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Rainey JP, Goodman SB, Jones LC, Sequeira SB, Mont MA. Part II: Biologic Augmentation Strategies as Useful Adjuncts in Musculoskeletal Surgery. J Arthroplasty 2025:S0883-5403(25)00524-8. [PMID: 40379116 DOI: 10.1016/j.arth.2025.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2025] [Revised: 03/31/2025] [Accepted: 05/07/2025] [Indexed: 05/19/2025] Open
Abstract
Osseous healing after injury, whether by arthritis, osteonecrosis, or fracture, follows a fairly predictable and stepwise order of events. New bone formation requires osteoinductive, osteoconductive, and osteogenetic signals and environments for rapid and complete healing. Biologic augmentation strategies, such as bone marrow aspirate concentrates (BMACs) and other forms of mesenchymal stem cells (MSCs), have been studied with renewed interest as a way to enhance healing in patients who have osteoarthritis, osteonecrosis, delayed unions, and nonunions. Many studies have demonstrated positive results in favor of biologic augmentation strategies to treat or temporize arthritis, osteonecrosis, and nonunion. Future research is required to definitively determine the utility of these biologic augmentation strategies, and larger randomized controlled trials with longer-term follow-up are needed.
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Li L, Dou X, Song X, Wang F. The Current Status and Future Prospects of Intra-articular Injection Therapy for Hip Osteoarthritis: A Review. Curr Pain Headache Rep 2025; 29:64. [PMID: 40100299 PMCID: PMC11919992 DOI: 10.1007/s11916-025-01378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2025] [Indexed: 03/20/2025]
Abstract
PURPOSE OF REVIEW Hip osteoarthritis constitutes a prevalent condition among individuals aged 55 and above, serving as one of the primary triggers for joint discomfort and impairment, and marking a substantial origin of chronic pain particularly affecting the elderly population. Our article provides an exhaustive summary of the mechanisms of action, therapeutic efficacy, and potential adverse consequences associated with novel therapeutic modalities including glucocorticoids, hyaluronic acid, platelet-rich plasma, mesenchymal stem cells, and stromal vascular fraction. Concurrently, we conducted a comprehensive evaluation of the clinical efficacy and potential applications of various medications. RECENT FINDINGS In comparison to physical therapy, oral analgesics, and other nonsurgical modalities, intra-articular injection therapy is characterized by enhanced safety and greater efficacy. Moreover, when contrasted with surgical intervention, intra-articular injection demonstrates a lower degree of invasiveness and incurs fewer adverse reactions. Intra-articular treatments have shown excellent local efficacy while significantly minimizing adverse reactions in patients. These methods hold significant potential for development but require comprehensive research and thorough discussion within the academic community.
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Affiliation(s)
- Li Li
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Nursing department, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Xiaofan Dou
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Nursing department, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Xueliang Song
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
- Nursing department, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Fengxian Wang
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
- Nursing department, Zhejiang Provincial People'S Hospital (Affiliated People'S Hospital, Hangzhou Medical College), No. 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
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Labarre KW, Grathwol PA, Zimmermann G. "Cellularity as a predictive tool for mesenchymal stem cell concentration in bone marrow concentrates: Implications for regenerative medicine". Bone Rep 2025; 24:101820. [PMID: 39691445 PMCID: PMC11650265 DOI: 10.1016/j.bonr.2024.101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 11/22/2024] [Accepted: 11/23/2024] [Indexed: 12/19/2024] Open
Abstract
Background Mesenchymal stem cells (MSCs) derived from bone marrow play an increasingly important role in regenerative medicine due to their capacity to promote tissue regeneration in various clinical contexts. Applications include the treatment of osteoarthritis, bone regeneration post-injury, and the management of conditions such as Crohn's disease, alopecia, and nervous system reconstruction. Accurate quantification of MSCs within Bone Marrow Concentrates (BMCs) is essential for ensuring the quality and efficacy of these cell therapy products in clinical settings. Objective This study aims to quantify the population of CD271+ and CD45- cells in BMCs prepared using the method we have selected and to provide a basis for comparing these results with other BMC products. Additionally, we seek to determine whether the total cell count in BMCs can serve as a reliable indicator of MSC numbers and if cellularity (the number of cells per ml) can predict a higher percentage of MSCs within the population. Methods Bone Marrow Aspirates (BMA) were collected from 41 patients undergoing knee or hip arthroplasty. Aspirates were processed using density gradient centrifugation and positive selection of CD271+ cells. Flow cytometry was applied to analyze cell subsets, and cell counts were determined with a NucleoCounter. The relationships between BMA cellularity (total cells per ml), MSC concentration (MSC count per ml), and MSC percentage (the proportion of MSCs within the total cell population) were assessed. Results The mean percentage of CD271+ CD45- cells in bone marrow samples was 0.03 % (SD 0.03 %). Cellularity varied significantly among samples, with a mean of 6 million cells/ml (SD 8.7 million cells/ml). A strong correlation was observed between BMC cellularity and MSC concentration (p < 0.05), although no correlation was found between cellularity and the MSC percentage. Conclusion Despite high variability in cellularity, the concentration of MSCs correlated strongly with BMC cellularity, suggesting that total cell counts can be used to estimate MSC numbers in BMCs. However, cellularity is not an indicator of a particularly high MSC content. This study supports the use of cell counts as a measure for estimating MSC concentration in BMCs. Future research should focus on establishing direct comparisons with other BMC products and exploring factors influencing cellularity and MSC percentages to enhance BMC quality for clinical applications.
