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Meta-Analysis
. 2022 Jan-Dec:31:9636897211051743.
doi: 10.1177/09636897211051743.

Preclinical and Clinical Amelioration of Bone Fractures with Mesenchymal Stromal Cells: a Systematic Review and Meta-Analysis

Hanxiao Yi  1 , Yang Wang  2 , Qunying Liang  1 , Xiaoqun Mao  1
Affiliations
Meta-Analysis

Preclinical and Clinical Amelioration of Bone Fractures with Mesenchymal Stromal Cells: a Systematic Review and Meta-Analysis

Hanxiao Yi et al. Cell Transplant. 2022 Jan-Dec.

Abstract

Even though reunion of bone fracture confronts clinicians, mesenchymal stromal cells (MSCs) are investigated to be curative in bone fracture. This study aimed to explore the application potential of MSCs for healing bone fractures. By inputting search terms and retrieving studies published up to March 2021, multiple databases, including PubMed, EMBASE, Web of Science, and Cochrane Library, were searched to identify eligible studies. The mean difference (MD) and 95% confidence interval (95% CI) were calculated to analyze the main results in the meta-analysis. Data analysis was performed using Engauge Digitizer 10.8 and R Software. Of the 31 articles, 26 were preclinical studies (n = 913), and 5 were clinical trials (n = 335). Preclinically, MSCs therapy significantly augmented the progress of bone regeneration [(bone volume over tissue volume (MD7.35, p < 0.01)], despite some non-significant effects (on the callus index, bone strength, work to failure, and stiffness). Clinically, the MSC group had a significantly reduced incidence of poor recovery (odds ratio (OR) 0.30, p < 0.01); however, a significant decrease in healing time was not observed in the MSC group (MD 2.47, p = 0.26). In summary, our data suggest that patients with bone fractures benefited from MSC administration and that MSCs are a potentially useful agent for bone regeneration. Despite these satisfactory outcomes, larger randomised clinical trials (RCTs) are necessary to confirm these findings.

Keywords: bone regeneration; clinical trials; mesenchymal stromal cells; meta-analysis; preclinical trials.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow Chart of the Article Screening Process.
Figure 2.
Figure 2.
Quality evaluation of the included studies. Quality assessment of included clinical trials using the Cochrane RoB tool.
Figure 3.
Figure 3.
Subgroup analysis for BV, BV/TV, TV, callus width, callus area and callus index. (A) Subgroup analysis of BV at the 2nd, 8th, and 12th weeks and BV/TV at the 1st, 2nd, 4th, 5th, 8th, and 12th weeks. (B) Pooled analysis of TV. (C) Subgroup analysis of the callus width and callus area at the 2nd, 3rd, and 4th weeks. (D) Pooled analysis of the callus index. All analyses were conducted by using a random- or fixed-effects model with a 95% confidence interval. BV, bone volume; TV, tissue volume.
Figure 4.
Figure 4.
Funnel plots of primary and secondary outcomes. Funnel plots were generated for BMD, BV, BV/TV, and ultimate load.
Figure 5.
Figure 5.
Clinical outcomes of healing time and poor recovery. Pooled analysis of (A) the healing time and (B) the rate of poor recovery.
See this image and copyright information in PMC

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