If you are suffering from osteoarthritic pain and are researching alternatives to joint replacement or for help in relieving continued pain after joint replacement you will come upon information comparing the use of bone marrow derived stem cells and adipose or fat derived stem cells in aiding your situation.

In my office I choose to use bone marrow-derived stem cells because I find that we can achieve  both success in the patient’s expectations and the goals of the treatment of Stem Cell Therapy, which can be accomplished best and simply by harnessing bone marrow stem cells.

We do not use adipose (fat) stem cells since it is more traumatic for the patient. In addition to breaking up fat tissue with a long trocar, a thick needle has to be used for the injections. In short, adipose procedures are not liked by patients.

Bone Marrow Aspiration (harvesting the stem cells from bone marrow) takes about a minute once I locate the specific area to aspirate, is basically painless for most patients after a lidocaine injection, and can be injected with very small needle. In addition, when we use bone marrow, we are injecting both platelets (PRP) from the bone marrow and stem cells from the bone marrow, in essence two treatments instead of one.

As we discuss these techniques it is important to understand that medicine is a practice and an evolving one. Medicine is also a technology and the technology is ever advancing. Tomorrow Stem Cell Therapy may evolve into something altogether different and we may find new techniques that achieve the results we are looking for.

Researchers have evaluated the effectiveness of Stem Cell Therapy and tissue engineering for treating osteoarthritis. Both bone marrow and adipose-derived stem cells have the potential to provide a permanent biological solution.

One must be careful in analyzing studies.

One study I read suggests that there are more stem cells in adipose than bone marrow. But we are not sure that the number of cells is important, since stem cells divide logarithmically inside the body. And the following studies show that bone marrow stem cells are more effective than adipose stem cells.

  • Researchers at the Mayo Clinic have begun preliminary studies on Bone Marrow Aspirated Stem Cells. They write: Early results show that Bone Marrow Aspirated Stem Cells are safe to use and is a reliable and viable cellular product.1
  • Researchers from the Institutes of Immunology and Pathology, Rikshospitalet University Hospital in Norway, compared articular chondrocytes (the building blocks or cartilage) with stem cells from human bone marrow and adipose tissue, all cultured in hyaluronic acid scaffolds, for their ability to express genes and synthesize proteins associated with chondrogenesis (creating cartilage). The cells were expanded in monolayer cultures. The results were that Chondrogenesis in hyaluronic acid  scaffolds was more efficient using bone marrow stem cells than  than adipose tissue stem cells or chondrocytes.2
  • Doctors at Iran’s Stem Cell Biology Department, Stem Cell Technology Research Center in Tehran found bone marrow stem cells showed the highest capacity for osteogenic differentiation (a processes of bone formation) and hold promising potential for bone tissue engineering and cell therapy applications compared to adipose stem cells. The growth factor genes were expressed more in the differentiated state in bone marrow stem cells compared to adipose tissue.3
  • In a study of stem cells effectiveness on arthritic joints, A greater improvement was seen with Bone marrow stem cells  when compared to adipose-derived stromal vascular fraction and placebo treatment in this horse clinical study conducted at Equine Orthopaedic Research Center, Department of Clinical Sciences, Colorado State University.4

A paper from 2016 published by doctors at the Department of Orthopedics, Georgia Regents University compiled the following findings:

  • Bone Marrow derived stem cells have a higher chondrogenic capability than ADSCs. the Georgia doctors cited a study from the Department of Orthopaedic Surgery, National University of Singapore.
  • Animal studies were also cited that the researchers said: “demonstrate the capability of Bone Marrow derived stem cells to combat osteoarthritis.”
  • The work of Spanish researchers were also noted who treated osteoarthritic knee patients who were unresponsive to conservative treatments. Bone Marrow derived stem cells were injected, and their results indicated strong clinical efficacies such as improved cartilage quality and pain relief without hospitalization or surgery
  • Research from Iran was examined in which patients with hip, knee, and ankle osteoarthritis were treated with bone marrow derived stem cells. All patients enjoyed increased walking distances, improved pain measuring scores,, and improved cartilage regeneration as demonstrated on MRI.5

This clinical study from the Guilin Medical College in China, demonstrated bone-marrow-MSCs to have greater in vivo chondrogenic potential than periosteum, synovium, adipose, and muscle MSCs in this research from the Department of Orthopaedics, the Affiliated Hospital of Guilin Medical College, Guilin, China.6

