Stem cell therapies for periodontal tissue regeneration: a network meta-analysis of preclinical studies

Abstract

Background Periodontal tissue regeneration (PTR) is the ultimate goal of periodontal therapy. Currently, stem cell therapy is considered a promising strategy for achieving PTR. However, there is still no conclusive comparison that distinguishes clear hierarchies among different kinds of stem cells. Methods A systematic review and network meta-analysis (NMA) was performed using MEDLINE (via PubMed), EMBASE, and Web of Science up to February 2020. Preclinical studies assessing five types of stem cells for PTR were included; the five types of stem cells included periodontal ligament-derived stem cells (PDLSCs), bone marrow-derived stem cells (BMSCs), adipose tissue-derived stem cells (ADSCs), dental pulp-derived stem cells (DPSCs), and gingival-derived stem cells (GMSCs). The primary outcomes were three histological indicators with continuous variables: newly formed alveolar bone (NB), newly formed cementum (NC), and newly formed periodontal ligament (NPDL). We performed pairwise meta-analyses using a random-effects model and then performed a random-effects NMA using a multivariate meta-analysis model. Results Sixty preclinical studies assessing five different stem cell-based therapies were identified. The NMA showed that in terms of NB, PDLSCs (standardized mean difference 1.87, 95% credible interval 1.24 to 2.51), BMSCs (1.88, 1.17 to 2.59), and DPSCs (1.69, 0.64 to 2.75) were statistically more efficacious than cell carriers (CCs). In addition, PDLSCs were superior to GMSCs (1.49, 0.04 to 2.94). For NC, PDLSCs (2.18, 1.48 to 2.87), BMSCs (2.11, 1.28 to 2.94), and ADSCs (1.55, 0.18 to 2.91) were superior to CCs. For NPDL, PDLSCs (1.69, 0.92 to 2.47) and BMSCs (1.41, 0.56 to 2.26) were more efficacious than CCs, and PDLSCs (1.26, 0.11 to 2.42) were superior to GMSCs. The results of treatment hierarchies also demonstrated that the two highest-ranked interventions were PDLSCs and BMSCs. Conclusion PDLSCs and BMSCs were the most effective and well-documented stem cells for PTR among the five kinds of stem cells evaluated in this study, and there was no statistical significance between them. To translate the stem cell therapies for PTR successfully in the clinic, future studies should utilize robust experimental designs and reports.

Stem Cells and Their Derivatives—Implications for Alveolar Bone Regeneration: A Comprehensive Review

“…The histological analyses performed after 12 weeks post-transplantation revealed that SHED formed the largest osteoid area and synthesized more collagen fibers compared with other stem cell types [48]. Furthermore, according to comprehensive metaanalyses of preclinical studies focused on the therapeutic potential of five cell lineages (PDLSCs, BMSCs, DPSCs, GMSCs, and ADSCs) in periodontal tissue regeneration, PDLSCs and BMSCs were the most effective in new alveolar bone, cementum, and periodontal ligament formation [49]. Finally, in the most recent study, Qu et al ( 2021) compared the osteogenic potential of four dental-derived MSCs, including DPSCs, PDLSCs, DFSCs, and alveolar bone-derived MSCs (ABMMSCs).…”

Pharmacological Approaches and Regeneration of Bone Defects with Dental Pulp Stem Cells

“…Therapeutic effects like reduction of periodontal probing depth, clinical attachment gain, and increase of radiographic bone height were found out in all 10 cases at the 6 months after the transplantation. This approach based on cell sheet engineering proved its safety and efficacy and offers an innovative strategy for treating severe periodontal defects [ 40 ]. The immunomodulatory properties of hPDLSCs and their paracrine mechanism were revealed in a study by Diomede et al They demonstrated that the paracrine factors secreted by hPDLSCs can accumulate in conditioned medium and thus regulate cell mobilization and osteogenic differentiation.…”

Elements of 3D Bioprinting in Periodontal Regeneration: Frontiers and Prospects

“…Studies showed the proliferation and osteogenic ability of the cells were promoted when cultured with the proper scaffold [38]. A systemic review showed that, compared with other stem cells, GMSCs are easy to obtain, high in proliferation rates and colony-forming efficiency, and can induce a stable periodontal tissue regeneration [36]. Therefore, GMSCs can be a substitute for PDLSCs in periodontal recovery.…”