Impact of combined tranexamic acid and vancomycin treatment on osteogenic differentiated human bone marrow-derived mesenchymal stromal cells (hBMSCs) in vitro

Background In our current study, we investigated the impact of tranexamic acid (TXA) and vancomycin powder (VP) on osteogenic differentiated human bone-marrow derived mesenchymal stromal cells (hBMSCs) in vitro . Although topical application of TXA and VP is widely used to prevent post-operative blood loss and perioperative joint infection (PJI) in total joint replacements, the effects of both substances on periarticular tissues are not fully understood. Methods hBMSCs were isolated and multiplied in monolayer cell cultures before osteogenic differentiation was induced for 21 days. ATP assays were used to analyze cell proliferation and Annexin 5 assays were used to analyze cell viability and apoptosis. Expression levels of osteogenic marker genes were measured using semiquantitative RT-PCR. Results Combined treatment with TXA and VP for 96 hours (h) led to significantly decreased cell proliferation rates and decreased cell viability independent of the concentrations used. When using high concentrations of VP (50 mg/mL) this trend was visible after 48 h. In addition, combined treatment with TXA and VP negatively impacted Alizarin Red S staining in a dose-dependent manner. Conclusions Therefore, combined topical application of TXA and VP could be safe when limiting exposure to a maximum of 24 h and using low concentrations. Further in vitro and in vivo research is necessary to fully determine the effects on articular and periarticular tissues.