Bone Marrow Aspirate Concentrate and Expanded Stem Cell Applications in Orthopaedics

by

Mohamed A. Imam, Martyn Snow

DOI: 10.2174/97816810864911180101
eISBN: 978-1-68108-649-1, 2018
ISBN: 978-1-68108-650-7



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This reference presents insights into the development of bone marrow aspirate stem cell (BMAC) technology and the potential role of st...[view complete introduction]
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Table of Contents

Foreword

- Pp. i
Richard E Field
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Preface

- Pp. ii
Mohamed A Imam and Martyn Snow
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Dedication

- Pp. iii
Mohamed Imam and Martyn Snow
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Acknowledgement

- Pp. iv
Mohamed A Imam and Martyn Snow
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List of Contributors

- Pp. v-vi (2)
Mohamed A Imam and Martyn Snow
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Introduction

- Pp. 1-4 (4)
Mohamed A. Imam, Yasser Elsherbini and Martyn Snow
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Basic Sciences Behind BMAC and Expanded Stem Cells

- Pp. 5-21 (17)
Mohamed Ahmed Mandour, Asmaa Kamal Abdel Maogood, Eman Gamal Ahmed and Rania Mohammed Kishk
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Ethics in the Clinical Use and Research of Stem Cells and BMAC

- Pp. 22-35 (14)
Ahmed Negida, Ahmed Elgebaly, Daniel Jackson and Mohamed A. Imam
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How to Design Clinical Trials of Stem Cells and BMAC in Orthopedic Surgery

- Pp. 36-50 (15)
Ahmed S. Negida, Salma Y. Fala, Mohamed A. Imam and Bassem T. Elhassan
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Role in Non-union and Bone Defects

- Pp. 51-59 (9)
Khaled Emara, Ramy Ahmed Diab and Ahmed K. Emara
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Management of Osteoarthritis

- Pp. 60-67 (8)
Mohamed A. Mokhtar, Mohamed A. Imam, Florian Grubhofer and Asser A. Sallam
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Clinical Applications in Cartilage Pathology

- Pp. 68-74 (7)
James Holton, Mohamed A. Imam, Yasser Elsherbini and Martyn Snow
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Role of BMAC in Avascular Necrosis

- Pp. 75-79 (5)
Tomek Kowalski, Mohamed A. Imam, Kuen Chin and Martyn Snow
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Bone Marrow Aspirate Concentrate in Nerve and Spinal Cord Injury

- Pp. 80-89 (10)
Asser A. Sallam, Mohamed A. Imam and Ali Narvani
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Uses in Spine Surgery

- Pp. 90-95 (6)
Asser A. Sallam, Amr Sami Hussien and Oscar Garcia Casas
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Role of BMAC in Tendinitis or Tendon Pathology

- Pp. 96-103 (8)
Saman Horriat, Mohamed A. Imam, Lukas Ernstbrunner and Rohit Gupta
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BMAC in Foot and Ankle Surgery

- Pp. 104-107 (4)
Mohamed A. Imam, Mohamed Shehata, Saqib Javed and Arshad Khaleel
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Risks of Bone Marrow Aspirate Concentrate

- Pp. 108-111 (4)
Benjamin David and Kevin Newman
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Subject Index

- Pp. 112-116 (5)
Mohamed A Imam and Martyn Snow
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Foreword

Advances in surgical practice have always depended upon the introduction of enabling technologies. In the mid 19th century, the introduction of anaesthesia enabled surgeons to develop procedures to remove diseased or damaged tissues. In the mid 20th century, the advent of antibiotics and greater understanding of biocompatibility issues allowed surgeons to replace damaged tissues; the introduction of immunosuppressive therapies extended this technology to transplantation of whole organs. In the latter years of the 20th century, advances in computer and imaging technologies provided the tools needed to develop endoscopic interventions. These enabled surgeons to remove diseased tissues with less collateral damage and begin to repair damaged tissues in situ. The 21st century has seen the nascence of stem cell technologies. Surgeons are now seeking ways to employ stem cells to regenerate damaged tissues.

At each step in this surgical journey, the enabling technologies have been exponentially more complex and sophisticated. Where surgery of the 19th and 20th centuries may have been viewed as a craft specialty, development of surgical practice in the 21st century surgery will necessitate the translation of tissue engineering, synthetic biology, materials science and computer assisted technologies into the operating environment. This can only be achieved if biologists, engineers, computer scientists and surgeons are brought together to share their skills.

Unlike genetically modified foods, the public broadly welcomes stem cell technology and patients’ requests for stem cell treatments are increasing. Imam and Snow provide a much-needed insight into the development of stem cell technology and the potential role of stem cell expansion in the regeneration of damaged and deficient musculoskeletal tissues. The authors explain where stem cells come from, what makes them special, how they can be made to multiply and be influenced to differentiate into different tissues. In contrast to the public demand for stem cell treatments, legislative and governance bodies have struggled to create an ethical framework for the investigation, development and clinical introduction of stem cell treatments. The authors explain these challenges and the varying constraints on the development of this technology around the world.

Imam and Snow provide us with a snapshot of current progress in the application of stem cell expansion across the spectrum of musculoskeletal medicine. In addition to work on the use of stem cells in the treatment of non-unions and bone defects, they explore the potential for articular cartilage regeneration, repair of tendon injuries, the treatment of degenerative joint disease, revascularization of bone and regeneration of damaged nerves.

