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. 2022 Nov 28;24(1):260.
doi: 10.1186/s13075-022-02953-0.

Intra-articular injection choice for osteoarthritis: making sense of cell source-an updated systematic review and dual network meta-analysis

Yijian Zhang  1   2 , Huilin Yang  3   4 , Fan He  5 , Xuesong Zhu  6   7
Affiliations

Intra-articular injection choice for osteoarthritis: making sense of cell source-an updated systematic review and dual network meta-analysis

Yijian Zhang et al. Arthritis Res Ther. .

Abstract

Background: Intra-articular injection is indicated for mild or moderate osteoarthritis (OA). However, the superiority of cell-based injection and the role of diverse cell sources are still unclear. This study aimed to compare the therapeutic effect of intra-articular injection with mesenchymal stem cells (MSCs) and cell-free methods for OA treatment.

Methods: A literature search of published scientific data was carried out from PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Internet (CNKI). Randomized controlled trials (RCTs) compared the efficacy and safety of MSC and cell-free intra-articular injection treatments for OA with at least 6-month follow-up.

Results: Dual network meta-analysis validated the therapeutic advantages of MSC treatments (VAS, Bayesian: 90% versus 10% and SUCRA: 94.9% versus 5.1%; WOMAC total, Bayesian: 83% versus 17% and SUCRA: 90.1% versus 9.9%) but also suggested a potential negative safety induced by cell injection (adverse events, Bayesian: 100% versus 0% and SUCRA: 98.2% versus 1.8%). For the MSC source aspect, adipose mesenchymal stem cells (ADMSCs) and umbilical cord mesenchymal stem cells (UBMSCs) showed a better curative effect on pain relief and function improvement compared with bone marrow mesenchymal stem cells (BMMSCs).

Conclusion: Intra-articular injection of MSCs is associated with more effective pain alleviation and function improvement than cell-free OA treatment. However, the potential complications induced by MSCs should be emphasized. A comparative analysis of the MSC sources showed that ADMSCs and UBMSCs exerted a better anti-arthritic efficacy than BMMSCs. Schematic illustration of MSC-based intra-articular injection for treating OA. Three major MSCs (UBMSCs, ADMSCs, and BMMSCs) are extracted and expanded in vitro. Subsequently, the amplified MSCs are concentrated and injected into the knee joint to treat OA.

Keywords: Adverse effects; Function improvement; Intra-articular injection; Mesenchymal stem cells; Osteoarthritis; Pain relief.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Selection flowchart of undertaken literature search. Databases include PubMed, Embase, Cochrane Library, MEDLINE, Web of Science, and China National Knowledge Internet (CNKI)
Fig. 2
Fig. 2
Summary of the risk of bias assessment for the included studies
Fig. 3
Fig. 3
Network geometry of eligible studies. A VAS score. B WOMAC total. C WOMAC function. D WOMAC pain. E WOMAC stiffness. F Adverse events. The size of the node represents the number of patients in each treatment. The thickness of the edges represents the number of contributed studies between the two interventions. VAS, visual analog scale; WOMAC, Western Ontario and McMaster Universities Arthritis Index; BMMSCs, bone marrow mesenchymal stem cell; ADMSCs, adipose mesenchymal stem cell; UBMSCs, umbilical cord mesenchymal stem cell; PRP, platelet-rich plasma; HA, hyaluronic acid; CT, conservative treatment
Fig. 4
Fig. 4
Forest plots of direct comparison between the two interventions. A VAS score. B WOMAC total. C WOMAC function. D WOMAC pain. E WOMAC stiffness. F Adverse events. MD, mean difference; RR, risk ratio
Fig. 5
Fig. 5
Ranking probability based on the Bayesian model. Different color represents the calculated rank for each intervention (from first to seventh). A VAS score. B WOMAC total. C WOMAC function. D WOMAC pain. E WOMAC stiffness. F Adverse events
Fig. 6
Fig. 6
Matching ranking probability of each effect size according to the Bayesian and SUCRA models. Different interventions are represented by different color. A VAS score. B WOMAC total. C WOMAC function. D WOMAC pain. E WOMAC stiffness. F Adverse events
See this image and copyright information in PMC

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