Intraarticular injection of bone marrow-derived mesenchymal stem cells enhances regeneration in knee osteoarthritis.

Claire Doyle, Emily; Wragg, Nicholas; Louise Wilson, Samantha

Abstract

PURPOSE: This review aimed to evaluate the efficacy of intra-articular injections of bone marrow derived mesenchymal stem cells (BM-MSCs) for the treatment of knee osteoarthritis (KOA). METHODS: This narrative review evaluates recent English language clinical data and published research articles between 2014 and 2019. Key word search strings of ((("bone marrow-derived mesenchymal stem cell" OR "bone marrow mesenchymal stromal cell" OR "bone marrow stromal cell")) AND ("osteoarthritis" OR "knee osteoarthritis")) AND ("human" OR "clinical"))) AND "intra-articular injection" were used to identify relevant articles using PMC, Cochrane Library, Web Of Science and Scopus databases. RESULTS: Pre-clinical studies have demonstrated successful, safe and encouraging results for articular cartilage repair and regeneration. This is concluded to be due to the multilineage differential potential, immunosuppressive and self-renewal capabilities of BM-MSCs, which have shown to augment pain and improve functional outcomes. Subsequently, clinical applications of intra-articular injections of BM-MSCs are steadily increasing, with most studies demonstrating a decrease in poor cartilage index, improvements in pain, function and Quality of Life (QoL); with moderate-to-high level evidence regarding safety for therapeutic administration. However, low confidence in clinical efficacy remains due to a plethora of heterogenous methodologies utilised, resulting in challenging study comparisons. A moderate number of cells (40?×?106) were identified as most likely to achieve optimal responses in individuals with grade =?2 KOA. Likewise, significant improvements were reported when using lower (24?×?106) and higher (100?×?106) cell numbers, although adverse effects including persistent pain and swelling were a consequence. CONCLUSION: Overall, the benefits of intra-articular injections of BM-MSCs were deemed to outweigh the adverse effects; thus, this treatment be considered as a future therapy strategy. To realise this, long-term large-scale randomised clinical trials are required to enable improved interpretations, to determine the validity of efficacy in future studies. LEVEL OF EVIDENCE: IV.

Citation

Claire Doyle, E., Wragg, N., & Louise Wilson, S. (2020). Intraarticular injection of bone marrow-derived mesenchymal stem cells enhances regeneration in knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 28, 3827–3842. https://doi.org/10.1007/s00167-020-05859-z

• Journal Article Type: Article
• Acceptance Date: Jan 16, 2020
• Publication Date: Jan 31, 2020
• Journal: Knee Surgery, Sports Traumatology, Arthroscopy
• Print ISSN: 0942-2056
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 28
• Pages: 3827–3842
• DOI: https://doi.org/10.1007/s00167-020-05859-z
• Keywords: Allogenic, Autologous, Cell therapies, Clinical efficacy, Immunomodulation, Mesenchymal stem cells, Optimal dosage, Osteoarthritis.
• Publisher URL: https://link.springer.com/article/10.1007%2Fs00167-020-05859-z