Transplantation of three mesenchymal stem cells for knee osteoarthritis, which cell and type are more beneficial? a systematic review and network meta-analysis

• Published in: Journal of orthopaedic surgery and research Vol. 19; no. 1; pp. 366 - 15
• Main Authors: Chen, Xiyang, Zheng, Jinglu, Yin, Li, Li, Yikai, Liu, Hongwen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.06.2024; BioMed Central; BMC
• Subjects: Adipose Tissue - cytology; Adipose tissues; Advertising executives; Antiarthritic agents; Care and treatment; Complications and side effects; Female; Humans; Hyaluronic acid; Knee; Male; Medical research; Medicine, Experimental; Mesenchymal Stem Cell Transplantation - methods; Mesenchymal Stem Cells; Middle Aged; Network Meta-Analysis; Osteoarthritis; Osteoarthritis, Knee - therapy; Outcomes; Pain; Pain Measurement; Range of Motion, Articular; Rankings; Review; Stem cell types; Stem cells; Transplantation; Transplantation, Autologous - methods; Treatment Outcome; Umbilical Cord - cytology; Knee; Stem cell types; Osteoarthritis; Outcomes; Mesenchymal stem cells
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-024-04846-1

In knee osteoarthritis (KOA), treatments involving knee injections of bone marrow-derived mesenchymal stem cells (BM-MSC), adipose tissue-derived mesenchymal stem cells (AD-MSC), or umbilical cord-derived mesenchymal stem cells (UC-MSC) have shown promise in alleviating symptoms. However, which types of mesenchymal stem cells (MSCs) have the best therapeutic outcomes remain uncertain. We systematically searched PubMed, OVID, Web of Science, and the Cochrane Library until January 1, 2024. The study evaluated five endpoints: Visual Analog Score (VAS) for Pain, Range of Motion (ROM), Whole-Organ Magnetic Resonance Imaging Score (WORMS), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and adverse events (ADs). Standard meta-analysis and network meta-analysis were performed using Stata 16.0. Fifteen studies involving 585 patients were included in the meta-analysis. Standard meta-analysis revealed significant improvements with MSCs in VAS score (P < 0.001), knee ROM (P < 0.001), and WOMAC (P < 0.016) compared to traditional therapy. In the network meta-analysis, autologous MSCs significantly improved VAS score [SMD = 2.94, 95% CI (1.90, 4.56)] and knee ROM [SMD = 0.26, 95% CI (0.08, 0.82)] compared to traditional therapy. Similarly, BM-MSC significantly improved VAS score [SMD = 0.31, 95% CI (0.11, 0.91)] and knee ROM [SMD = 0.26, 95% CI (0.08, 0.82)] compared to hyaluronic acid. However, compared with traditional therapy, autologous or allogeneic MSCs were associated with more adverse reactions [SMD = 0.11, 95% CI (0.02, 0.59)], [SMD = 0.13, 95% CI (0.002, 0.72)]. Based on the surface under the cumulative ranking results, autologous BM-MSC showed the most improvement in ROM and pain relief in KOA patients, UC-MSC (SUCRA 94.1%) were most effective for positive WORMS, and AD-MSC (SUCRA 70.6%) were most effective for WOMAC-positive patients. MSCs transplantation effectively treats KOA patients, with autologous BM-MSC potentially offering more excellent benefits.