The science of bone marrow concentrate. Lisa A. Fortier, DVM, PhD, - PowerPoint PPT Presentation

Cornell University College of Veterinary Medicine The science of bone marrow concentrate. Lisa A. Fortier, DVM, PhD, DACVS James Law Professor of Surgery laf4@cornell.edu Disclosures: Arthrex Consultant, VRN Consultant, Scientific Board Kensey Nash

Disclosures • Consultant: Arthrex, Veterinary Recommended Nutraceuticals, TissueGen • Royalties: Arthrex • Scientific Board: Kensey Nash

Evidence for BMC OJSM 2016 4x10 8

Bone marrow concentrate • “off the shelf” product – GF and stem cells Eydt 2014 • What you need – Bone marrow needle, disposable device, centrifuge, 15 minutes ? Heparin coated

Left = BMAC Right = MFx control JBJS 2010 JBJS 2017 Axial FSE Axial FSE T2 mapping T1 rho T2 mapping T1 rho No bony overgrowth Fill < 25% Fill > 75%

Is BMC just PRP with a few MSC? Williams Hematology

Study design Courtesy, Kennedy N=29 48.2 yrs (23-68) Blood collection Bone marrow aspiration BMA BMC-A BMC-B WB PRP WB, PRP, BMA, BMC-A, BMC-B BMA, BMC-A, BMC-B Cytology Cytokines Cell Culture Flow Catabolic: Anabolic: Leukocytes: cytometry: Colony IL-1 β • PDGF • • Lymphocytes • CD271 forming • IL-6 • TGF β 1,2,3 • Neutrophils • CD73 units • IL-8 • FGF • Monocytes Trilineage • CD146 TNF α • • IL-1ra • Eosinophils differentiation • CD34 IFN γ Basophils • • • CD45 Platelets Cassano KSSTA 2016

Cytology Mean ± S.D. PRP BMC p-value WBC 3.1 ± 1.2 36.7 ± 16.9 <0.0001 thou/ul Neutrophils 0.9 ± 0.4 17.5 ± 9.8 0.0002 thou/ul Monocytes 0.3 ± 0.2 3.3 ± 2.3 0.0005 thou/ul Platelets 202.3 ± 86.1 151.6 ± 111.2 0.46 thou/uL

Bioactive proteins: BMC>>PRP Mean ± S.D. PRP BMC p-value PDGF 5975 ± 2644 7549 ± 3601 0.25 pg/mL TGF- β2 65± 70 219 ± 219 0.024 pg/mL VEGF 10 ± 19 276 ± 273 0.0005 pg/mL IL-8 < 3.50 273 ± 300 N/A pg/mL IL- 1β < 0.70 7 ± 13 N/A pg/mL Not detectable: IL-6, TNF- α , INF- γ , FGF

IL-1ra / Orthokine / IRAP

-1Ra / IRAP / Orthokine / Regenokine

Making IL-1RA aka Orthokine / Regenokine In horses since 2007!

Why use BMC? • IA or cartilage repair • Growth factors • Stem cells • Recruits stem cells • IRAP/IL-1RA/Regenokine • Evidence

Acknowledgements