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Trialing Stem Cell Combination Therapy for Bone Regeneration

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Review of  “Bone Regeneration Using the Freshly Isolated Autologous Stromal Vascular Fraction of Adipose Tissue in Combination With Calcium Phosphate Ceramics” from Stem Cells Translational Medicine by Stuart P. Atkinson

After injury or disease to the jaw area, dental implant placement often requires additional bone transplants. Harvested autologous bone is the current gold standard; however, as the harvesting procedure can be harmful, researchers continue to search for new and improved strategies for bone regeneration.

To this end, researchers from the laboratory of Marco N. Helder (VU University Medical Center, Amsterdam, The Netherlands) sought to assess the potential of patient-derived adipose stem cells (ASCs), which exhibit potent osteogenic differentiation properties [1, 2], combined with osteoinductive calcium phosphate (CaP) carriers [3]. 

Previous preclinical animal studies demonstrated the feasibility of a one-step surgical procedure for ASC/CaP implantation [4, 5] and in a new Stem Cells Translational Medicine article, Prins et al now report back on the feasibility, safety, and efficacy of this stem cell combination therapy in a clinical setting [6].

The adjoined figure represents a scanning electron microscope image demonstrating ASCs attached to the calcium phosphate material (main picture) and the calcium phosphate granules (inset). This phase 1 study evaluated this ASCs/calcium phosphate carrier combination in a total of ten patients, reporting no adverse effects during the procedure or during the three years of follow-up. While the trial aimed and succeeded in demonstrating feasibility and safety, the authors also noted higher levels of bone and osteoid percentages after the application of the combination therapy. Encouragingly, the increase in vertical bone/bone substitute height at 6 months reached a level which allowed the proper placement of dental implants. 

This new study suggests that this stem cell combination therapy may be an effective means to replace bone required for dental implants and also to regenerate bone in general. The authors do note that, while efficacy is encouraging, further trials using an expanded number of patients and assessing increased concentrations of cells may allow improved bone regeneration capacity and increase the potential worth of this stem cell combination therapy.

References

  1. Jurgens WJ, Kroeze RJ, Bank RA, et al. Rapid attachment of adipose stromal cells on resorbable polymeric scaffolds facilitates the one-step surgical procedure for cartilage and bone tissue engineering purposes. J Orthop Res 2011;29:853-860.
  2. Overman JR, Farre-Guasch E, Helder MN, et al. Short (15 minutes) bone morphogenetic protein-2 treatment stimulates osteogenic differentiation of human adipose stem cells seeded on calcium phosphate scaffolds in vitro. Tissue Eng Part A 2013;19:571-581.
  3. Schulten EA, Prins HJ, Overman JR, et al. A novel approach revealing the effect of a collagenous membrane on osteoconduction in maxillary sinus floor elevation with beta-tricalcium phosphate. Eur Cell Mater 2013;25:215-228.
  4. Hoogendoorn RJ, Lu ZF, Kroeze RJ, et al. Adipose stem cells for intervertebral disc regeneration: current status and concepts for the future. J Cell Mol Med 2008;12:2205-2216.
  5. Vergroesen PP, Kroeze RJ, Helder MN, et al. The use of poly(L-lactide-co-caprolactone) as a scaffold for adipose stem cells in bone tissue engineering: application in a spinal fusion model. Macromol Biosci 2011;11:722-730.
  6. Prins HJ, Schulten EA, Ten Bruggenkate CM, et al. Bone Regeneration Using the Freshly Isolated Autologous Stromal Vascular Fraction of Adipose Tissue in Combination With Calcium Phosphate Ceramics. Stem Cells Transl Med 2016;5:1362-1374.