Abstract
PurposeOsteoarthritis (OA) represents a relevant social and economic burden worldwide. “Mesenchymal stem cells” or, as recently proposed, “medicinal signaling cells” (MSCs) have been recently introduced as injective treatments for OA with the aim of restoring joint homeostasis. The aim of this review is to provide the reader with the tools necessary to interpret the currently available clinical data, focusing on the MSC mechanisms of action which might help to clarify what we should expect from this treatment.MethodsClinical studies reporting MSC injections for the treatment of knee OA, either freshly isolated or culture-expanded cells, have been included and commented in relation to the supposed therapeutic effect that MSCs might exert giving their supposed mode of actions.ResultsThe majority of the studies reports significant improvements in terms of pain and knee function compared to baseline values, up to 24 months of follow-up. Although these data support the expected therapeutic effect of this therapy giving the features of these cells, only 14% of the studies present a control group and more than one-third of them report the results on less than ten patients.ConclusionsDespite the constant presence of positive and satisfactory results in the studies analyzed, the complexity of MSC metabolism and related therapeutic effects as well as the weakness of most of the studies do not allow withdrawing definitive conclusions about the superiority of one tissue source over another, as well as about the best cell dose and the long-term durability of the effects of these procedures. Given the high potential value of these therapies in the treatment of OA, further studies accurately designed, carefully defining the type of patients to be included and pursuing minimal standard requirements in terms of follow-up, number of patients, and types of measurements should be conducted to finally assess the efficacy of MSC-based injective treatments.
Highlights
Osteoarthritis (OA), the most widespread type of arthritis, is expected to become the fourth cause of disability by 2020 [1, 2], resulting in a relevant socioeconomic burden and affecting the gross domestic product of developed countries [3]
We selectively focused on injective conservative procedures to evaluate the effects of the paracrine activity of mesenchymal stem cells (MSCs) in a pathological joint, aiming to answer the question: “Do the current results about the use of MSCs—either as freshly harvested or after culture expansion—for the treatment of OA support the supposed mechanisms of action of these cells?”
Substantial data have been published to date mostly accompanied by satisfactory results, the complexity of MSC metabolism and related therapeutic effects does not allow withdrawing definitive conclusions about the superiority of one tissue source over another, as well as about the best cell dose and the long-term durability of the effects of these procedures
Summary
Osteoarthritis (OA), the most widespread type of arthritis, is expected to become the fourth cause of disability by 2020 [1, 2], resulting in a relevant socioeconomic burden and affecting the gross domestic product of developed countries [3]. The establishment of adequate therapies able to counteract the progression of the disease and, to prevent the loss of articular function and joint replacement is needed. Anti-inflammatory drugs and intraarticular steroids can be used to get pain relief and improve joint function [4]. In patients who do not respond to optimal conservative management, joint replacement represents the unique available therapeutic option. In this scenario, the development of efficacious conservative approaches would be relevant to treat young individuals with early OA, since their more active and physically demanding lifestyle negatively correlates with the prosthetic implant survival [5]
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