Factors Influencing the Yield of Progenitor Cells in Bone Marrow Aspiration Concentrate—A Retrospective Analysis of 58 Patients

Muthu, Sathish; Jeyaraman, Madhan; Narula, Aditya; Ravi, V. R.; Gandi, Avinash; Khanna, Manish; Maffulli, Nicola; Gupta, Ashim

doi:10.3390/biomedicines11030738

Cited by 5 publications

(1 citation statement)

References 54 publications

(69 reference statements)

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“…Importantly, there are no approved MSC products in the United States of America [ 53 ]. Thus, despite the existence of examples of successful global commercial MSC products, including the approval of StemOne®, an allogeneic cell therapy treatment for knee OA approved by the Drug Controller General of India in September 2022 [ 54 ], there is also evidence of mixed clinical effectiveness, which has limited commercial success in major markets. With respect to OA, MSC treatment, as assessed in several randomized clinical trials and meta-analyses, improves pain, function, quality of life scores and cartilage volume [ 46 – 50 , 55 ], but data are based on limited sample sizes, and larger, high-powered trials are needed to reach definitive conclusions.…”

Section: Introductionmentioning

confidence: 99%

Culture-expanded mesenchymal stromal cell therapy: does it work in knee osteoarthritis? A pathway to clinical success

2023

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Osteoarthritis (OA) is a degenerative multifactorial disease with concomitant structural, inflammatory, and metabolic changes that fluctuate in a temporal and patient-specific manner. This complexity has contributed to refractory responses to various treatments. MSCs have shown promise as multimodal therapeutics in mitigating OA symptoms and disease progression. Here, we evaluated 15 randomized controlled clinical trials (RCTs) and 11 nonrandomized RCTs using culture-expanded MSCs in the treatment of knee OA, and we found net positive effects of MSCs on mitigating pain and symptoms (improving function in 12/15 RCTs relative to baseline and in 11/15 RCTs relative to control groups at study endpoints) and on cartilage protection and/or repair (18/21 clinical studies). We examined MSC dose, tissue of origin, and autologous vs. allogeneic origins as well as patient clinical phenotype, endotype, age, sex and level of OA severity as key parameters in parsing MSC clinical effectiveness. The relatively small sample size of 610 patients limited the drawing of definitive conclusions. Nonetheless, we noted trends toward moderate to higher doses of MSCs in select OA patient clinical phenotypes mitigating pain and leading to structural improvements or cartilage preservation. Evidence from preclinical studies is supportive of MSC anti-inflammatory and immunomodulatory effects, but additional investigations on immunomodulatory, chondroprotective and other clinical mechanisms of action are needed. We hypothesize that MSC basal immunomodulatory “fitness” correlates with OA treatment efficacy, but this hypothesis needs to be validated in future studies. We conclude with a roadmap articulating the need to match an OA patient subset defined by molecular endotype and clinical phenotype with basally immunomodulatory “fit” or engineered-to-be-fit-for-OA MSCs in well-designed, data-intensive clinical trials to advance the field.

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