“…Nineteen studies including 584 knee OA patients (352 cases for MSC group and 232 cases for control group) fulfilled the predefined inclusion criteria and were included in the final analysis ( Figure 1 ). Eighteen publications were full-text articles [ [2] , [3] , [4] , [5] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , 21 , 23 ], and one publication was conference abstract [ 6 ]. Figure 1 Flow diagram of studies identified, included and excluded.…”
Section: Evidence Synthesismentioning
confidence: 99%
“…The characteristics of included studies are shown in Table 1 . Among the included studies, there were 15 RCTs [ 3 , 5 , 6 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , 18 , 19 , 21 , 23 ], two retrospective studies [ 1 , 17 ] and two cohort studies [ 4 , 16 ]. All the 19 papers were fully published during the period from 2012 to 2019.…”
Section: Evidence Synthesismentioning
confidence: 99%
“…OA is characterized by reduction of articular chondrocytes and destruction of joint matrix [ 2 ]. Specifically, symptoms of OA include continuous chondrocyte cartilage damage [ 3 ], articular chondrocyte loss [ 4 ], subchondral microfracture [ 5 ], subchondral bone exposure [ 6 ], joint edge and subchondral bone hyperplasia [ 10 ]. Clinically OA patients suffer from slowly developing joint pain, joint stiffness, joint swelling, decreased joint range of movement and joint deformity [ 2 , 7 ].…”
Summary
Stem cells are considered to be one of the greatest potential treatments to cure degenerative diseases. Stem cells injection for knee osteoarthritis (OA) is still a relatively new treatment and has not yet gained popularity. So, the effectiveness, safety and potential of mesenchymal stem cells (MSCs) for knee OA treatment is worthy to be explored. Explore the effectiveness and safety of mesenchymal stem cells (MSCs) in the treatment of knee osteoarthritis. We collected clinical trials using MSCs as treatment for knee OA (before April 2019), including randomized controlled trials (RCTs), retrospective studies and cohort studies. We searched PubMed, EMBASE, Cochrane Library, Web of Science and the ClinicalTrials.gov with keywords (Mesenchymal stem cells [MSCs], Knee osteoarthritis, Effectiveness and Safety), and then performed a systematic review and cumulative metaanalysis of all RCTs and retrospective comparative studies. To evaluate the effectiveness and safety of MSC in knee OA treatment, we applied visual analog scale score, Western Ontario and McMaster Universities Osteo-arthritis Index and adverse events. We included 15 RCTs, two retrospective studies and two cohort studies including a total of 584 knee OA patients in this study. We demonstrated that MSC treatment could significantly decrease visual analog scale in a 12-month follow-up study compared with controls (p < 0.001). MSC therapy also showed significant decreases in Western Ontario and McMaster Universities Osteoarthritis Index scores after the 6-month follow-up (p < 0.001). MSC therapy showed no difference compared with controls (p > 0.05) in adverse events. We suggest that MSC therapy could serve as an effective and safe therapy for clinical application in OA treatment.
The translational potential of this article
This study provided the best available evidence and a wider perspective to MSCs application in the management of knee OA. MSCs therapy will have great translational potential in the clinical treatment of various degenerative diseases once optimum formula and explicit target population are identified.
