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Treatment of Osteochondral Defects in the Rabbit's Knee Joint by Implantation of Allogeneic Mesenchymal Stem Cells in Fibrin Clots
Published on: May 21, 2013
Advanced therapy with mesenchymal stromal cells for knee osteoarthritis: Systematic review and meta-analysis of
Caio Gomes Tabet1,2,3, Rafael Leite Pacheco4,5, Ana Luiza Cabrera Martimbianco4,5,6
1Sports Medicine Division, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina do Hospital das Clínicas da Universidade de São Paulo (USP), São Paulo, Brazil.
Background:
Advanced cell therapies emerged as promising candidates for treatment of knee articular diseases, but robust evidence regarding their clinical applicability is still lacking.
Objective:
To assess the efficacy and safety of advanced mesenchymal stromal cells (MSC) therapy for knee osteoarthritis (OA) and chondral lesions.
Methods:
Systematic review of randomized controlled trials conducted in accordance with Cochrane Handbook and reported following PRISMA checklist. GRADE approach was used for assessing the evidence certainty.
Results:
25 randomized controlled trials that enrolled 1048 participants were included. Meta-analyses data showed that, compared to viscosupplementation (VS), advanced MSC therapy resulted in a 1.91 lower pain VAS score (95 % CI -3.23 to -0.59; p < 0.00001) for the treatment of knee OA after 12 months. Compared to placebo, the difference was 0.99 lower pain VAS points (95 % CI -1.94 to -0.03; p = 0.76). According to the GRADE approach, the evidence was very uncertain for both comparisons. By excluding studies with high risk of bias, there was a similar size of effect (VAS MD -1.54, 95 % CI -2.09 to -0.98; p = 0.70) with improved (moderate) certainty of evidence, suggesting that MSC therapy probably reduces pain slightly better than VS. Regarding serious adverse events, there was no difference from advanced MSC therapy to placebo or to VS, with very uncertain evidence.
Conclusion:
Advanced MSC therapy resulted in lower pain compared to placebo or VS for the treatment of knee OA after 12 months, with no difference in adverse events. However, the evidence was considered uncertain.
The Translational Potential Of This Article:
Currently, there is a lack of studies with good methodological structure aiming to evaluate the real clinical impact of advanced cell therapy for knee OA. The present study was well structured and conducted, with Risk of Bias, GRADE certainty assessment and sensitivity analysis. It explores the translational aspect of the benefits and safety of MSC compared with placebo and gold-standard therapy to give practitioners and researchers support to expand this therapy in their practice.
Prospero Registration Number:
CRD42020158173. Access at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=158173.
Insights
Advanced mesenchymal stromal cells (MSC) therapy shows potential for reducing knee osteoarthritis pain compared to viscosupplementation, though evidence remains uncertain. Further high-quality studies are needed to confirm the clinical impact of this cell therapy.
Area of Science:
- Orthopedics and Regenerative Medicine
- Cellular Therapy Research
- Clinical Trial Methodology
Background:
- Advanced cell therapies, particularly mesenchymal stromal cells (MSC), show promise for knee articular diseases.
- Robust clinical evidence for the efficacy and safety of MSC therapy in knee osteoarthritis (OA) and chondral lesions is currently limited.
Purpose of the Study:
- To systematically evaluate the efficacy and safety of advanced MSC therapy for knee OA and chondral lesions.
- To assess the comparative effectiveness of MSC therapy against placebo and viscosupplementation (VS).
Main Methods:
- Systematic review and meta-analysis of 25 randomized controlled trials (RCTs) involving 1048 participants.
- Adherence to Cochrane Handbook guidelines and PRISMA checklist; GRADE approach for evidence certainty assessment.
- Sensitivity analysis excluding studies with high risk of bias.
Main Results:
- MSC therapy demonstrated a statistically significant reduction in pain (VAS score) compared to VS at 12 months (MD -1.91).
- Compared to placebo, the pain reduction with MSC therapy was not statistically significant (MD -0.99).
- Evidence certainty for both comparisons was rated as very uncertain; however, after excluding high-risk studies, moderate certainty suggested MSC therapy may slightly outperform VS.
Conclusions:
- Advanced MSC therapy may reduce pain in knee OA patients compared to placebo and VS, but the current evidence is uncertain.
- No significant differences in serious adverse events were observed between MSC therapy and control groups.
- High-quality RCTs are crucial to establish the definitive clinical utility of MSC therapy for knee OA.
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