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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Apr 26, 2020; 12(4): 241-250
Published online Apr 26, 2020. doi: 10.4252/wjsc.v12.i4.241
Bone marrow-derived products: A classification proposal – bone marrow aspirate, bone marrow aspirate concentrate or hybrid?
Joseph Purita, José Fábio Santos Duarte Lana, Morey Kolber, Bruno Lima Rodrigues, Tomas Mosaner, Gabriel Silva Santos, Carolina Caliari-Oliveira, Stephany Cares Huber
Joseph Purita, Institute of Regenerative Medicine, Boca Raton, FL 33432, United States
José Fábio Santos Duarte Lana, Tomas Mosaner, Gabriel Silva Santos, Institute of Bone and Cartilage, Indaiatuba, SP 13334-170, Brazil
Morey Kolber, Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL 33314, United States
Bruno Lima Rodrigues, Stephany Cares Huber, University of Campinas, Campinas, SP 13083-970, Brazil
Carolina Caliari-Oliveira, In Situ Cell Therapy, Ribeirão Preto, SP 14056-680, Brazil
Author contributions: Purita J and Kolber M wrote the manuscript; Lana JFSD and Rodrigues BL designed the ACH classification concepts; Huber SC and Caliari-Oliveira C created Tables 1 and 2 and compiled the reference list; Santos GS proposed the schematic representation of the ACH classification illustrated in Figure 1 and Mosaner T reviewed the literature to validate information.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: José Fábio Santos Duarte Lana, MD, Chief Doctor, Surgeon, Institute of Bone and Cartilage, 1386 Presidente Kennedy Avenue, Indaiatuba, SP 13334-170, Brazil. josefabiolana@gmail.com
Received: December 25, 2019
Peer-review started: December 25, 2019
First decision: January 19, 2020
Revised: February 7, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 26, 2020
Processing time: 123 Days and 19.4 Hours
Abstract

Degenerative musculoskeletal disorders are one of the top causes of pain and disability in the adult population. Current available alternatives to mitigate symptoms include conservative treatments such as the administration of pharmacological agents and an educative approach towards lifestyle modification. The use of certain analgesics, such as opiates and corticosteroids, delivers short term results but do not address the etiological source of pain and disability. Also, prolonged use of such medications may cause additional complications. Therefore, the demand for musculoskeletal tissue regeneration has led to an alternative approach referred to as “orthobiologics”. This alternative is based on cellular and molecular components capable of inducing and promoting tissue repair. Bone marrow (BM) aspirate (BMA) and concentrate are well-known orthobiologics used to treat musculoskeletal conditions. Orthobiologics derived from the BM have been discussed in the literature; however, the lack of standardization regarding collection and processing protocols presents a challenge for generalization of study outcomes and determination of efficacy. Since BM-derived orthobiologics have not yet been classified, to our knowledge, this manuscript proposes the ACH classification system, which speaks to BMA (A), BMA and concentrate (C) and hybrid (H), which combines A and C. This classification proposes and describes 8 parameters that are relevant for the quality of biological products. The more parameters used would imply greater characterization and complexity of the evaluation of the biological product used. The ACH classification envisages a necessary contribution to the comprehension of both clinical procedures and research outcomes, ultimately ushering in a standardization of best practice.

Keywords: Bone-marrow classification; Bone-marrow aspirate concentrate; Regenerative medicine; Stem cells; Musculoskeletal disorders; Orthobiologics

Core tip: Degenerative musculoskeletal disorders are one of the top causes of pain and disability in the adult population. The use of certain analgesics delivers short term results but do not address the etiological source of pain and disability. The demand for musculoskeletal tissue regeneration has led to an alternative approach referred to as orthobiologics, which is based on cellular and molecular components capable of promoting tissue repair. Bone marrow aspirate and concentrate are well-known orthobiologics used to treat musculoskeletal conditions. Since bone marrow-derived orthobiologics have not yet been classified, to our knowledge, this manuscript proposes the ACH classification system.