“…Nineteen studies including 584 knee OA patients (352 cases for MSC group and 232 cases for control group) fulfilled the predefined inclusion criteria and were included in the final analysis ( Figure 1 ). Eighteen publications were full-text articles [ [2] , [3] , [4] , [5] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , 21 , 23 ], and one publication was conference abstract [ 6 ]. Figure 1 Flow diagram of studies identified, included and excluded.…”
Section: Evidence Synthesismentioning
confidence: 99%
“…The characteristics of included studies are shown in Table 1 . Among the included studies, there were 15 RCTs [ 3 , 5 , 6 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , 18 , 19 , 21 , 23 ], two retrospective studies [ 1 , 17 ] and two cohort studies [ 4 , 16 ]. All the 19 papers were fully published during the period from 2012 to 2019.…”
Section: Evidence Synthesismentioning
confidence: 99%
“…OA is characterized by reduction of articular chondrocytes and destruction of joint matrix [ 2 ]. Specifically, symptoms of OA include continuous chondrocyte cartilage damage [ 3 ], articular chondrocyte loss [ 4 ], subchondral microfracture [ 5 ], subchondral bone exposure [ 6 ], joint edge and subchondral bone hyperplasia [ 10 ]. Clinically OA patients suffer from slowly developing joint pain, joint stiffness, joint swelling, decreased joint range of movement and joint deformity [ 2 , 7 ].…”
Summary
Stem cells are considered to be one of the greatest potential treatments to cure degenerative diseases. Stem cells injection for knee osteoarthritis (OA) is still a relatively new treatment and has not yet gained popularity. So, the effectiveness, safety and potential of mesenchymal stem cells (MSCs) for knee OA treatment is worthy to be explored. Explore the effectiveness and safety of mesenchymal stem cells (MSCs) in the treatment of knee osteoarthritis. We collected clinical trials using MSCs as treatment for knee OA (before April 2019), including randomized controlled trials (RCTs), retrospective studies and cohort studies. We searched PubMed, EMBASE, Cochrane Library, Web of Science and the ClinicalTrials.gov with keywords (Mesenchymal stem cells [MSCs], Knee osteoarthritis, Effectiveness and Safety), and then performed a systematic review and cumulative metaanalysis of all RCTs and retrospective comparative studies. To evaluate the effectiveness and safety of MSC in knee OA treatment, we applied visual analog scale score, Western Ontario and McMaster Universities Osteo-arthritis Index and adverse events. We included 15 RCTs, two retrospective studies and two cohort studies including a total of 584 knee OA patients in this study. We demonstrated that MSC treatment could significantly decrease visual analog scale in a 12-month follow-up study compared with controls (p < 0.001). MSC therapy also showed significant decreases in Western Ontario and McMaster Universities Osteoarthritis Index scores after the 6-month follow-up (p < 0.001). MSC therapy showed no difference compared with controls (p > 0.05) in adverse events. We suggest that MSC therapy could serve as an effective and safe therapy for clinical application in OA treatment.
The translational potential of this article
This study provided the best available evidence and a wider perspective to MSCs application in the management of knee OA. MSCs therapy will have great translational potential in the clinical treatment of various degenerative diseases once optimum formula and explicit target population are identified.
“…Historically, autologous transplantation has been the gold standard for cell therapies to avoid an adverse immune response or even donor rejection. There are several reports of clinical improvements using autologous and allogeneic MSCs and chondrocytes for subchondral bone and cartilage repair . Moreover, allogeneic stem cells are promising, readily available products that could revolutionize interventions for the treatment of early‐onset OA.…”
Section: Stem Cell Therapy Bone Marrow Concentrate Lipoaspirate Anmentioning
confidence: 99%
“…There are several reports of clinical improvements using autologous and allogeneic MSCs and chondrocytes for subchondral bone and cartilage repair. [103][104][105][106][107][108] Moreover, allogeneic stem cells are promising, readily available products that could revolutionize interventions for the treatment of early-onset OA. However, it is also important to remember that clinical judgment, using autologous or allogeneic stem cells, should be based on evidence.…”
Section: Sources Of Stem Cells and Their Therapeutic Potentialmentioning
Musculoskeletal injuries that disrupt the structure and function of diarthrodial joints can cause permanent biomechanical alterations and lead to a more severe, chronic condition. Despite advancements that have been made to restore tissue function and delay the need for joint replacement, there are currently no disease-modifying therapies for osteoarthritis (OA). To reduce the risk of OA, innovative preventive medicine approaches have been developed over the last decade to treat the underlying pathology. Several biological approaches are promising treatment modalities for various stages of OA owing to their minimally invasive nature and actively dynamic physiological mechanisms that attenuate tissue degradation and inflammatory responses. Individualized growth factor and cytokine therapies, tissue-engineered biomaterials, and cell-based therapies have revolutionary potential for orthopedic applications; however, the paucity of standardization and categorization of biological components and their counterparts has made it difficult to determine their clinical and biological efficacy. Cell-based therapies and tissue-engineered biologics have become lucrative in sports medicine and orthopedics; nonetheless, there is a continued effort to produce a biological treatment modality tailored to target intra-articular structures that recapitulates tissue function. Advanced development of these biological treatment modalities will potentially optimize tissue healing, regeneration, and joint preservation strategies. Therefore, the purpose of this paper is to review current concepts on several biological treatment approaches for OA.
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