Abstract
Articular cartilage damaged through trauma or disease has a limited ability to repair. Untreated, focal lesions progress to generalized changes including osteoarthritis. Musculoskeletal disorders including osteoarthritis are the most significant contributor to disability globally. There is increasing interest in the use of mesenchymal stem cells (MSCs) for the treatment of focal chondral lesions. There is some evidence to suggest that the tissue type from which MSCs are harvested play a role in determining their ability to regenerate cartilage in vitro and in vivo. In humans, MSCs derived from synovial tissue may have superior chondrogenic potential. We carried out a systematic literature review on the effectiveness of synovium-derived MSCs (sMSCs) in cartilage regeneration in in vivo studies in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Twenty studies were included in our review; four examined the use of human sMSCs and 16 were conducted using sMSCs harvested from animals. Most studies reported successful cartilage repair with sMSC transplantation despite the variability of animals, cell harvesting techniques, methods of delivery, and outcome measures. We conclude that sMSC transplantation holds promise as a treatment option for focal cartilage defects. We believe that defining the cell population being used, establishing standardized methods for MSC delivery, and the use of objective outcome measures should enable future high quality studies such as randomized controlled clinical trials to provide the evidence needed to manage chondral lesions optimally.
Highlights
Damage to articular cartilage can occur as a consequence of trauma or disease (Thomas et al, 2017)
The transplantation of mesenchymal stem cells (MSCs) is being tested in over 300 registered clinical trials (Trounson and McDonald, 2015). In this PRISMA systematic review, we examine the potential for synovium-derived MSCs (sMSCs) to regenerate cartilage by analyzing in vivo studies in the literature
A total of 389 articles were retrieved, the title and abstract of each article was screened for appropriateness
Summary
Damage to articular cartilage can occur as a consequence of trauma or disease (Thomas et al, 2017). Cartilage is a relatively avascular structure, and has a limited ability to repair (Convery et al, 1972). In an attempt to do so, inflammation ensues within the joint with long term sequelae including osteoarthritis (Soren et al, 1976; Lohmander and Roos, 2007). Musculoskeletal disorders including osteoarthritis are the most significant contributor to disability globally (GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016), and arthritis alone affects over 8 million people in the UK (National Collaborating Centre for Chronic Conditions (UK), 2008). Osteoarthritis adversely affects joint function and causes long term pain (Jordan et al, 2009).
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