Adult Stem Cells: MFAT or BMAC?

Samuel G Oltman. ND, RMSK

The two legitimate ways to obtain mesenchymal stem cells is via fat or bone marrow. The fat-based product that we use at Cascade Regenerative Medicine is called micro-fragmented adipose tissue (MFAT). The bone marrow-based product used by other clinics is called bone marrow aspirate concentrate (BMAC). (There is a totally seperate conversation on "stem cell therapy", of which neither of these are). There are differences in the cellular composition of each tissue but at the end of the day, the only difference that matters for you, the patient, is: which one works better? 

Stem Cell Studies

Two recent studies looked at MFAT vs BMAC head to head for knee osteoarthritis. The results of both studies were that the effectiveness of the two types of therapy were equal. One study looked at outcomes at 6 months and the other for up to 18 months post treatment. MFAT and BMAC had comparable pain relief and function benefits (1, 2). 

Relatedly, the number of mesenchymal stem cells in each tissue type has been contested. While MFAT has a greater percentage of stem cells, bone marrow has more total cells, so it ends up being roughly equal. This may account for the equal effectiveness. However, there is a much greater variability in bone marrow harvesting than in fat harvesting, meaning that in theory they are equal but in practice, the cell number you’re getting from bone marrow is much more dependent on proper harvesting technique and the health of the patient (3). 

MFAT vs BMAC Harvesting

If MFAT and BMAC have roughly the same number of stem cells and seem to be equally effective, what’s the difference? The harvesting method and its impact on you is the most important thing to consider. Harvesting fat is very simple, easy, and relatively painless with nothing more than local anesthetic. Harvesting bone marrow is technically simple, but much more invasive and requires sedation because of the pain of drilling into your bone. MFAT is superior because of the ease in obtaining the cells and we can obtain much higher volumes as needed based on the procedure. 

The complexity and invasiveness of BMAC also raises the price of this treatment. We know from above that you can’t expect any superior pain relief. So why do a procedure that requires you to pay for an anesthesiologist to sedate you when you can get the same clinical benefit with MFAT using local anesthesia for a lower price? 

When proponents of BMAC talk about the differences in harvesting they use literature comparing plastic surgery liposuction with bone marrow harvesting, showing a higher complication rate for liposuction. But this is an “apples to oranges'' comparison: the harvest for MFAT is not like aesthetic liposuction. It is lower pressure, more gentle, and much lower volume, effectively eliminating all the documented adverse effects. 

Moreover, a more detailed criticism of MFAT relates to the average fat harvest using lidocaine (4, 5), a substance toxic to stem cells. Here at Cascade Regenerative Medicine, we do not use lidocaine for anything that touches stem cells. We use ropivicaine, which has been shown to allow for robust stem cell growth. 

Lastly, the aspect that is not conveyed in the studies on MFAT is the specific approach we use here: We combine every MFAT treatment with PRP to maximize the growth factor dose and optimize the response of the stem cells. This nullifies the advantage BMAC has over MFAT in terms of growth factor content. We believe provides the best combination of clinical improvement, stem cell dose, and minimal invasiveness. 

We understand that this landscape can be confusing and we work to make it as clear as possible for you. In our experience, the ease of MFAT leaves patients much happier and allows us to perform the procedure for a lower price than clinics doing BMAC. Our goal is to provide the best therapies at the best price. When you look at the details, we stand out from the rest. Come see the difference today at Cascade Regenerative Medicine.

References:

1. Mautner K, Bowers R, Easley K, Fausel Z, Robinson R. Functional outcomes following microfragmented adipose tissue versus bone marrow aspirate concentrate injections for symptomatic knee osteoarthritis. Stem Cells Transl Med. 2019;8(11):1149-1156.

2. Pintore A, Notarfrancesco D, Zara A, et al. Intra-articular injection of bone marrow aspirate concentrate (Bmac) or adipose-derived stem cells (Adscs) for knee osteoarthritis: a prospective comparative clinical trial. Journal of Orthopaedic Surgery and Research. 2023;18(1):350.

3. Brozovich A, Sinicrope BJ, Bauza G, et al. High variability of mesenchymal stem cells obtained via bone marrow aspirate concentrate compared with traditional bone marrow aspiration technique. Orthop J Sports Med. 2021;9(12):23259671211058460.

4. MD CC. Why liposuction anesthetic kills stem cells - regenexx®. Regenexx.

5. Wang WZ, Fang XH, Williams SJ, et al. Lidocaine-induced ASC apoptosis (Tumescent vs. Local anesthesia). Aesthetic Plast Surg. 2014;38(5):1017-1023.