Background: Regenerative strategies based on the use of platelet concentrates
as an autologous source of growth factors (GF) has been proposed to promote
the healing of long bone nonunions. However, the relatively high failure rate stimulates
interest in growing knowledge and developing solutions to obtain the best results
from the regenerative approach.
Objective: In this study we evaluated whether a cell-based assay system could be
able to recognize patients who will benefit or not from the use of autologous platelet
Method: The autologous serum was used in culture medium to promote the osteogenic
differentiation of normal bone-marrow stromal cells (BMSC). Blood samples were collected
from 16 patients affected by aseptic long bone nonunion who were candidates to the treatment with
autologous platelet-rich fibrin. The osteoinductive effect was detected by measuring the BMSC proliferation,
the mineralization activity, and the expression of bone-related genes. Serum level of basic fibroblast
growth factor (bFGF) was considered as a representative marker of the delivery of osteogenic
GFs from platelets. Laboratory results were related to the characteristics of the disease before the treatment
and to the outcome at 12 months.
Results: Serum samples from "good responders" showed significantly higher levels of bFGF and were
able to induce a significantly higher proliferation of BMSC, while no significant differences were observed
in terms of osteoblast differentiation.
Conclusion: BMSC-based assay could be a useful tool to recognize patients who have a low probability to
benefit from the use of autologous platelet concentrate to promote the healing of long bone nonunion.