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Literature Refs

The results were amazing. Thirty days post treatment, the ultrasound showed healing which would have normally occurred at the
five- to six-month stage without the stem cell treatment. We are completely satisfied with the results and are happy to
say that Losar
is back to full work and showing successfully.
Donna & Bill Poeta Old Lyme, CT

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Abstracts: Stem Cells in Bone Regeneration
Bruder SP, Jaiswal N, Ricalton N, Mosca J, Kraus K, Kadiyala S: Mesenchymal Stem Cells in Osteobiology and Applied Bone
Regeneration. Clinical Orthopaedics and Related Research:S247-S256, 1998.
Bone marrow contains a population of rare progenitor cells capable of differentiating into bone, cartilage, muscle, tendon,
and other connective tissues. These cells, referred to as MSCs, can be purified and culture expanded from animals and
humans. This review summarizes recent experimentation focused on characterizing the cellular aspects of osteogenic
differentiation, and exploration of the potential for using autologous stem cell therapy to augment bone repair and
regeneration. The authors have completed an array of preclinical studies showing the feasibility and efficacy of MSC based
implants to heal large osseous defects. After confirming that syngeneic rat MSCs could heal a critical size segmental defect
in the femur, it was established that human MSCs form bone of considerable mechanical integrity when implanted in an osseous
defect in an immunocompromised animal. Furthermore, bone repair studies in dogs verify that the technology is transferable to
large animals, and that the application of this technology to patients at geographically remote sites is feasible. These
studies suggest that by combining MSCs with an appropriate delivery vehicle, it may be possible to offer patients new
therapeutic options.
Bruder SP, Kraus K, Goldberg V, Kadiyala S: The Effect of Implants Loaded with Autologous Mesenchymal Stem Cells on the
Healing of Canine Segmental Bone Defects. The Journal of Bone and Joint Surgery, Incorporated 80-A:985-996, 1998.
Bone marrow has been shown to contain a population of rare mesenchymal stem cells that are capable of forming bone, cartilage,
and other connective tissues. We examined the effect of cultured autologous mesenchymal stem cells on the healing of
critical-sized (twenty-one-millimeter-long) segmental defects in the femora of adult female dogs. Autologous mesenchymal stem
cells were isolated from bone marrow, grown in culture, and loaded onto porous ceramic cylinders consisting of hydroxyapatite
(65 per cent) and beta-tricalcium phosphate ceramic (35 per cent). The animals were randomly assigned to one of three
groups. In Group A (six dogs), a porous ceramic cylinder that had been loaded with autologous mesenchymal stem cells was
implanted in the defect. In Group B (six dogs), a ceramic cylinder that had not been loaded with cells was placed in the
defect. In Group C (three dogs), the defect was left untreated (no ceramic cylinder was implanted). Radiographs were made
immediately after the operation and at four-week intervals. At sixteen weeks, the animals were killed, the involved femora
were removed, and undecalcified histological sections from defects and adjacent bone were prepared. Histological and
histomorphometric studies were carried out to examine the healing of the defects and the formation of bone in and around the
ceramic implants. Atrophic non-union occurred in all of the femora that had untreated defects, and only a small amount of
trabecular bone formed at the cut ends of the cortex of the host bone in this group. In contrast, radiographic union was
established rapidly at the interface between the host bone and the implants that had been loaded with mesenchymal stem
cells. Numerous fractures, which became more pronounced with time, developed in the implants that had not been loaded with
cells. Histological and morphometric analyses demonstrated that both woven and lamellar bone had filled the pores of the
implants that had been loaded with mesenchymal stem cells; the amount of bone was significantly greater (p<0.05) than that
found in the pores of the implants that had not been loaded with cells. In addition, a large collar of bone (mean maximum
thickness, 3.14 millimeters) formed around the implants that had been loaded with cells; this collar became integrated and
contiguous with callus that formed in the region of the periosteum of the host bone. The collar of bone remodeled during the
sixteen-week period of study, resulting in a size and shape that were comparable with those of the segment of bone that had
been resected. Callus did not develop around the cortex of the host bone or around the defect in any of the specimens in the
other two groups.
Huang JI, Beanes SR, Zhu M, Lorenz HP, Hedrick MH, Benhaim P: Rat extramedullary adipose tissue as a source of
osteochondrogenic progenitor cells. Plast Reconstr Surg 109:1033-1041, 2002.