In this rapidly evolving field, Imam and Snow have provided an invaluable explanation and record of the first applications of stem cell technology in musculoskeletal healthcare. The book should prove to be a landmark in orthopaedic history and an inspiration to young scientists and surgeons alike.

Richard E Field
St George’s University of London
UK
South West London Elective Orthopaedic Centre
Epsom & St Helier NHS Trust
Society for Hip Arthroscopy


Preface

Mesenchymal Stem Cells in the form of expanded stem cells are believed to have multipotent plasticity. The expanded stem cells are capable of being differentiated into various cell lineages such as cartilage, bone, tendon, muscle, and nerve. These unique purported properties can play a significant role in the repair and regeneration of various tissues across a number of orthopaedic specialties.

Bone marrow is regarded as the most used source of Mesenchymal Stem Cells in orthopaedic surgery and historically many surgeons have utilised unprocessed Bone Marrow Aspirate, in attempt to stimulate healing.

The main concern in using Bone Marrow Aspirate to stimulate tissue repair/regeneration is the low concentration of stem cells found within it. To address this issue, various protocols have been developed to concentrate the nucleated cell numbers to produce Bone Marrow Aspirate Concentrate.

The concept of Bone Marrow Aspirate Concentrate is to improve the recovery of the nucleated cells from the marrow aspirate, while decreasing the recovery of non-nucleated cells such as RBCs. This book aims to examine the current reported clinical applications of bone marrow aspirate concentrate and expanded stem cells and their effectiveness in orthopaedic surgery.

Mohamed A Imam
The Royal Orthopaedic Hospital
Birmingham, B31 2AP
UK
Suez Canal University Hospitals
Ismailia, 41111
Egypt

Martyn Snow
The Royal Orthopaedic Hospital
Birmingham
UK

List of Contributors

Author(s):
Mohamed A. Imam


Martyn Snow




Contributor(s):
Ahmed Elgebaly
Faculty of Medicine
Al-Azhar University
Cairo
Egypt


Ahmed K. Emara
Orthopaedic Surgery Department
Ain Shams University
Cairo
Egypt


Ahmed Negida
Faculty of Medicine
Zagazig University
Egypt


Ali Narvani
Ashford and St Peter’s NHS Trust
Chertsey, Surrey
UK


Amr Sami Hussien
Warwick University Hospital
Warwick
UK


Arshad Khaleel
Ashford and St Peter’s NHS Trust
UK


Asmaa Kamal Abdel Maogood
Department of Clinical Pathology
Faculty of Medicine, Suez Canal University
Ismailia
Egypt


Asser A. Sallam
Department of Trauma and Orthopedic Surgery
Suez Canal University Hospitals
Ismailia
Egypt


Bassem T. Elhassan
Mayo Clinic
Rochester
Minnesota
USA


Benjamin David
Ashford and St Peter’s NHS Hospital
Surrey
UK


Daniel Jackson
Queen Elizabeth Hospital
Birmingham
UK


Eman Gamal Ahmed
Department of Clinical Pharmacology
Faculty of Medicine, Suez Canal University
Ismailia
Egypt


Florian Grubhofer
Consultant Orthopaedic Surgeon
Der Balgrist University Hospital
Zurich
Switzerland


James Holton
The Royal Orthopaedic Hospital
Birmingham
UK


Kevin Newman
Ashford and St Peter’s NHS Hospital
Surrey
UK


Khaled Emara
Orthopaedic Surgery Department
Ain Shams University
Cairo
Egypt


Kuen Chin
Consultant Orthopaedic Surgeon
University Hospitals Birmingham NHS Trust
Birmingham
UK


Lukas Ernstbrunner
Department of Orthopaedics
Balgrist University Hospital, University of Zurich
Forchstrasse 340, 8008 Zurich
Switzerland
/
Department of Orthopaedics and Traumatology Paracelsus Medical University
Muellner Hauptstrasse 48, 5020
Salzburg
Austria


Mohamed A. Imam
Department of Arthroscopy
The Royal Orthopaedic Hospital
Birmingham
UK


Mohamed Mokhtar
Department of Trauma and Orthopedic Surgery
Suez Canal University Hospitals
Ismailia
Egypt


Martyn Snow
Department of Arthroscopy
The Royal Orthopaedic Hospital
Birmingham
UK


Mohamed Ahmed Mandour
De Duve Institute
University Catholique de louvain (UCL)
Brussels
Belgium
/
Department of Clinical Pathology
Faculty of Medicine, Suez Canal University
Ismailia
Egypt


Mohamed Shehata
Faculty of Medicine
Zagazig University
Egypt


Oscar Garcia Casas
Ashford and St Peter’s NHS Trust
Chertsey
UK


Ramy Ahmed Diab
Orthopaedic Surgery Department
Ain Shams University
Cairo
Egypt


Rania Mohammed Kishk
Department of Microbiology and Immunology
Faculty of Medicine, Suez Canal University
Ismailia
Egypt


Rohit Gupta
Ashford and St Peter’s NHS Hospital
Surrey
UK


Salma Y. Fala
Faculty of Medicine
Suez Canal University
Ismailia
Egypt


Saman Horriat
St George’s Hospital
London
UK


Saqib Javid
Ashford and St Peter’s NHS Trust
UK


Tomek Kowalski
The Royal Orthopaedic Hospital
Northfield
Birmingham
UK


Yasser Elsherbini
Research and Development
OxCell, OX3 8AT Oxford
UK
/
Institute of Biomedical Engineering
University of Oxford, OX3 7DQ Oxford
UK




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