ask-the-doc

Why do some doctors swear by adipose treatments and some by bone marrow? I’m totally confused by which is best. Does it depend on the treatment needed, age of patient, doctor preference, or what?

Dr. Riordan:

Because our focus at Riordan-McKenna Institute is orthopedics, I will answer mostly in that context.

The advantage in orthopedics for using bone marrow aspirate concentrate (BMAC) vs. adipose is that like adipose, BMAC contains mesenchymal stem cells (MSCs) that can stimulate wound healing, reduce inflammation, and modulate immune cells, but unlike adipose, it also contains significant numbers of other cell types that can induce new blood vessel growth and reinvigorate tissue that doesn’t have adequate blood supply. The bone marrow cells include cells that can induce angiogenesis; new blood vessel formation. Without new blood vessel formation, no tissue heals properly or completely.

That being said, in my experience, adipose-derived cells can be somewhat useful for certain immune conditions like MS and rheumatoid arthritis but umbilical cord tissue-derived MSCs, which are not available in the US, are a better option.

So, the type of stem cells and other biologics used certainly does depend on the condition treated. Age, especially when using a patient’s own stem cells, which decrease in number and potency as they age, is another important factor. Of course, doctor preference always comes into play.

Dr. McKenna:

Bone marrow, especially augmented with AlphaGEMS amniotic tissue product, does a better job than fat alone.

The angiogenic potential in fat is compromised by the lack of CD34 positive cells. CD34+ cells are the stem cells that form the other cells found in the blood and are crucial to micro-angiogenesis (new blood vessel growth) and the healing of cartilage, tendons, and soft tissues . All that begins and ends with micro blood vessels and angiogenesis.

Even the chondrogenic (cartilage-forming) potential from a fat stem cell is different from bone marrow stem cells. There are several hundred known components that make of a cell’s secretome (secreted molecules in free form and inside of particles known as exosomes and microvesicles). The secretome of a bone marrow MSC is different than a fat MSC’s secretome. For example, the bone marrow MSCs secrete molecules that are crucial for making new cartilage.

The only real advantage to fat is relatively higher MSC counts than bone marrow. Significant cell counts can be obtained with large liposuctions. However, in orthopedics, these large numbers of cells only work best in fat grafting, which also requires PRP. Overall, for orthopedics, BMAC augmented with AlphaGEMS is the way to go in my opinion.

Regardless of whether fat-derived stromal vascular fraction is a viable option for orthopedic conditions, it is currently illegal to use it in the US in any way that makes sense.

The use of enzymatic digestion, washing of the tissue and concentration of the cellular volume from fat, is illegal because the FDA considers enzimatic digestion a violation of its current and newly proposed guidelines. Therefore, in our clinic setting, we avoid using fat for any reason in order to avoid confrontation with the FDA, which has recently started to crack down on clinics treating patients with adipose products.

It is a bit ironic that we don’t use fat at our US clinic since Dr. Riordan developed the first stromal vascular fraction treatments in the world and also pioneered the use of MSCs cultured from fat for the treatment of autoimmune conditions nearly a decade ago, including the first in human safety paper using stromal vascular fraction from fat in patients with rheumatoid arthritis with Indiana University.

Non-expanded adipose stromal vascular fraction cell therapy for multiple sclerosis

Autologous stromal vascular fraction therapy for rheumatoid arthritis: rationale and clinical safety

Autologous stromal vascular fraction cells: A tool for facilitating tolerance in rheumatic disease