Human liposuction aspirates contain pluripotent adipose-derived mesodermal stem cells that have previously been shown to
differentiate into various mesodermal cell types, including osteoblasts and chondrocytes. To develop an autologous research
model of bone and cartilage tissue engineering, the authors sought to determine whether rat inguinal fat pads contain a
similar population of osteochondrogenic precursor cells. It was hypothesized that the rat inguinal fat pad contains
adipose-derived multipotential cells that resemble human adipose-derived mesodermal stem cells in their osteochondrogenic
capacity. To test this, the authors assessed the ability of cells isolated from the rat inguinal fat pad to differentiate into
osteoblasts and chondrocytes by a variety of lineage-specific histologic stains. Rat inguinal fat pads were isolated and
processed from Sprague-Dawley rats into fibroblast-like cell population. Cell cultures were placed in pro-osteogenic media
containing dexamethasone, ascorbic acid, and beta-glycerol phosphate. Osteogenic differentiation was assessed at 2, 4, and 6
weeks. Alkaline phosphatase activity and von Kossa staining were performed to assess osteoblastic differentiation and the
production of a calcified extracellular matrix. Cell cultures were also placed in prochondrogenic conditions and media
supplemented with transforming growth factor-beta1, insulin, transferrin, and ascorbic acid. Chondrogenic differentiation was
assessed at 2, 7, and 14 days by the presence of positive Alcian blue staining and type II collagen
immunohistochemistry. Cells placed in osteogenic conditions changed in structure to a more cuboidal shape, formed bone
nodules, stained positively for alkaline phosphatase activity, and secreted calcified extracellular matrix by 2 weeks. Cells
placed in chondrogenic conditions formed cartilaginous nodules within 48 hours that stained positively for Alcian blue and
type II collagen. The authors identified the rat inguinal fat pad as a source of osteochondrogenic precursors and developed a
straightforward technique to isolate osteochondrogenic precursors from a small animal source. This relatively easily obtained
source of osteochondrogenic cells from the rat may be useful for study of tissue engineering strategies and the basic science
of stem cell biology.
Kon E, Muraglia A, Corsi A, Bianco P, Maracci M, Martin I, Boyde A, Ruspantini I, Chistolini P, Rocca M, Giardino R,
Cancedda
R, Quarto R: Autologous bone marrow stromal cells loaded onto porous hydroxyapatite ceramic accelerate bone repair in
critical-size defects of sheep long bones. J Biomed Mater Res 49:328-337, 2000.
The ability of marrow-derived osteoprogenitor cells to promote repair of critical-size tibial gaps upon autologous
transplantation on a hydroxyapatite ceramic (HAC) carrier was tested in a sheep model. Conditions for in vitro expansion of
sheep bone marrow stromal cells (BMSC) were established and the osteogenic potential of the expanded cells was
validated. Ectopic implantation of sheep BMSC in immunocompromised mice led to extensive bone formation. When used to repair
tibial gaps in sheep, cell-loaded implants (n=2) conducted a far more extensive bone formation than did cell-free HAC
cylinders (n=2) over a 2-month period. In cell-loaded implants, bone formation was found to occur both within the internal
macropore space and around the HAC cylinder while in control cell-free implants, bone formation was limited mostly to the
outer surface and was not observed in most of the inner pores. As tested in an indentation assay, the stiffness of the complex
HAC-bone material was found to be higher in cell-loaded implants compared to controls. Our pilot study on a limited number of
large-sized animals suggests that the use of autologous BMSC in conjunction with HAC-based carriers results in faster bone
repair compared to HAC alone. Potentially this combination could be used clinically in the treatment of extensive long bone
defects.
Lu X, Li S, Cheng J. Bone marrow mesenchymal stem cells: progress in bone/cartilage defect repair. Sheng Wu Yi Xue Gong
Cheng
Xue Za Zhi 2002; 19 (1): 135.
Mesenchymal stem cells (MSC) are thought to be multi-potent cells that have the potential to differentiate into lineages of
mesenchymal tissues, including bone, cartilage, tendon, fat, muscle, and marrow stroma during embryo morphogenesis. In recent
years, cells that have the characteristics of mesenchymal stem cells were isolated from marrow aspirates of human and a few
animals. It was found that these cells retain the characteristics of stem cells in vitro and could be induced to differentiate
exclusively into the osteocytic, chondrocytic, myoblastic and adipocytic lineages. It was demonstrated that MSC could heal
clinically significant bone and cartilage defects in animal models. The role of MSC in repairing tendon defect was also
testified.
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