title: Mesenchymal stem cell implantation in atrophic nonunion of the long bones: A translational study.
abstract: OBJECTIVE
  To explore the therapeutic potential of combining bone marrow-derived mesenchymal stem cells (BM-MSCs) and hydroxyapatite (HA) granules to treat nonunion of the long bone.
  
  
  METHODS
  Ten patients with an atrophic nonunion of a long bone fracture were selectively divided into two groups. Five subjects in the treatment group were treated with the combination of 15 million autologous BM-MSCs, 5g/cm(3) (HA) granules and internal fixation. Control subjects were treated with iliac crest autograft, 5g/cm(3) HA granules and internal fixation. The outcomes measured were post-operative pain (visual analogue scale), level of functionality (LEFS and DASH), and radiograph assessment.
  
  
  RESULTS
  Post-operative pain evaluation showed no significant differences between the two groups. The treatment group demonstrated faster initial radiographic and functional improvements. Statistically significant differences in functional scores were present during the first (p = 0.002), second (p = 0.005) and third (p = 0.01) month. Both groups achieved similar outcomes by the end of one-year follow-up. No immunologic or neoplastic side effects were reported.
  
  
  CONCLUSIONS
  All cases of nonunion of a long bone presented in this study were successfully treated using autologous BM-MSCs. The combination of autologous BM-MSCs and HA granules is a safe method for treating nonunion. Patients treated with BM-MSCs had faster initial radiographic and functional improvements. By the end of 12 months, both groups had similar outcomes.Cite this article: H.D. Ismail, P. Phedy, E. Kholinne, Y. P. Djaja, Y. Kusnadi, M. Merlina, N. D. Yulisa. Mesenchymal stem cell implantation in atrophic nonunion of the long bones: A translational study. Bone Joint Res 2016;5:287-293. DOI: 10.1302/2046-3758.57.2000587.
authors.affiliation: Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo General Hospital-Faculty of Medicine, Universitas Indonesia, and Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Otista 3/36, RT 1 RW 8, East Jakarta 13330, Indonesia ismailortho@gmail.com.
authors.forename: H D
authors.initials: HD
authors.lastname: Ismail
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Salemba 6, Jakarta Pusat 10430, Indonesia.
authors.forename: P
authors.initials: P
authors.lastname: Phedy
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Salemba 6, Jakarta Pusat 10430, Indonesia.
authors.forename: E
authors.initials: E
authors.lastname: Kholinne
authors.affiliation: Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo General Hospital, Janur Indah I Blok LA2 no 9, North Jakarta 14240, Indonesia.
authors.forename: Y P
authors.initials: YP
authors.lastname: Djaja
authors.affiliation: ReGeniC Laboratory, PT Bifarma Adiluhung and Stem Cell & Cancer Institute, PT Kalbe Farma Tbk, Jl. Jenderal Ahmad Yani Jl. Pulo Mas No.2, RT.3/RW.13, Kayu Putih, Kota Jakarta Timur, Daerah Khusus Ibukota Jakarta, Indonesia.
authors.forename: Y
authors.initials: Y
authors.lastname: Kusnadi
authors.affiliation: ReGeniC Laboratory, PT Bifarma Adiluhung and Stem Cell & Cancer Institute, PT Kalbe Farma Tbk, Jl. Jenderal Ahmad Yani Jl. Pulo Mas No.2, RT.3/RW.13, Kayu Putih, Kota Jakarta Timur, Daerah Khusus Ibukota Jakarta, Indonesia.
authors.forename: M
authors.initials: M
authors.lastname: Merlina
authors.affiliation: Department of Radiology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Diponegoro 71, Jaharta Pusat, Indonesia.
authors.forename: N D
authors.initials: ND
authors.lastname: Yulisa
keywords: Atrophic nonunion of the long bones; Bone marrow-derived mesenchymal stem cells (BM-MSCs); Hydroxyapatite (HA) granules