Objective

Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of articular cartilage and secondary osteogenesis. Cell-based agents, such as mesenchymal stem cells, have turned into the most extensively explored new therapeutic agents for OA. However, evidence-based research is still lacking.

Methods

We searched public databases up to February 2020 and only included randomized controlled trials. The outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the visual analogue scale (VAS) score, and serious adverse events (SAEs). A network meta-analysis was also performed in this work.

Results

We included 13 studies in the meta-analysis. The effect size showed that cell-based therapy did not significantly reduce the WOMAC score at the 6-month follow-up (standard mean difference [SMD] −3.6; 95% confidence interval [CI] −0.90 to 0.18; P = 0.1928). However, cell-based therapy significantly improved the KOOS at the 12-month follow-up (SMD 0.68; 95% CI 0.07-1.30; P = 0.0288) and relieved pain (SMD −1.05; 95% CI −1.46 to −0.64; P < 0.0001). The findings also indicated that high-dosage adipose-derived mesenchymal stem cells (ADMSCs) may be more advantageous in terms of long-term effects.

Conclusions

Cell-based therapy had a better effect on KOOS improvement and pain relief without safety concerns. However, cell-based therapy did not show a benefit in terms of the WOMAC. Allogeneic cells might have advantages compared to controls in the WOMAC and KOOS scores. The long-term effect of high-dose ADMSC treatment for OA is worthy of further study.

中文翻译：

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骨关节炎关节内细胞治疗的疗效和安全性：系统评价和网络荟萃分析。

客观的

骨关节炎（OA）是一种以关节软骨退化和继发性成骨为特征的慢性关节疾病。基于细胞的药物，如间充质干细胞，已成为研究最广泛的 OA 新治疗药物。然而，基于证据的研究仍然缺乏。

方法

我们检索了截至 2020 年 2 月的公共数据库，仅纳入随机对照试验。结果包括西安大略和麦克马斯特大学骨关节炎指数 (WOMAC)、膝关节损伤和骨关节炎结果评分 (KOOS)、视觉模拟评分 (VAS) 评分和严重不良事件 (SAE)。在这项工作中还进行了网络荟萃分析。

结果

我们在荟萃分析中纳入了 13 项研究。效应量显示，基于细胞的治疗在 6 个月的随访中并未显着降低 WOMAC 评分（标准均数差 [SMD] -3.6；95% 置信区间 [CI] -0.90 至 0.18；P = 0.1928） . 然而，基于细胞的治疗在 12 个月的随访中显着改善了 KOOS（SMD 0.68；95% CI 0.07-1.30；P = 0.0288）并缓解了疼痛（SMD -1.05；95% CI -1.46 至 -0.64；P < 0.0001)。研究结果还表明，高剂量脂肪来源的间充质干细胞 (ADMSCs) 在长期效果方面可能更有利。

结论

基于细胞的治疗在改善 KOOS 和缓解疼痛方面有更好的效果，而且没有安全问题。然而，就 WOMAC 而言，基于细胞的治疗并未显示出益处。与 WOMAC 和 KOOS 评分中的对照相比，同种异体细胞可能具有优势。大剂量ADMSC治疗OA的远期疗效值得进一步研究。