Demographic Factors Affect the BMAC Proteome

Abstract

Bone marrow aspirate concentrate (BMAC) is a promising orthobiologic therapy, yet the impact of patient demographics on its proteomic profile remains poorly understood. This study investigates how smoking status, age, sex, and BMI modulate BMAC’s protein composition, focusing on 109 analytes across inflammation, immune response, and tissue regeneration pathways. BMAC samples from 120 patients (iliac crest: n = 77; humeral head: n = 43) were stratified by smoking status (current, former, never-smokers) and analyzed via antibody microarrays. Nonparametric statistical analyses (Kruskal–Wallis, Dunn’s post hoc) with false discovery rate (FDR) corrections revealed significant proteomic alterations in iliac crest-derived BMAC from smokers, including upregulated pro-inflammatory cytokines (IL-17, TNF-α; p < 0.05, FDR-adjusted) and downregulated anabolic factors (TGF-β1, BMP-9). Former smokers exhibited intermediate profiles, suggesting partial recovery postcessation. Sex-based differences (e.g., BMP-5, FGF-4) were noted but did not survive FDR correction. Humeral head samples showed minimal smoking-related changes, highlighting site-specific effects. These findings underscore smoking’s catabolic influence on BMAC’s therapeutic potential and advocate for pretreatment cessation protocols.