title: Osteogenic progenitors in bone marrow aspirates have clinical potential for tibial non-unions healing in diabetic patients.
abstract: There is a significantly higher incidence of delayed unions, non-unions, and increased healing time in diabetic patients compared with non-diabetic patients. Studies suggest that diabetics suffer from deficiencies of pancreatic stem/progenitor cells, and a clinically relevant question arises concerning the availability and functionality of progenitor cells obtained from bone marrow of diabetics for applications in bone repair.
  
  
  
  We have evaluated the cellularity and frequency of osteogenic mesenchymal stem cells (MSCs) in bone marrow from 54 diabetic patients (12 with type 1 and 42 with type 2) with tibial non-unions. These patients were treated with bone marrow MSCs (BM-MSCs) delivered in an autologous bone marrow concentrate (BMC). Clinical outcomes and marrow cellularity were compared to 54 non-diabetic, matched patients with tibial non-unions also treated with BMC.
  
  
  
  After adjusting for age and sex, no differences were identified with respect to bone marrow cellularity and MSC number among the diabetic and non-diabetic groups and both groups received approximately the same number of MSCs on average. BMC treatment promoted non-union healing in 41 diabetic patients (76 %) and 49 non-diabetic patients (91 %), but the non-diabetic patients healed more quickly and produced a larger volume of callus.
  
  
  
  We recommend that diabetic patients be treated with an increased number of progenitor cells by increasing the bone marrow aspiration volume. We also anticipate a need to extend the time of casting and non-weight bearing for diabetic patients as compared with non-diabetic patients.
authors.affiliation: Orthopaedic Surgery, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France.
authors.forename: Charles Henri
authors.initials: CH
authors.lastname: Flouzat-Lachaniette
authors.affiliation: Orthopaedic Surgery, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France.
authors.forename: Clemence
authors.initials: C
authors.lastname: Heyberger
authors.affiliation: Orthopaedic Surgery, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France.
authors.forename: Charlie
authors.initials: C
authors.lastname: Bouthors
authors.affiliation: Orthopaedic Surgery, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubineau
authors.affiliation: EFS Cell Therapy Facility, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chevallier
authors.affiliation: EFS Cell Therapy Facility, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Rouard
authors.affiliation: Orthopaedic Surgery, Hôpital Henri Mondor, University Paris East (UPEC), 94010, Creteil, France. philippe.hernigou@wanadoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hernigou
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000188:drug therapy*; D005260:Female; D005599:Fractures, Ununited / Q000628:therapy*; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D008875:Middle Aged; D010012:Osteogenesis; D014945:Wound Healing / Q000187:drug effects*
keywords: Bone marrow progenitors in diabetes; Diabetes; Functionality of progenitor cells in diabetes; Mesenchymal stem cells; Non-union