Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow‐up of three patients

Abstract

Aim: Osteoarthritis is a degenerative joint disease characterized by the destruction of joint cartilage. Mesenchymal stem cells (MSCs) are found in low numbers in normal cartilage, mainly in the superficial layer, acting as repairing agents. In OA, MSCs are seen in larger numbers, but act chaotic and are unable to repair the cartilage. The synovial membrane becomes inflamed and interacts with the cartilage. Transplanted MSC have the ability to normalize them, redirecting them to their normal function. In a preliminary study, we showed that MSC could improve knee OA in four patients at 6 months. This report shows their long-term follow-up at 5 years.Methods: One patient was lost to follow-up at 2 years and three were followed for 5 years. They were aged 55, 57, 65 and 54 years, and had moderate to severe knee osteoarthritis. The worse knee of each patient was injected with 8-9 9 10 6 MSC.Results: As previously reported, all parameters improved in transplant knees at 6 months (walking time, stair climbing, gelling pain, patella crepitus, flection contracture and the visual analogue score on pain). Then, they started gradually to deteriorate, but at 5 years they were still better than at baseline. PGA (Patient Global Assessment) improved from baseline to 5 years. The better knee at baseline (no MSC), continued its progression toward aggravation and at 5 years became the worse knee. Conclusion:Transplant knees were all in a rather advanced stage of OA. Earlier transplantation may give better results in long-term follow-up. This is what future studies have to demonstrate.

Efficacy of mesenchymal stem cells in treating patients with osteoarthritis of the knee: A meta-analysis

“…Four systematic reviews (35)(36)(37)(38) were also excluded. An assessment of the remaining 18 studies revealed that 10 used a single-arm prospective design (18)(19)(20)(39)(40)(41)(42)(43)(44)(45), four used quasi-experimental trials (46)(47)(48)(49) and four used RCT (50-53) (Table I). A total of 565 participants (226 males and 339 females) were included from the 18 studies.…”

“…MSCs, which can be derived from blood, bone marrow, skeletal muscle, adipose, skin and synovial membrane (13), have the capacity to differentiate into osteocytes, adipocytes, chondrocytes, myoblasts, tenocytes (14,15), secrete bioactive molecules that stimulate angiogenesis and tissue repair, and reduce the response of T cells and inflammation (16,17). Previous clinical trials have reported that mild/moderate OA or advanced OA can be treated efficiently using autologous or allogenic MSCs through implantation, micro fracture or intra-articular injections (18)(19)(20). However, so far, no meta-analytic research has evaluated the efficacy and safety of MSCs in treating patients with KOA.…”

Stem Cell Therapy in Osteoarthritis

“…A similar study by Devatchi et al [8] where patients received intra-articular injection of autologous bone-marrow derived MSCsin osteoarthritic knee joints and followed over 5 year showed beneficial effect started to decline after 6 months. However clinical outcomes were still better at 5 years compared with baseline, and there were no patient who underwent knee arthroplasty, while better knee at baseline (no MSCs), continued its progression towards aggravation and at 5 years became the worse knee, as reported by patients.…”

Cell Therapy for Osteoarthritis

“…MSCs are widely studied for OA treatment as it expresses certain enzymes such as growth factors, cytokines and are also capable of exerting anti-inflammatory activity [17,18]. Recently Davatchi et al [19] studied 5 year follow up of three patients of knee OA. The authors injected autologous bone marrow derived MSCs into the worst knee of patients aged 57, 65 and 54 years.…”

“…The study examined that the implanted knee was better than at the baseline while the better knee became the worst knee by the end of 5 years. The article concluded that in long term follow up earlier transplantation would give a better result for advanced stage of OA [19]. Subsequently Mehrabani et al treated a middle aged 47 years old nomad woman suffering from a severe right knee OA with an intra-articular injection of bone marrow-derived MSCs.…”