Autologous stem cell therapy in knee osteoarthritis: a systematic review of randomised controlled trials

Abstract

ObjectiveStem cell therapy is increasingly used for knee osteoarthritis (KOA). We aimed to review the evidence of autologous mesenchymal stem cell therapy on pain, function and severity on imaging in KOA.DesignSystematic review of randomised controlled trials (RCTs).Eligibility criteriaRCTs evaluating autologous mesenchymal stem cell (MSC) therapy on patient-reported outcome measures and disease severity.Data sourcesSeven databases were searched until 31 December 2020.Risk of bias and data synthesisRisk of bias was assessed using the ROB V.2. We used Grading of Recommendations Assessment, Development and Evaluation to appraise the certainty of the evidence. Data were synthesised descriptively.ResultsFourteen RCTs were included. A total of 408 patients with KOA received MSC therapy derived from bone marrow, adipose tissue or activated peripheral blood. After 1 year, 19 of 26 (73%) clinical outcome measures improved with MSCs compared with control. In the MSC group, patients improved by 1.8–4.4 points on the Visual Analogue Scale (0–10) and 18–32 points of the Knee Osteoarthritis Outcome Score (0–100). Four studies showed better disease severity on imaging after MSC compared with control at 1 year. Ten of 14 (71%) RCTs were at high risk of bias on all outcomes. No serious adverse events were reported after MSC therapy during a maximum of 4 years follow-up.ConclusionWe found a positive effect of autologous MSC therapy compared with control treatments on patient-reported outcome measures, and disease severity. The certainty of this evidence was low to very low.PROSPERO registration numberCRD42019120506

Stem cell-based therapy for human diseases

“…Moreover, the positive evidence obtained from MRI analysis was low to very low strength of evidence after 1-year post administration. 70 Similar results were also found in the outcome analysis of autologous adipose tissuederived MSCs (AT-MSCs). Thus, the review indicated low quality of evidence for the therapeutic potential of MSC therapy on clinical outcomes and MRI analysis.…”

“…Another systematic review covering 36 clinical trials, of which 14 studies were randomized trials, provides an interesting view in terms of the efficacy of autologous MSC-based therapy in the treatment of OA. 70 In terms of BM-MSCs, 14 clinical trials reported the clinical outcomes at the 1-year follow-up, in which 57% of trials reported clinical outcomes that were significantly better in comparison with the control group. However, strength analysis of the data set showed that outcomes from six trials were low, whereas the outcomes of the remaining eight trials were extremely low.…”

Intraarticular Injections of Mesenchymal Stem Cells in Knee Osteoarthritis: A Review of Their Current Molecular Mechanisms of Action and Their Efficacy

“…Table 1 summarizes systematic reviews and meta-analyses on the clinical efficacy of intraarticular injections of MSCs in knee OA [ 19 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

Intra-articular injection choice for osteoarthritis: making sense of cell source—an updated systematic review and dual network meta-analysis

“…Recently, in-depth research on regenerative medicine represented by mesenchymal stem cells (MSCs) has provided a novel therapeutic strategy for OA treatment [7]. MSC-based intra-articular injections have excellent histocompatibility and robust bioactivity to promote repairs of injured cartilage and cartilage regeneration through injected stem cells and secreted extracellular matrix (ECM) components [8]. Bone marrow mesenchymal stem cells (BMMSCs) achieve satisfactory clinical outcomes due to their convenient availability that enhances its wide application for OA injection therapy [9].…”