Intra-articular injection of mesenchymal stem cells for clinical outcomes and cartilage repair in osteoarthritis of the knee: a meta-analysis of randomized controlled trials

Kim, Seong Hwan; Ha, Chul‐Won; Park, Yong Bum; Nam, Eunwoo; Lee, Jung-Eun; Lee, Han-Jun

doi:10.1007/s00402-019-03140-8

Cited by 99 publications

(108 citation statements)

References 36 publications

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“…MSC-induced cartilage improvements, visible in MRI, are an ongoing topic of debate and contradicting results are continuously reported. While some authors demonstrate cartilage regeneration in accordance with clinical improvements [76,77,82,87,97,99], others could not confirm changes in cartilage structure, although clinical improvements were observed [95,103,115].…”

Section: Radiological and Arthroscopic Outcome Evaluationsmentioning

confidence: 91%

“…Most of the aforementioned studies need to be interpreted with caution as they showed a low level of evidence. Results from a recent meta-analysis that assessed five randomized controlled trials on MSC-based therapy for knee OA [64,67,78,79,81] found that limited evidence for pain relief and functional outcomes does exist, yet there is a lack of evidence to support the claim that MSC-based therapy facilitates cartilage repair [115].…”

Section: Radiological and Arthroscopic Outcome Evaluationsmentioning

confidence: 99%

“…al. could not find a recommended cell dose, due to a great variation of concentrations, applied in different randomized controlled trials [115].…”

Section: Cell Dosementioning

confidence: 99%

See 2 more Smart Citations

Mesenchymal Stromal Cell-Based Therapy—An Alternative to Arthroplasty for the Treatment of Osteoarthritis? A State of the Art Review of Clinical Trials

Maleitzke

Elazaly

Festbaum

et al. 2020

JCM

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Osteoarthritis (OA) is the most common degenerative joint disorder worldwide and to date no regenerative treatment has been established in clinical practice. This review evaluates the current literature on the clinical translation of mesenchymal stromal cell (MSC)-based therapy in OA management with a focus on safety, outcomes and procedural specifics. PubMed, Cochrane Library and clinicaltrials.gov were searched for clinical studies using MSCs for OA treatment. 290 articles were initially identified and 42 articles of interest, including a total of 1325 patients, remained for further examination. Most of the included studies used adipose tissue-derived MSCs or bone-marrow-derived MSCs to treat patients suffering from knee OA. MSC-based therapy for knee OA appears to be safe and presumably effective in selected parameters. Yet, a direct comparison between studies was difficult due to a pronounced variance regarding methodology, assessed outcomes and evidence levels. Intensive scientific engagement is needed to identify the most effective source and dosage of MSCs for OA treatment in the future. Consent on outcome measures has to be reached and eventually patient sub-populations need to be identified that will profit most from MSC-based treatment for OA.

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Section: Radiological and Arthroscopic Outcome Evaluationsmentioning

confidence: 91%

Section: Radiological and Arthroscopic Outcome Evaluationsmentioning

confidence: 99%

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Mesenchymal Stromal Cell-Based Therapy—An Alternative to Arthroplasty for the Treatment of Osteoarthritis? A State of the Art Review of Clinical Trials

Maleitzke

Elazaly

Festbaum

et al. 2020

JCM

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“…Many of the systemic reviews have reported that the treatment of knee osteoarthritis with intra-articular injections of stem cells showed favorable results in which the therapy can reduce knee pain and improve physical func-tion and cartilage quality [34,51,52]. However, there have been reports which did not have optimistic or promising point of views [53,54].…”

Section: ) Osteoarthritismentioning

confidence: 99%

Stem cell therapy in pain medicine

et al. 2019

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Stem cells are attracting attention as a key element in future medicine, satisfying the desire to live a healthier life with the possibility that they can regenerate tissue damaged or degenerated by disease or aging. Stem cells are defined as undifferentiated cells that have the ability to replicate and differentiate themselves into various tissues cells. Stem cells, commonly encountered in clinical or preclinical stages, are largely classified into embryonic, adult, and induced pluripotent stem cells. Recently, stem cell transplantation has been frequently applied to the treatment of pain as an alternative or promising approach for the treatment of severe osteoarthritis, neuropathic pain, and intractable musculoskeletal pain which do not respond to conventional medicine. The main idea of applying stem cells to neuropathic pain is based on the ability of stem cells to release neurotrophic factors, along with providing a cellular source for replacing the injured neural cells, making them ideal candidates for modulating and possibly reversing intractable neuropathic pain. Even though various differentiation capacities of stem cells are reported, there is not enough knowledge and technique to control the differentiation into desired tissues in vivo. Even though the use of stem cells is still in the very early stages of clinical use and raises complicated ethical problems, the future of stem cells therapies is very bright with the help of accumulating evidence and technology.

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“…[2][3][4] A randomized controlled clinical trial is generally designed to compare the differences in efficacy between treatments for knee OA. [5] However, a small sample size (n < 30 patients for each treatment group) is usually enrolled to examine the differences, [6] which might be due to lack of human and financial resources. A small sample size is associated with low statistical power of the study, which could produce inconclusive results.…”

Section: Introductionmentioning

confidence: 99%

Comparison of statistical methods for analysis of small sample sizes for detecting the differences in efficacy between treatments for knee osteoarthritis

Shih¹,

Hung

2020

Preprint

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Background A small sample size (n < 30 for each treatment group) is usually enrolled to investigate the differences in efficacy between treatments for knee osteoarthritis (OA). The objective of this study was to use simulation for comparing the power of four statistical methods for analysis of small sample size for detecting the differences in efficacy between two treatments for knee OA. Methods A total of 10,000 replicates of 5 sample sizes (n=10, 15, 20, 25, and 30 for each group) were generated based on the previous reported measures of treatment efficacy. Four statistical methods were used to compare the differences in efficacy between treatments, including the two-sample t-test (t-test), the Mann-Whitney U-test (M-W test), the Kolmogorov-Smirnov test (K-S test), and the permutation test (perm-test). Results The bias of simulated parameter means showed a decreased trend with sample size but the CV% of simulated parameter means varied with sample sizes for all parameters. For the largest sample size (n=30), the CV% could achieve a small level (<20%) for almost all parameters but the bias could not. Among the non-parametric tests for analysis of small sample size, the perm-test had the highest statistical power, and its false positive rate was not affected by sample size. However, the power of the perm-test could not achieve a high value (80%) even using the largest sample size (n=30). Conclusion The perm-test is suggested for analysis of small sample size to compare the differences in efficacy between two treatments for knee OA.

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Intra-articular injection of mesenchymal stem cells for clinical outcomes and cartilage repair in osteoarthritis of the knee: a meta-analysis of randomized controlled trials

Cited by 99 publications

References 36 publications

Mesenchymal Stromal Cell-Based Therapy—An Alternative to Arthroplasty for the Treatment of Osteoarthritis? A State of the Art Review of Clinical Trials

Mesenchymal Stromal Cell-Based Therapy—An Alternative to Arthroplasty for the Treatment of Osteoarthritis? A State of the Art Review of Clinical Trials

Stem cell therapy in pain medicine

Comparison of statistical methods for analysis of small sample sizes for detecting the differences in efficacy between treatments for knee osteoarthritis

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