Clinical efficacy and safety of mesenchymal stem cell transplantation for osteoarthritis treatment: A meta-analysis

Abstract

PurposeThe aim of this study was to evaluate the therapeutic efficacy and safety of mesenchymal stem cells (MSCs) for the treatment of patients with knee osteoarthritis (OA).MaterialsWe performed a meta-analysis of relevant published clinical studies. An electronic search was conducted for randomized controlled trials (RCTs) of MSC-based therapy in knee OA. The visual analogue scale (VAS), International Knee Documentation Committee (IKDC) form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne algofunctional indices (Lequesne), Lysholm knee scale (Lysholm), Tegner activity scale (Tegner) and adverse events (AEs) were evaluated.ResultsEleven eligible trials with 582 knee OA patients were included in the present meta-analysis. We demonstrated that MSC treatment could significantly decrease VAS and increase IKDC scoresafter a 24-month follow-up compared with controls (P<0.05). MSC therapy also showed significant decreases in WOMAC and Lequesne scores after the 12-month follow-up (P<0.01). Analysis of Lysholm (24-month) and Tegner (12- and 24-month) scores also demonstrated favorable results for MSC treatment (P<0.05).ConclusionOverall, MSC transplantation treatment was shown to be safe and has great potential as an efficacious clinical therapy for patients with knee OA.

Emerging Potential of Cell Based Therapies for Articular Cartilage Repair and Regeneration

“…25,26 However, the clinical outcome with these treatments has been modest, mostly requiring TKR. 8,27 The major limiting factor with prosthetic implants is the lifespan of current implants which remains a concern, especially in young population. TKR is also associated with significant complications that includes deep vein thrombosis and infection, as well as post-surgical joint stiffness and muscle atrophy.…”

“…6,7 Osteoarthritis of the knee is the most common chronic condition affecting all races, gender and ages, but known to be the most common in elderly and obese people. 8,9 The knee acts as a conduit for transferring body weight essential for normal human mobility and the menisci is known to maintain the normal function of the knee, distribute load, lubricate the joint and provide joint stability. Injury to the meniscus from ageing cartilage, repetitive activity or trauma results in pain, limits movement and can accelerate the occurrence and development of OA.…”

“…8,10,11 While the prevalence of OA increases with age and causes significant decline in the quality of life of individuals above the age of 65, there is increasing evidence of OA in younger population as a result of prior injuries such as anterior cruciate ligament tear or meniscal tears. 8,12,13 Osteoarthritis affects about 237 million of the population, of which an estimated 9 million people alone in United States suffer from symptomatic knee osteoarthritis and it is predicted that an additional 19 million people will be affected by arthritis by 2020. [14][15][16][17] The incidence of chondral defects is frequent with sporting injuries, and in elderly patients specifically 10% of population over the age of 55 years have troublesome knee pain, and of those, 25% are severely disabled.…”

“…The basic pathophysiological characteristic of knee OA is loss of articular cartilage which is linked to biomechanical and biochemical changes in the cartilage of the knee joint such as, diminished ability to withstand normal mechanical stresses, limited supply of nutrients and oxygen, inadequate synthesis of extracellular matrix components, increased synthesis of tissue-destructive proteinases (matrix metalloproteinases and aggrecanase) and overall apoptosis of chondrocytes. 8,9,20,21 Although, recently synovial inflammation has been reported as a factor limiting cartilage repair. 22 Articular cartilage exhibits little or no ability for self-repair, because of the low mitotic ability of chondrocytes, and lack of blood, lymphatic or nerve supply, resulting in progressive tissue loss and dysfunction and presenting as a potential challenge for orthopaedic surgeons.…”

“…8,10,11 While the prevalence of OA increases with age and causes significant decline in the quality of life of individuals above the age of 65, there is increasing evidence of OA in younger population as a result of prior injuries such as anterior cruciate ligament tear or meniscal tears. 8,12,13 Figure 1 Comparison schematic between healthy knee and arthritic knee.Osteoarthritis affects about 237 million of the population, of which an estimated 9 million people alone in United States suffer from symptomatic knee osteoarthritis and it is predicted that an additional 19 million people will be affected by arthritis by 2020. …”