFH, would improve the survivorship of femoral heads and reduce the need for hip arthroplasty.
: Mesenchymal stromal cells (MSCs) have been investigated as a treatment for various inflammatory diseases because of their immunomodulatory and reparative properties. However, many basic questions concerning their mechanisms of action after systemic infusion remain unanswered. We performed a detailed analysis of the immunomodulatory properties and proteomic profile of MSCs systemically administered to two patients with severe refractory acute respiratory distress syndrome (ARDS) on a compassionate use basis and attempted to correlate these with in vivo anti-inflammatory actions. Both patients received 2 × 106 cells per kilogram, and each subsequently improved with resolution of respiratory, hemodynamic, and multiorgan failure. In parallel, a decrease was seen in multiple pulmonary and systemic markers of inflammation, including epithelial apoptosis, alveolar-capillary fluid leakage, and proinflammatory cytokines, microRNAs, and chemokines. In vitro studies of the MSCs demonstrated a broad anti-inflammatory capacity, including suppression of T-cell responses and induction of regulatory phenotypes in T cells, monocytes, and neutrophils. Some of these in vitro potency assessments correlated with, and were relevant to, the observed in vivo actions. These experiences highlight both the mechanistic information that can be gained from clinical experience and the value of correlating in vitro potency assessments with clinical effects. The findings also suggest, but do not prove, a beneficial effect of lung protective strategies using adoptively transferred MSCs in ARDS. Appropriate randomized clinical trials are required to further assess any potential clinical efficacy and investigate the effects on in vivo inflammation.
This article describes the cases of two patients with severe refractory adult respiratory syndrome (ARDS) who failed to improve after both standard life support measures, including mechanical ventilation, and additional measures, including extracorporeal ventilation (i.e., in a heart-lung machine). Unlike acute forms of ARDS (such in the current NIH-sponsored study of mesenchymal stromal cells in ARDS), recovery does not generally occur in such patients.
UCLA wide receiver and Canadian decathlon standout Zach Bornstein suffered a hamstring tear 18 months ago. Conventional treatment and therapy were not working so Zach decided to undergo stem cell therapy at Riordan-McKenna Institute in late June 2015. Dr. McKenna treated Zack with precisely guided injections of bone marrow aspirate concentrate (BMAC) harvested with the patented BioMAC bone marrow aspiration cannula and *AlphGEMS amniotic tissue product.
Complete healing was confirmed by MRI 8 weeks after treatment:
1) No evidence for hamstring strain or denervation and no evidence for tendon tear.
2) No evidence for focal atrophy or hematoma.
3) No osseous abnormalities seen.
After receiving the MRI results, Zack’s father Dean said, “I am not a doctor but looks like you and your procedure has performed a medical miracle! …Thanks for all of your efforts.”
Zack is currently a red shirt freshman at UCLA. He played football at Oaks Christian High School from 2011-’14 and lettered 3 years in football and all 4 years in track. In 2013, Zack was named to the All-Marmonte 2nd team. He played in the FBU Youth All-American game in 2010. In track, he is considered to be one of the top decathletes in the country. Zack competed at the 2013 Pan American Junior Championships in Medellin, Columbia, finishing in 5th place with 7,097 points. In July of 2013, he became the Canadian Junior National Champion (6,918 pts). Zack won the silver medal at the 2013 Arcadia Invitational Decathlon, scoring 6,967 points to set a new California state record for juniors (2nd highest score in California state history). Zack is a 12-time National Champion, 44-time All-American and a member of three National Championship cross country teams.
*Amniotic tissue is donated after normal, healthy births.
Board Certified Orthopedic Surgeon, Dr. Wade McKenna talks about better patient outcomes using a combination of Stemnexa stem cell therapy and amniotic tissue product together with minimally-invasive arthroscopic surgery.
Wade McKenna DO is a board-certified orthopedic surgeon who is fellowship-trained in trauma and post-traumatic reconstruction. He is the Medical Director at the Riordan-McKenna Institute (RMI) of Regenerative Orthopedics. RMI specializes in non-surgical stem cell therapy and stem cell-enhanced surgery for orthopedics.