Controversies in regenerative medicine: should knee joint osteoarthritis be treated with mesenchymal stromal cells?

Area of Science:

• Immunology
• Regenerative Medicine
• Orthopedics

Background:

• Knee joint osteoarthritis is a complex degenerative and immunological condition.
• Current treatments do not halt osteoarthritis progression.
• Mesenchymal stromal cell (MSC) therapy is being researched for holistic knee joint regeneration.

Purpose of the Study:

• To provide a controversial overview of preclinical and clinical studies on MSC therapy for knee joint osteoarthritis.
• To discuss the potential of MSC secretome and local MSC activation for therapeutic effects.
• To highlight the challenges in comparing diverse study protocols and achieving clinical translation of disease-modifying effects.

Main Methods:

• Narrative review of existing preclinical and clinical studies on MSC therapy for knee osteoarthritis.
• Analysis of the mechanisms of MSC action, including paracrine effects and local MSC activation.
• Evaluation of clinical outcomes, symptom modification, and functional improvements reported in the literature.

Main Results:

• Preclinical models show symptom- and disease-modifying effects of MSC therapy.
• Clinical studies indicate potential for autologous and allogeneic MSC therapy in improving symptoms and function.
• Contradictory clinical outcomes exist, making the overall effectiveness of MSC therapy unclear.

Conclusions:

• The paracrine effect of MSCs is central to their regenerative capacity.
• While promising, the clinical translation of disease-modifying effects of MSC therapy for knee osteoarthritis has not yet been demonstrated.
• Variability in study designs (cell sources, protocols) hinders direct comparison and definitive conclusions on MSC therapy efficacy.