Abstract
BackgroundPeripheral blood (PB) is a potential source of chondrogenic progenitor cells that can be used for cartilage repair and regeneration. However, the cell types, isolation and implantation methods, seeding dosage, ultimate therapeutic effect, and in vivo safety remain unclear.MethodsPubMed, Embase, and the Web of Science databases were systematically searched for relevant reports published from January 1990 to December 2019. Original articles that used PB as a source of stem cells to repair cartilage in vivo were selected for analysis.ResultsA total of 18 studies were included. Eight human studies used autologous nonculture-expanded PB-derived stem cells (PBSCs) as seed cells with the blood cell separation isolation method, and 10 animal studies used autologous, allogenic or xenogeneic culture-expanded PB-derived mesenchymal stem cells (PB-MSCs), or nonculture-expanded PBSCs as seed cells. Four human and three animal studies surgically implanted cells, while the remaining studies implanted cells by single or repeated intra-articular injections. 121 of 130 patients (in 8 human clinical studies), and 230 of 278 animals (in 6 veterinary clinical studies) using PBSCs for cartilage repair achieved significant clinical improvement. All reviewed articles indicated that using PB as a source of seed cells enhances cartilage repair in vivo without serious adverse events.ConclusionAutologous nonculture-expanded PBSCs are currently the most commonly used cells among all stem cell types derived from PB. Allogeneic, autologous, and xenogeneic PB-MSCs are more widely used in animal studies and are potential seed cell types for future applications. Improving the mobilization and purification technology, and shortening the culture cycle of culture-expanded PB-MSCs will obviously promote the researchers' interest. The use of PBSCs for cartilage repair and regeneration in vivo are safe. PBSCs considerably warrant further investigations due to their superiority and safety in clinical settings and positive effects despite limited evidence in humans.
Highlights
Articular cartilage covering the surface of joints plays a very important role in bearing loads, absorbing mechanical shocks, and enabling synovial joints to articulate with low friction (Chen et al, 2017)
This review comprehensively evaluated the feasibility, efficacy, and safety of using peripheral blood (PB)-derived stem cells (PBSCs) for cartilage repair and regeneration in vivo by analyzing the preoperative characteristics, therapeutic details, outcomes, and adverse events reported in currently published literature
This review evaluated the use of PBSCs in cartilage repair and regeneration in vivo for the first time
Summary
Articular cartilage covering the surface of joints plays a very important role in bearing loads, absorbing mechanical shocks, and enabling synovial joints to articulate with low friction (Chen et al, 2017). Since BMS techniques, osteochondral transplantation, and ACI have limitations and shortcomings, such as fibrocartilage regeneration, donor site complications, graft failure, dedifferentiation of seed cells, and two-stage invasive surgical procedures (Fortier et al, 2010; Andriolo et al, 2017; Riboh et al, 2017), MSCs, which are multipotent progenitor cells with an intrinsic potential for multilineage differentiation, self-renewal, low immunogenicity, anti-inflammatory activity, and immunomodulatory effects by suppressing the graft-versushost reaction, may be obtained from multiple tissues of individual patients, and these cells are cultured, amplified, and purified (Goldberg et al, 2017; Guadix et al, 2017). The cell types, isolation and implantation methods, seeding dosage, ultimate therapeutic effect, and in vivo safety remain unclear
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