  • In a large animal model from Freiburg University Hospital in Germany, ASC seem to be inferior to BMSC in terms of osteogenic potential, but that can partially be compensated by the addition of PRP to the ASC. However, BMSC already has PRP within the solution, so no PRP needs to be added to this group.7
  • In this horse model from Louisiana State University, equine BMSCs have superior chondrogenic potential compared with ASCs.8
  • Doctors in Taiwan noted that: Mesenchymal stem cells (MSCs) isolated from either bone marrow or adipose tissue show considerable promise for use in cartilage repair. The MSCs can be sourced from any or all joint tissues and can modulate the immune response. Additionally, MSCs can directly differentiate into chondrocytes under appropriate signal transduction. They also have immunosuppressive and anti-inflammatory paracrine effects. (They change the joint environment from breakdown to healing by telling the other cells to start repairing.)9

In an editorial in the January 2016 issue of the Journal of Arthroscopic and Related Surgery, Associate Editor Merrick J. Wetzler, M.D., wrote: “Harvesting of the ADSCs [fat stem cells] does require an additional procedure, and the cost-effectiveness of the procedure is still under investigation, but as researchers stated in their editorials in 2012 and 2013, ‘We are believers in Stem Cell Therapy’ and ‘Stem cells have substantial potential to allow 21st century physicians and surgeons… to achieve unprecedented tissue healing and repair.’

“We do believe that it is only a matter of time before the harvesting and growth of stem cells will become cost-effective and commercially available and will be added to our treatment options for restoration of articular cartilage.”

That is a good endorsement from surgeons – however, as Dr. Wetzler noted, there is an added cost of the stem cell procedure using adipose (fat) stem cells, along with the more complex harvesting procedure involved in obtaining the fat cells.

Nevertheless, there is more research pending on the value of stem cells from bone marrow vs fat, and other doctors in the field have not concurred on the best modality. In time, studies will most likely provide the answer. And since the field is fairly new, much more exploration is required.

Ask Dr. Darrow about this article

1 Shapiro SA, Kazmerchak SE, Heckman MG, Zubair AC, O’Connor MI. A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis. Am J Sports Med. 2017 Jan;45(1):82-90. doi: 10.1177/0363546516662455. Epub 2016 Sep 30.

2: Jakobsen RB, Shahdadfar A, Reinholt FP, Brinchmann JE. Chondrogenesis in a hyaluronic acid scaffold: comparison between chondrocytes and MSC from bone marrow and adipose tissue. Knee Surg Sports Traumatol Arthrosc. 2010 Oct;18(10):1407-16. doi: 10.1007/s00167-009-1017-4. Epub 2009 Dec 18. Erratum in:Knee Surg Sports Traumatol Arthrosc. 2014 Jul;22(7):1711-4.

3. Shafiee A, Seyedjafari E, Soleimani M, Ahmadbeigi N, Dinarvand P, Ghaemi N. A comparison between osteogenic differentiation of human unrestricted somatic stem cells and mesenchymal stem cells from bone marrow and adipose tissue. Biotechnol Lett. 2011 Jun;33(6):1257-64. doi: 10.1007/s10529-011-0541-8. Epub 2011 Feb 2.

4. Frisbie DD, Kisiday JD, Kawcak CE, Werpy NM, McIlwraith CW. Evaluation of adipose-derived stromal vascular fraction or bone marrow-derived mesenchymal stem cells for treatment of osteoarthritis. J Orthop Res. 2009 Dec;27(12):1675-80. doi: 10.1002/jor.20933. Colorado State University

5 Burke, J., Hunter, M., Kolhe, R., Isales, C., Hamrick, M., & Fulzele, S. (2016). Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis. Clinical and Translational Medicine5, 27. http://doi.org/10.1186/s40169-016-0112-7

6. Li Q, Tang J, Wang R, Bei C, Xin L, Zeng Y, Tang X. Comparing the chondrogenic potential in vivo of autogeneic mesenchymal stem cells derived from different tissues. Artif Cells Blood Substit Immobil Biotechnol. 2011 Feb;39(1):31-8. doi: 10.3109/10731191003776769. Epub 2010 Nov 30. PubMed PMID: 21117872. Guillen China

7 Niemeyer P, Fechner K, Milz S, Richter W, Suedkamp NP, Mehlhorn AT, Pearce S, Kasten P. Comparison of mesenchymal stem cells from bone marrow and adipose tissue for bone regeneration in a critical size defect of the sheep tibia and the influence of platelet-rich plasma. Biomaterials. 2010 May;31(13):3572-9.

8 Vidal MA, Robinson SO, Lopez MJ, Paulsen DB, Borkhsenious O, Johnson JR, Moore RM, Gimble JM. Comparison of chondrogenic potential in equine mesenchymal stromal cells derived from adipose tissue and bone marrow. Vet Surg. 2008 Dec;37(8):713-24. doi: 10.1111/j.1532-950X.2008.00462.x. PubMed PMID: 19121166;PubMed Central PMCID: PMC2746327.

9 Chang YH, Liu HW, Wu KC, Ding DC. Mesenchymal stem cells and their clinical applications in osteoarthritis. Cell Transplant. 2015 Dec 18. [Epub ahead of print.]