Abstract
Cartilage defects are a predisposing factor for osteoarthritis. Conventional therapies are mostly palliative and there is an interest in developing newer therapies that target the disease’s progression. Mesenchymal stem cells (MSCs) have been suggested as a promising therapy to restore hyaline cartilage to cartilage defects, though the optimal cell source has remained under investigation. A PRISMA systematic review was conducted utilising five databases (MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science) which identified nineteen human studies that used adipose tissue-derived MSC (AMSC)-based therapies, including culture-expanded AMSCs and stromal vascular fraction, to treat cartilage defects. Clinical, imaging and histological outcomes, as well as other relevant details pertaining to cartilage regeneration, were extracted from each study. Pooled analysis revealed a significant improvement in WOMAC scores (mean difference: −25.52; 95%CI (−30.93, −20.10); p < 0.001), VAS scores (mean difference: −3.30; 95%CI (−3.72, −2.89); p < 0.001), KOOS scores and end point MOCART score (mean: 68.12; 95%CI (62.18, 74.05)), thus showing improvement. The studies in this review demonstrate the safety and efficacy of AMSC-based therapies for cartilage defects. Establishing standardised methods for MSC extraction and delivery, and performing studies with long follow-up should enable future high-quality research to provide the evidence needed to bring AMSC-based therapies into the market.
Highlights
Mesenchymal stem cells (MSCs)-based therapies hold high potential for restorative treatment of cartilage defects, and, in recent years, there has been an interest in the use of adipose tissue-derived MSCs (AMSCs) due to their ease of collection and abundance
This systematic review and meta-analysis compiled the findings in human studies for the administration of AMSC-based therapies for amelioration of cartilage defects
The evidence suggests that there is an improvement in clinical, imaging and histological outcomes after AMSC or Stromal Vascular Fraction (SVF) administration with no severe adverse events reported
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. An important element of synovial joints, is composed of chondrocytes that lay down a highly organised extracellular matrix (ECM), consisting of water, type II collagen, glycosaminoglycans (GAGs) and proteoglycans, amalgamated into a dense collagenous network, which is responsible for its unique mechanical properties [1]. As well as crucial shock-absorbing and gliding properties that cartilage is well known for, cartilage. ECM has a role in chondrocyte homeostasis and cartilage phenotypic stability via chemokine signalling [2], and the synthesis of functional components of the skeletal system during embryogenesis [3]. Any insults to cartilage integrity and the surrounding ECM will have a profound impact on chondrocytes, which in turn will lead to ECM composition changes, all in a vicious cycle [4]
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