Intra-articular injection choice for osteoarthritis: making sense of cell source-an updated systematic review and dual network meta-analysis

• Published in: Arthritis research & therapy Vol. 24; no. 1; p. 260
• Main Authors: Zhang, Yijian, Yang, Huilin, He, Fan, Zhu, Xuesong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.11.2022; BioMed Central; BMC
• Subjects: Adverse effects; Arthritis; Bias; Biological activity; Care and treatment; Cartilage; Clinical trials; Diagnosis; Function improvement; Humans; Injections, Intra-Articular; Intra-articular injection; Knee; Mesenchymal Stem Cells; Meta-analysis; Network Meta-Analysis; Nonsteroidal anti-inflammatory drugs; Osteoarthritis; Osteoarthritis - drug therapy; Pain; Pain relief; Review; Software; Stem cells; Transplantation; China; Intra-articular injection; Function improvement; Adverse effects; Pain relief; Osteoarthritis; Mesenchymal stem cells
• ISSN: 1478-6362; 1478-6354; 1478-6362
• DOI: 10.1186/s13075-022-02953-0

Intra-articular injection is indicated for mild or moderate osteoarthritis (OA). However, the superiority of cell-based injection and the role of diverse cell sources are still unclear. This study aimed to compare the therapeutic effect of intra-articular injection with mesenchymal stem cells (MSCs) and cell-free methods for OA treatment. A literature search of published scientific data was carried out from PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and China National Knowledge Internet (CNKI). Randomized controlled trials (RCTs) compared the efficacy and safety of MSC and cell-free intra-articular injection treatments for OA with at least 6-month follow-up. Dual network meta-analysis validated the therapeutic advantages of MSC treatments (VAS, Bayesian: 90% versus 10% and SUCRA: 94.9% versus 5.1%; WOMAC total, Bayesian: 83% versus 17% and SUCRA: 90.1% versus 9.9%) but also suggested a potential negative safety induced by cell injection (adverse events, Bayesian: 100% versus 0% and SUCRA: 98.2% versus 1.8%). For the MSC source aspect, adipose mesenchymal stem cells (ADMSCs) and umbilical cord mesenchymal stem cells (UBMSCs) showed a better curative effect on pain relief and function improvement compared with bone marrow mesenchymal stem cells (BMMSCs). Intra-articular injection of MSCs is associated with more effective pain alleviation and function improvement than cell-free OA treatment. However, the potential complications induced by MSCs should be emphasized. A comparative analysis of the MSC sources showed that ADMSCs and UBMSCs exerted a better anti-arthritic efficacy than BMMSCs. Schematic illustration of MSC-based intra-articular injection for treating OA. Three major MSCs (UBMSCs, ADMSCs, and BMMSCs) are extracted and expanded in vitro. Subsequently, the amplified MSCs are concentrated and injected into the knee joint to treat OA.