Smoking Significantly Alters Iliac Crest BMAC Proteome, Upregulating Pro-inflammatory Cytokines and Downregulating Anabolic Factors

Bone marrow aspirate concentrate (BMAC) is a promising autologous orthobiologic therapy used in various musculoskeletal conditions, leveraging its rich cellular and growth factor composition to promote tissue regeneration and healing. Despite its growing clinical application, a critical gap exists in understanding how patient-specific demographic factors influence BMAC's biochemical potency. Current standard-of-care protocols often overlook the impact of lifestyle choices like smoking on the quality and efficacy of the aspirate, potentially leading to suboptimal therapeutic outcomes. This study addresses this by investigating how factors such as smoking status, age, sex, and BMI modulate BMAC's protein composition, particularly focusing on pathways related to inflammation, immune response, and tissue regeneration.

BMAC samples were collected from a total of 120 patients (iliac crest: n = 77; humeral head: n = 43) and stratified by smoking status (current, former, never-smokers). The study analyzed 109 analytes across inflammation, immune response, and tissue regeneration pathways using antibody microarrays. Nonparametric statistical analyses, specifically Kruskal-Wallis and Dunn's post hoc tests, were employed, with false discovery rate (FDR) corrections applied to account for multiple comparisons. The primary endpoint was the identification of significant proteomic alterations in BMAC composition correlated with demographic factors.