Stem cell therapy for osteonecrosis of femoral head: Opportunities and challenges

• Published in: Regenerative therapy Vol. 15; pp. 295 - 304
• Main Authors: Xu, Yingxing, Jiang, Yaping, Xia, ChangSuo, Wang, Yingzhen, Zhao, Zhiping, Li, Tao
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2020; Japanese Society for Regenerative Medicine; Elsevier
• Subjects: Cell implantation; Cell therapy; Femoral head; Osteonecrosis; Review; Stem cells; Tissue engineering; RCT; SVF; Cell therapy; Femoral head; ONFH; ALP; MRI; VAS; Osteonecrosis; BMP-2; THA; TNF; DBM; β-TCP; AMSCs; HHS; MSCs; IP-CHA; BMC; XACB; CD; CSS; PBMSCs; UCMSCs; Tissue engineering; VEGF; Cell implantation; BCP; bFGF; TMCs; PLGA; SCPP; Stem cells; CPC; WOMAC; MVD; BMMNCs; BMSCs; VAS, visual analogue scale; AMSCs, adipose-derived MSCs; β-TCP, beta-tricalcium phosphate; CD, Core decompression; UCMSCs, umbilical cord-derived mesenchymal stem cells; ALP, alkaline phosphatase; CPC, calcium phosphate; HHS, Harris hip score; ONFH, Osteonecrosis of the femoral head; RCT, randomized controlled trial; CSS, cap-shaped separation; WOMAC, Western Ontario and McMaster Universities Arthritis Index; IP-CHA, interconnected porous calcium hydroxyapatite; SVF, stromal vascular fractions; MVD, microvessel density; TNF, tumor necrosis factor; BMC, bone marrow concentrate; VEGF, vascular endothelial growth factor; BMMNCs, bone marrow mononuclear cells; BCP, biphasic calcium phosphate; SCPP, strontium-doped calcium polyphosphate; THA, total hip arthroplasty; MRI, magnetic resonance imaging; TMCs, transformed mesenchymal cells; DBM, demineralized bone matrix; bFGF, basic fibroblast growth factor; BMSCs, bone marrow-derived mesenchymal stem cells; BMP-2, bone morphogenetic protein-2; MSCs, Mesenchymal stem cells; PLGA, poly lactide-co-glycolide; PBMSCs, peripheral blood-derived MSCs; XACB, xenogeneic antigen-extracted cancellous bone
• ISSN: 2352-3204; 2352-3204
• DOI: 10.1016/j.reth.2020.11.003

Osteonecrosis of the femoral head (ONFH) is a progressive disease with a complex etiology and unclear pathogenesis, resulting in severe hip pain and dysfunction mainly observed in young patients. Although total hip arthroplasty (THA) is the most effective treatment for patients with ONFH in the terminal stage, the results of THA in young patients or active populations are often not favorable, with some complications related to the prosthesis. With the development of biotechnology, an increasing number of studies pay attention to use of stem cells for the treatment of ONFH. Stem cells are characterized by the ability to self-renew and differentiate into multiple cell types, including differentiation into osteoblasts and endothelial cells to mediate bone repair and angiogenesis. Furthermore, stem cells can offer growth factors to promote blood supply in the necrotic regions by paracrine effects. Therefore, stem cell therapy has become one of the hip-preserving alternatives for ONFH. This review summarized the current trends in stem cell therapy for ONFH, from clinical applications to related basic research, and showed that an increasing number of studies have confirmed the effectiveness of stem cell therapy in ONFH. However, many unsolved problems and challenges in practical applications of stem cell therapy still exist, such as patient selection, standardized procedures, safety assessment, and the fate of transplanted cells in the body. Additional studies are required to find ideal cell sources, appropriate transplantation methods, and the optimal number of cells for transplantation. •Diversities in repair processes present a challenge in the targeted treatment of ONFH.•Osteogenesis and angiogenesis are the primary mechanisms of MSCs treatment in ONFH.•Systematic safety assessment and cell tracing are necessary for stem cell therapy.•Optimal numbers and methods of cell transplantation need to be further confirmed.