Allogenic perinatal tissue for musculoskeletal regenerative medicine applications: a systematic review protocol

Abstract

Background Musculoskeletal ailments impact the lives of millions of people, and at times necessitate surgery followed by physiotherapy, drug treatments, or immobilization. Regenerative musculoskeletal medicine has undergone enormous progress over the last few decades. Sources of tissues used for regenerative medicine purposes can be grouped into autologous or allogenic. Although autologous sources are promising, there is a wide range of limitations with the treatment, including the lack of randomized controlled studies for orthopaedic conditions, donor site morbidity, and highly variable outcomes for patients. Allogenic sources bypass some of these shortcomings and are a promising source for orthopaedic regenerative medicine applications. Methods A systematic search will be performed using PubMed, Elsevier, ScienceDirect, and Google Scholar databases for articles published in English before May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and guidelines will be used. Studies will be eligible if they apply to acute and chronic orthopaedic musculoskeletal complications or animal or human disease models. Publications must include the use of MSCs and/or tissue obtained from amniotic/chorionic membrane, amniotic fluid, umbilical cord, and/or umbilical cord-derived Wharton’s jelly as an intervention. Placebos, noninjury models, acute injury models, non-injury models, and gold standard treatments will be compared. The study selection will be performed by two independent reviewers using a dedicated reference management software. Data synthesis and meta-analysis will be performed separately for preclinical and clinical studies. Discussion The results will be published in relevant peer-reviewed scientific journals. Investigators will present results at national or international conferences. Trial registration: The Protocol will be registered on PROSPERO international prospective register of systematic reviews prior to commencement.

Exosomes for the Management of Low Back Pain: A Review of Current Clinical Evidence

“…The last decade has seen a marked increase in the use of orthobiologics for regenerative medicine applications, including managing chronic MSK pain conditions [18]. Orthobiologics currently utilized in the clinical practice include autologous peripheral blood-derived orthobiologics, such as leukocyte-rich or poor platelet-rich plasma; adipose tissue-derived formulations, such as stromal vascular fraction; bone marrow aspirate concentrate; and perinatal tissue-derived biologics such as amniotic tissue (membrane and/or fluid), umbilical cord and Wharton's jelly [2,[18][19][20][21][22][23][24]. The effectiveness of these biologics is credited to the presence of stem cells and/or bioactive molecules such as growth factors, cytokines, and extracellular vesicles or exosomes [25].…”

Wharton’s jelly and osteoarthritis of the knee

“… 14 Perinatal tissues for orthobiologic use can be sourced from the amnion/chorion membrane, amniotic fluid, umbilical cord (UC) and umbilical cord–derived Wharton’s jelly (UC-WJ) along with the mesenchymal stromal/stem cells associated with these tissues. 15 …”

Editorial: Regenerative biologics for musculoskeletal injuries

“…Musculoskeletal (MSK) injuries affect bones, tendons, ligaments, muscles and nerves, and, in the long-term, result in pain, diminished function, instability and osteoarthritis (OA) ( 1 , 2 ). MSK injuries are conventionally managed using non-pharmacological modalities such as immobilization, physiotherapy and activity modification; pharmacological agents such as non-steroidal anti-inflammatory drugs, narcotics, corticosteroids and viscosupplementation; minimally invasive procedures such as radiofrequency ablation; and surgery in advanced stages or when conservative therapies have been unsuccessful ( 1 – 3 ). However, these treatment options have shortcomings and potential side-effects ( 1 – 3 ).…”

“…The last decade has seen a significant increase in the use of biologics for MSK regenerative medicine applications. Biologics can be derived from autologous sources, such as platelet-rich plasma (PRP), or allogenic sources, such as perinatal tissue derived formulations ( 1 – 3 ). In our research topic, “ Regenerative Biologics for Musculoskeletal Injuries ”, three articles highlighted the potential of these biologics for different MSK conditions, and one emphasized the importance of ultrasound guidance to improve injection accuracy.…”