Osteoarthritis is a debilitating joint disease that affects millions of people across the world. It is characterized by progressive degeneration of the cartilage and underlying bone, resulting in pain, stiffness, decreased range of motion, and disability. Current treatments for osteoarthritis are only modestly effective, and replacement surgery is typically seen as a last resort. This has led to increased interest in cell-based therapies for treating osteoarthritis, which have shown promising results in animal studies and human case reports.
Autologous mesenchymal stromal cells (MSCs) are an attractive therapeutic option for treating osteoarthritis due to their excellent immunomodulatory properties and potential for tissue regeneration. However, the need for cell expansion makes this procedure slow and expensive. Allogeneic cells offer a cheaper alternative but come with the risk of host immune rejection. Fortunately, MSCs possess immune privileged or evasive properties that make them less likely to be rejected than other cell types. There is also no evidence of transplantation-related adverse events in animal experiments or clinical trials involving allogeneic MSCs.
Building on this evidence, recent studies have suggested that intra-articular injection of allogeneic MSCs may be an effective treatment strategy for knee osteoarthritis with minimal complications or side effects. The exact mechanism through which allogeneic MSCs exert beneficial effects in osteoarthritic joints remains unclear; however, it is hypothesized that they can reduce inflammation, stabilize cartilage degradation pathways, promote chondrocyte survival, restore synovial fluid composition, and improve joint function without causing significant immune responses or adverse events in patients receiving treatment.
Given these encouraging results from preclinical animal models and human clinical trials using allogeneic MSCs to treat osteoarthritis, there is hope that this novel therapy could be a viable option for many patients suffering from this painful condition who do not wish to resort to surgical procedures such as total joint replacements or injections with hyaluronic acid derivatives. Further research into the safety and efficacy of allogeneic MSCs for knee arthrosis treatment will be necessary before widespread implementation can take place.
A study, Treatment of Knee Osteoarthritis With Allogeneic Bone Marrow Mesenchymal Stem Cells: A Randomized Controlled Trial, looked into the potential of stem cell therapy for treating knee osteoarthritis.
Results of the Study
The 30 patients recruited for the study all suffered from grade II-IV chronic knee osteoarthritis and had been unresponsive to conventional treatments for at least 6 months before recruitment. The protocol of the trial featured a total of 6 visits, with the stem cell treatment being administered at the first visit.
To assess the outcomes of the trial, various scales were deployed, including 0%-100% Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne Algofunctional Indices, as well as a Short Form-12 Life Quality (SF-12) questionnaire and quantitative Magnetic Resonance Imaging (MRI) exploration. For every patient, multiple outcome measures were taken over 6 months after treatment commencement in order to evaluate its efficacy.
The study found that cell treatment had a medium to large effect size, significantly improving pain and disability. Pain was reduced by 6 and 12 months after MSC transplantation, while the active control (hyaluronic acid) showed only small improvements. These results were demonstrated across multiple algofunctional indices, including the general scale of WOMAC and Lequesne, with significant decreases at both 6 and 12 months among those in the MSC-treated group.
This improvement in their condition was reflected in patient satisfaction levels, as 77% of those in the cell-treated group reported they were satisfied or very satisfied with their treatment – a stark contrast to just 38% of those who received hyaluronic acid injections.The encouraging outcomes seen in this study demonstrate the potential for cell therapy to become an effective tool for treating osteoarthritis. Its efficacy is bolstered by its minimally invasive nature; cells are injected directly into damaged tissue, allowing for timely and efficient delivery without having to surgically open up the affected area.
This could reduce recovery time compared to more invasive treatments such as joint replacement surgery. Furthermore, there appears to be long-term benefits from MSCs – some studies have shown it can provide lasting relief from pain for up to 2 years post treatment. This makes it even more attractive than hyaluronic acid injections which may only provide temporary respite from symptoms due to its short half-life of three days or less.
