In some cases the patient or his relatives hear an ominous phrase from the doctor: bone marrow transplantation is needed. Usually, neither the patient nor his relatives really know what lies behind this term. They are not aware of the possible consequences or difficulties in the search of an appropriate donor for the transplantation.
IT IS NECESSARY TO SAY A FEW WORDS ABOUT THE TREATMENT USING BONE MARROW TRANSPLANTATION
Speaking generally, every person has a structure called bone marrow, which produces cells to “refresh” the blood during the person’s lifespan. However, there are some diseases or methods of treatment (such as chemotherapy in case of cancer) in the process of which the bone marrow may be damaged irreversibly.
In this case, the outcome is always fatal in just a matter of time. Under such conditions, fully understanding the state and perspective of the patient, his doctor may decide to recommend bone marrow transplantation.
WHAT HAPPENS DURING THIS PROCEDURE?
The bone marrow (in the form of a suspension of cells) is extracted surgically from a healthy person (the donor)and transferred into the patient’s (the recipient) body. The main point in this procedure is the transfer of healthy cells, because such is the goal of the treatment.
WHY ARE STEM CELLS USED?
Because mesenchymal stem cells (MSCs) are capable of differentiating into a vast variety of human tissues and have a great potential of usage in the field of regenerative medicine. Simply speaking, after entering the patient’s bloodflow, stem cells start the process of recovery (regeneration) of the organism.
A MODERN ALTERNATIVE TO BONE MARROW AS A SOURCE OF MSCS IS ADIPOSE TISSUE
Performed studies have shown that adipose-derived mesenchymal stem cells (AdMSCs) and bone marrow-derived mesenchymal stem cells (BMMSCs) in similar in vitro conditions of cultivation show almost identical morphologic, immunophenotypic and colony-forming properties.
However, a comparative study of stem cells derived from donors of similar age and health has shown that the effective regulation of the immune system requires a smaller dose of AdMSCs than BMMSCs to achieve the same effect on the cells of the immune system.
It was also established that adipose-derived mesenchymal stem cells have substantially greater immunomodulatory properties compared to bone marrow-derived mesenchymal stem cells, which is especially important in case of autoimmune disorders.
BONE MARROW-DERIVED MESENCHYMAL STEM CELLS
Bone marrow, also called hematopoietic marrow or red marrow, is one of the principal organs of blood-formation (hematopoiesis). It is mostly located in the middle part (diaphysis) of long bones – mainly in the pelvic bones, ribs and sternum. The quantity of mesenchymal stem cells in the bone marrow of an average adult does not exceed 0,005-0,01%.
In order to perform bone marrow transplantation, preliminary thorough medical examination is required to assure that the patient will be able to endure such a serious procedure. The examination stage takes up to a couple of weeks and costs several tens of thousands of dollars.
The procedure for obtaining bone marrow is standard for all types of transplantation (autologous and allogenic). Bone marrow is extracted with a special needle from the iliac bones of the pelvis or sternum under general or local anesthesia. Without damaging the patient’s health, it is possible to take only about 30-50 ml of bone marrow in a single aspiration.
The complications after this procedure usually include pain and discomfort in the place of puncture. A feeling of weakness and lack of energy may also be present due to the loss of bone marrow. Temps of recovery are individual and vary from a couple of weeks up to a month.
The post-operational period is the most difficult, dangerous and expensive. The patient will be constantly in need of high-priced medicine and long-term care. One of the most complicated and expensive issues will be assuring a special hospital chamber or room (sterile conditions) for the patient in order to protect him from possible infections, which will threaten the patient due to the weakened immune system after the procedure.
ADIPOSE-DERIVED MESENCHYMAL STEM CELLS
Adipose tissue is now the safest and most reliable source of mesenchymal stem cells. In contrast to BMMSCs, the quantity of which in the bone marrow is about 0,005-0,01%, AdMSCs number from 1 to 5% in the adipose tissue. The richest in stem cells is the abdominal area.
The process of adipose tissue extraction is simple and minimally invasive. 10-100 ml of fat are extracted by means of miniliposuction in the abdominal area under regional anesthesia.
The procedure consists in evacuating a small amount of body fat under negative pressure using a special device. The small puncture in the skin heals in a few days without leaving scars or any other traces on the skin.
The price of the treatment with autologous adipose-derived mesenchymal stem cells, in contrast to treatment with BMMSCs, is several tens of times lower – about 5-10 thousand dollars.
Extracted mesenchymal stem cells are administered to the patient intravenously. If the extracted stem cells are derived from bone marrow, it is possible to administer only the same quantity of them that was originally obtained. If the extracted stem cells are adipose-derived, it possible to cultivate them in special laboratories, therefore the administration dose can vary: the quantity of administered AdMSCs may be much greater than their original number. AdMSCs are easily cultivated, thus repeated administration of autologous AsMSCs is possible.
Usually, the treatment consists of three injections, which is much more effective than a one-time injection of bone marrow-derived mesenchymal stem cells.
Nowadays, cell therapy with adipose-derived mesenchymal stem cells is getting more and more popular and demanded. The procedure of obtaining adipose tissue is significantly less painful and invasive in comparison to aspiration of bone marrow, and cannot lead to complications, which are frequently present after bone marrow aspiration.
Another important factor is the price of the procedure of obtaining adipose-derived mesenchymal stem cells (AdMSCs). The cost of the procedure is tens of times lower than the similar procedure of extraction of MSCs from bone marrow.
THEREFORE, CELL THERAPY WITH AUTOLOGOUS MESENCHYMAL STEM CELLS IS A REAL ALTERNATIVE TO THE PROCEDURE OF BONE MARROW TRANSPLANTATION