Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar;9(6):452.
doi: 10.21037/atm-20-5116.

Which is the most effective one in knee osteoarthritis treatment from mesenchymal stem cells obtained from different sources?-A systematic review with conventional and network meta-analyses of randomized controlled trials

Zhen-Jie Wei  1   2 , Qian-Qian Wang  1 , Zheng-Guo Cui  2   3 , Hidekuni Inadera  2 , Xu Jiang  4 , Cheng-Ai Wu  1
Affiliations

Which is the most effective one in knee osteoarthritis treatment from mesenchymal stem cells obtained from different sources?-A systematic review with conventional and network meta-analyses of randomized controlled trials

Zhen-Jie Wei et al. Ann Transl Med. 2021 Mar.

Abstract

Background: Due to varying degrees of difficulty in obtaining different mesenchymal stem cells (MSCs), the distinct pain levels and treatment costs, and for providing concrete evidence for future clinical practice, a thorough comparison of all relevant MSCs remained critical. Hence, this study aimed to achieve this objective to compare the efficacy of MSCs obtained from different sources in clinical outcomes and cartilage repair of knee osteoarthritis (KOA).

Methods: The EmBase, PubMed and Cochrane Library databases were searched for eligible studies. Randomized controlled trials (RCTs) that compared MSCs from different sources with placebo or each other in KOA patients. Conventional meta-analysis and frequentist network meta-analysis (NMA) were conducted. The primary clinical outcome was pain relief. The frequentist NMA was conducted using Stata with the "network" command.

Results: Eight studies (seven trials) involving 203 KOA patients were included in this meta-analysis. The MSCs were considered superior over placebo for pain relief and improved function in KOA, but showed no statistically significant differences for cartilage regeneration. Among all the MSCs, the adipose tissue-derived MSCs (AD-MSCs) most effectively relieved pain.

Conclusion: These findings suggested that MSCs are effective in the treating of KOA. AD-MSCs might be the most effective for relieving pain, and Umbilical cord-derived mesenchymal stem cells (UC-MSCs) might be the most effective for improving function. However, the current evidence does not support the use of MSCs for improving cartilage repair in KOA patients.

Keywords: Relative efficacy; knee osteoarthritis (KOA); mesenchymal stem cells (MSCs); meta-analyses; randomized controlled trials.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-5116). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Systematic review flow diagram.
Figure 2
Figure 2
Meta-analysis of treatment effects on pain relief. (A) Conventional meta-analysis of treatment effects on pain relief for MSC from different sources overall compared with placebo in RCTs; (B) network meta-analysis of treatment effects on pain relief for MSC from different sources overall compared with placebo in RCTs. MSC, mesenchymal stem cell; RCT, randomized controlled trial.
Figure 3
Figure 3
Structure of network formed by interventions.
Figure 4
Figure 4
Meta-analysis of treatment effects on functional improvement. (A) Conventional meta-analysis of treatment effects on functional improvement for MSC from different sources overall compared with placebo in RCTs; (B) network meta-analysis of treatment effects on functional improvement for MSC from different sources overall compared with placebo in RCTs. MSC, mesenchymal stem cell; RCT, randomized controlled trial.
Figure 5
Figure 5
Meta-analysis of treatment effects on structural assessment. (A) Conventional meta-analysis of treatment effects on structural assessment for MSC from different sources overall compared with placebo in RCTs; (B) network meta-analysis of treatment effects on structural assessment for MSC from different sources overall compared with placebo in RCTs. MSC, mesenchymal stem cell; RCT, randomized controlled trial.
See this image and copyright information in PMC

References

    1. Prieto-Alhambra D, Judge A, Javaid MK, et al. Incidence and risk factors for clinically diagnosed knee, hip and hand osteoarthritis: influences of age, gender and osteoarthritis affecting other joints. Ann Rheum Dis 2014;73:1659-64. 10.1136/annrheumdis-2013-203355 - DOI - PMC - PubMed
    1. Barbour KE, Helmick CG, Boring M, et al. Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:246-53. 10.15585/mmwr.mm6609e1 - DOI - PMC - PubMed
    1. Childs BG, Gluscevic M, Baker DJ, et al. Senescent cells: an emerging target for diseases of ageing. Nat Rev Drug Discov 2017;16:718-35. 10.1038/nrd.2017.116 - DOI - PMC - PubMed
    1. McIntyre JA, Jones IA, Han B, et al. Intra-articular Mesenchymal Stem Cell Therapy for the Human Joint: A Systematic Review. Am J Sports Med 2018;46:3550-63. 10.1177/0363546517735844 - DOI - PubMed
    1. Barry F, Murphy M. Mesenchymal stem cells in joint disease and repair. Nat Rev Rheumatol 2013;9:584-94. 10.1038/nrrheum.2013.109 - DOI - PubMed

LinkOut - more resources