Research Paper on Is Autologous Mesenchymal Stromal Cell Therapy Culture Expansion Required to Achieve Superior Results in the Management of Knee Osteoarthritis? —Randomized Controlled Trials Meta-Analysis

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Title: Is Autologous Mesenchymal Stromal Cell Therapy Culture Expansion Required to Achieve Superior Results in the Management of Knee Osteoarthritis? —Randomized Controlled Trials Meta-Analysis

Abstract: Meta-analysis. Our goals were to examine the effects of cultured  Using randomized controlled trials (RCTs) from the literature, mesenchymal stromal cells (MSCs) expanded from the patient’s own body are used to treat osteoarthritis of the knee. Materials and Methods: We searched independently and twice through electronic databases like PubMed, Embase, Web of Science, and Cochrane Library for RCTs comparing the effectiveness and safety of culture-expanded autologous MSCs to non-cultured MSCs in the treatment of knee osteoarthritis up until August 2021. The outcomes that were analyzed included the pain Visual Analog Score (VAS), the Western Ontario McMaster University Osteoarthritis Index (WOMAC), the Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS), and adverse events. OpenMeta [Analyst] software was used for the analysis, which was done in the R platform. Results: 767 patients from 17 studies were included in the analysis.  Since no studies directly compared culture-expanded and non-cultured MSCs, we combined the findings of all studies that included both types of MSC sources and performed a comparative analysis of the results. At six months, culture expanded MSCs significantly outperformed the control group in terms of improvement (p 0.001). While cultured-expanded MSCs failed to show a significant change over the long term (12 months), uncultured MSCs showed a significant improvement in VAS (p 0.001), WOMAC (p = 0.025), and KOOS score (p = 0.016). The complications observed were not significantly worsened by MSC culture (p = 0.485). According to sub-group analysis, adipose-derived uncultured MSCs outperformed culture-expanded MSCs in functional outcome parameters like WOMAC (p 0.001, p = 0.025), Lysholm (p 0.006), and KOOS (p 0.003) at both short term (six months) and long term (12 months), respectively.  versus their controls. Conclusions: We found a gap in the literature regarding the effectiveness of MSCs expanded in culture for use in treating osteoarthritis of the knee. The results of our indirect literature review demonstrated that culture expansion of autologous MSCs is not a prerequisite for achieving superior outcomes in the treatment of knee osteoarthritis. Additionally, we advise using MSCs from adipose tissue when using uncultured autologous MSCs to achieve superior functional results. But we recommend  Future high-quality trials will be necessary to confirm our findings and reach an agreement on the necessity of MSC culture expansion for use in cellular therapy for knee osteoarthritis.

Keywords: mesenchymal stromal cell; culture; bone-marrow derived mesenchymal stromal cell; adipose-derived mesenchymal stromal cell; cartilage regeneration; knee osteoarthritis; meta-analysis

Paper Quality: SCOPUS / Web of Science Level Research Paper

Subject: Bioengineering

Writer Experience: 20+ Years

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