title: Treatment of AVN Using Autologous BM Stem Cells and Activated Platelet-Derived Growth Factor Concentrates.
abstract: BACKGROUND
  Avascular Necrosis (AVN) of hip is a devastating condition seen in younger individuals. It is the ischemic death of the constituents of the bone cartilage of the hip. The femoral head (FH) is the most common site for AVN. It results from interruption of the normal blood flow to the FH that fits into the hip socket. Earlier studies using autologous bone marrow stem cell concentrate injections have shown encouraging results with average success rates. The current study was designed to improve significantly the cartilage regeneration and clinical outcome.
  
  
  METHODS
  Total of 48 patients underwent autologous bone marrow stem cell and activated platelet-rich plasma derived growth factor concentrate (PRP-GFC) therapy for early and advanced stages AVN of femoral head in a single multi-specialty center. The total treatment was divided into three phases. In the phase I, all the clinical diagnostic measurements such as magnetic resonance imaging (MRI), computed tomography (CT) etc. with respect to the AVN patients and bone marrow aspiration from posterior iliac spine from the patients were carried out. In the phase II, isolation of stem cells and preparation from the patients were performed. Subsequently, in phase III, the stem cells and PRP- GFCs were transplanted in the enrolled patients.
  
  
  RESULTS
  Ninety three percent of the enrolled AVN patients showed marked enhancement in the hip bone joint space (more than 3mm) after combined stem cells and PRP-GFC treatment as evidenced by comparison of the pre- and post-treatment MRI data thus indicative of regeneration of cartilage. The treated patients showed significant improvement in their motor function, cartilage regrowth (3 to 10mm), and high satisfaction in the two-year follow-up.
  
  
  CONCLUSIONS
  Combination of stem cell and PRP-GFC therapy has shown promising cartilage regeneration in 45 out of 48 patients of AVN. This study clearly demonstrates the safety and efficacy of this treatment. Larger numbers of patients need to be evaluated to better understand the efficacy of the combined stem cell and PRP-GFC therapy on AVN patients.
authors.affiliation: Department of Orthopedics and Neurology, LIVE 100 Hospital, Bangalore, India.|Department of Regenerative Medicine, LIVE 100 Hospital, Bangalore, India.
authors.forename: Nagaraj H
authors.initials: NH
authors.lastname: Nandeesh
authors.affiliation: Department of Regenerative Medicine, LIVE 100 Hospital, Bangalore, India.
authors.forename: Kiranmayee
authors.initials: K
authors.lastname: Janardhan
authors.affiliation: Merisis Therapeutics - DiponEd BioIntelligence, Bangalore, India.
authors.forename: Vignesh
authors.initials: V
authors.lastname: Subramanian
authors.affiliation: Merisis Therapeutics - DiponEd BioIntelligence, Bangalore, India.
authors.forename: Abhishek Bhushan
authors.initials: AB
authors.lastname: Ashtekar
authors.affiliation: Merisis Therapeutics - DiponEd BioIntelligence, Bangalore, India.
authors.forename: Nandagiri
authors.initials: N
authors.lastname: Srikruthi
authors.affiliation: Merisis Therapeutics - DiponEd BioIntelligence, Bangalore, India.
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Koka
authors.affiliation: Merisis Therapeutics - DiponEd BioIntelligence, Bangalore, India.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Deb
mesh_terms: D000293:Adolescent; D000328:Adult; D001854:Bone Marrow Cells / Q000166:cytology*; D002356:Cartilage / Q000000981:diagnostic imaging / Q000502:physiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010982:Platelet-Derived Growth Factor / Q000494:pharmacology*; D053657:Platelet-Rich Plasma / Q000378:metabolism; D011379:Prognosis; D012038:Regeneration / Q000187:drug effects; D033581:Stem Cell Transplantation; D013234:Stem Cells / Q000166:cytology* / Q000187:drug effects; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D010982:Platelet-Derived Growth Factor
keywords: Avascular Necrosis; Cartilage; Femur Head; Hip; Platelet Rich Plasma - Growth Factor Concentrate (PRP-GFC); Stem Cells