Ultrasound-Guided Intra-Articular Injection of Expanded Umbilical Cord Mesenchymal Stem Cells in Knee Osteoarthritis: A Safety/Efficacy Study with MRI Data

Abstract

Aim: This study has the primary objective of studying the effect of Wharton jelly mesenchymal stem cells (WJMSCs) in the treatment of knee osteoarthritis. As a secondary end point, we report on the efficacy of such therapy. Patients and methods: 16 patients with advanced Kellgren stage were treated using two doses of expanded WJMSCs given 1 month apart. Patients were followed for 48 months using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and 12 months using magnetic resonance imaging (MRI). Results: Treatment was well tolerated. One patient developed moderate effusion and one superficial phlebitis. We observed functional and pain improvement at 12 and 48 months (p < 0.0001), with statistically significant improvement on MRI scans at 12 months in cartilage loss, osteophytes, bone marrow lesions, effusion and synovitis (p < 0.01), and highly significant improvement in subchondral sclerosis (p < 0.0001). Conclusion: WJMSCs are safe and potentially effective in producing significant improvement in KOOS and MRI scores when administered intra-articularly in knee osteoarthritis cases under ultrasound guidance.

Wharton’s jelly and osteoarthritis of the knee

“…Exclusion criteria encompassed various factors such as age, high BMI, whether the prospective female patient was of childbearing age, malignancy, using immunosuppressants or were scheduled for knee arthroplasty. 45 Baseline and postoperative MRI scans used a semi-quantitative assessment form to assess various chondrocytic and osteocytic characteristics (i.e. cartilage damage, bone marrow lesions, osteophytes, subchondral sclerosis, joint effusion and synovitis).…”

“…Improvement in cartilage damage, bone marrow lesions, synovitis, subchondral sclerosis and osteophyte development demonstrated statistically significant results between 6- and 12-month follow-up visits. 45 …”

“…concluded that WJ-MSCs were both safe and effective in patients with knee OA, but the small cohort and lack of long-term data are important limitations to note when interpreting this study. 45 …”

Allogenic Perinatal Tissue for Musculoskeletal Regenerative Medicine Applications: A Systematic Review

“…Samara et al describes the results of an IA injection of UC-dWJ MSCs in 16 patients with a total of 25 osteoarthritic knees. Interval decreases in severity was found in baseline MRI images at 1 year follow ups for the following elements: cartilage damage, osteophyte formation, bone marrow lesions, joint effusion severity, synovitis severity, and subchondral sclerosis [ 39 ].…”

Clinical Relevance of Mesenchymal Stromal Cells from Various Sources: Insights into Transcriptome Analysis for Identifying Inherent Potential

“…The ability of MSCs to differentiate into chondrocytes has made cartilage repair a successful regenerative application of these cells. Among the several bone and cartilage disorders investigated in MSC-based clinical studies, knee osteoarthritis is one of the most extensively studied, with various clinical trials employing MSCs from different sources [93][94][95]. Most of these trials have utilized an autologous source of MSCs, either from the BM or AT, and have produced encouraging results, with one study progressing to the phase III stage [96].…”