• Ryosuke Kuroda, Takahiro Niikura, Tomoyuki Matsumoto, Tomoaki Fukui, Keisuke Oe, Yutaka Mifune, Hironobu Minami, Hiroshi Matsuoka, Kimikazu Yakushijin, Yoshiharu Miyata, Shinichiro Kawamoto, Tatsuo Kagimura, Yasuyuki Fujita, and Atsuhiko Kawamoto.
• Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
• Bmc Med. 2023 Oct 5; 21 (1): 386386.

BackgroundWe previously demonstrated that CD34 + cell transplantation in animals healed intractable fractures via osteogenesis and vasculogenesis; we also demonstrated the safety and efficacy of this cell therapy in an earlier phase I/II clinical trial conducted on seven patients with fracture nonunion. Herein, we present the results of a phase III clinical trial conducted to confirm the results of the previous phase studies using a larger cohort of patients.MethodsCD34 + cells were mobilized via administration of granulocyte colony-stimulating factor, harvested using leukapheresis, and isolated using magnetic cell sorting. Autologous CD34 + cells were transplanted in 15 patients with tibia nonunion and 10 patients with femur nonunion, who were followed up for 52 weeks post transplantation. The main outcome was a reduction in time to heal the tibia in nonunion patients compared with that in historical control patients. We calculated the required number of patients as 15 based on the results of the phase I/II study. An independent data monitoring committee performed the radiographic assessments. Adverse events and medical device failures were recorded.ResultsAll fractures healed during the study period. The time to radiological fracture healing was 2.8 times shorter in patients with CD34 + cell transplantation than in the historical control group (hazard ratio: 2.81 and 95% confidence interval 1.16-6.85); moreover, no safety concerns were observed.ConclusionsOur findings strongly suggest that autologous CD34 + cell transplantation is a novel treatment option for fracture nonunion.Trial RegistrationUMIN-CTR, UMIN000022814. Registered on 22 June 2016.© 2023. BioMed Central Ltd., part of Springer Nature.

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