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Affiliation(s)
- Klaus Werner Labarre
- Department of Trauma Surgery, Theresienkrankenhaus, Bassermannstraße 1, 68165 Mannheim, Germany
| | - Peter Ansgar Grathwol
- Department of Trauma Surgery, Theresienkrankenhaus, Bassermannstraße 1, 68165 Mannheim, Germany
| | - Gerald Zimmermann
- Department of Trauma Surgery, Theresienkrankenhaus, Bassermannstraße 1, 68165 Mannheim, Germany
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Giorgino R, Alessandri Bonetti M, Migliorini F, Nannini A, Vaienti L, Peretti GM, Mangiavini L. Management of hip osteoarthritis: harnessing the potential of mesenchymal stem cells-a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3847-3857. [PMID: 39254726 PMCID: PMC11519189 DOI: 10.1007/s00590-024-04089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 08/25/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Hip osteoarthritis (OA) is a prevalent and debilitating condition, necessitating effective and safe treatment options. This systematic review aims to explore the potential of intra-articular mesenchymal stem cell (MSC) infiltrations as a therapeutic approach for hip OA. METHODS Following PRISMA guidelines, a systematic review was conducted, encompassing PubMed, Embase, and Cochrane Library databases. Inclusion criteria involved studies focusing on intra-articular MSC injections in patients with hip OA and reporting pain relief as an outcome measure. Quality assessment utilized the Newcastle-Ottawa scale and methodological index for non-randomized studies. RESULTS Ten studies were included in the review, exhibiting varied designs and sample sizes (316 patients). Outcome measures consisted of cartilage repair assessed through MRI and radiographies, pain scores (WOMAC, VAS, NRS), and functional improvements (HOS-ADL, OHS, FRI, PDQQ, LEFS). The studies reported favorable improvements in functional scores, pain relief, and cartilage repair/radiographic findings, with minimal reported adverse events. CONCLUSIONS Intra-articular MSC infiltrations demonstrate promise as an effective and safe therapeutic intervention for managing hip OA, offering pain relief and functional enhancements. Nevertheless, limited high-quality studies and outcome measure variations underscore the need for further research to establish definitive treatment guidelines. Future investigations should address optimal MSC utilization, long-term outcomes, and potential complications to ensure the success of MSC-based therapies for hip OA management, ultimately improving patient outcomes. The findings provide valuable insights into the potential of MSC-based treatments for hip OA, advocating further rigorous research in this field. TRIAL REGISTRATION The protocol was registered on PROSPERO database (CRD42023436973).
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Affiliation(s)
- Riccardo Giorgino
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20161, Milan, Italy.
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy.
| | | | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Alessandra Nannini
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20161, Milan, Italy
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy
| | - Luca Vaienti
- Department of Plastic Surgery, University of Milan, 20161, Milan, Italy
| | - Giuseppe Michele Peretti
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy
| | - Laura Mangiavini
- I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122, Milan, Italy
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Chandrashekar S, Jeyaraman M, Mounissamy P, Jeyaraman N, Khanna M, Gupta A. Safety and Efficacy of Bone-Marrow Aspirate Concentrate in Hip Osteoarthritis: A Systematic Review of Current Clinical Evidence. Indian J Orthop 2024; 58:835-844. [PMID: 38948376 PMCID: PMC11208346 DOI: 10.1007/s43465-024-01183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/04/2024] [Indexed: 07/02/2024]
Abstract
Introduction Hip osteoarthritis (OA) is one of the leading causes of disability and morbidity worldwide. It is estimated to affect 9.2% individuals globally with age over 45 years. Conventional treatment modalities have limitations and side-effects. To overcome these limitations, over the last decade, there has been an increased interest in the use of orthobiologics derived from autologous sources including platelet-rich plasma (PRP), bone-marrow aspirate concentrate (BMAC) and adipose tissue derived formulations. This review qualitatively presents the in-vitro, pre-clinical, clinical and on-going clinical studies exploring the safety and efficacy of BMAC for management of hip OA. Materials and methods The electronic database search was done through PubMed, Embase, Web of Science, Scopus, ProQuest and Google Scholar till February 2024. The search terms used were "osteoarthritis" OR "hip osteoarthritis" OR "orthobiologics" OR "efficacy or use of orthobiologic treatment" OR "bone-marrow concentrate" OR "bone-marrow aspirate concentrate", AND "BMAC". The inclusion criteria were clinical studies of any level of evidence written in the English language, published till February 2024, evaluating the safety and efficacy of intra-articular administration of BMAC for the management of hip OA. Results A total of 5 studies were included in this review for qualitative data synthesis. The total number of patients who participated in the study was 182, ranging from 4 to 112 in a single study. No adverse events were reported throughout the duration of the study. In addition, intra-articular administration of BMAC led to reduced pain, and improved function and overall quality of life (QoL). Conclusion The results from this review demonstrated that administration of BMAC is safe and potentially efficacious in terms of reducing pain, improving function and overall QoL of patients with hip OA in short- and mid-term average follow-up based on the included studies. Nonetheless, more adequately powered, multi-center, prospective, double-blind, non-randomized and randomized controlled trials with long-term follow-up are warranted to establish long-term safety and efficacy of BMAC for management of hip OA and justify its routine clinical use.
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Affiliation(s)
- Sushma Chandrashekar
- Fellow in Orthopaedic Rheumatology, Dr RML National Law University, Lucknow, 226010 Uttar Pradesh India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077 Tamil Nadu India
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA
| | - Prabu Mounissamy
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077 Tamil Nadu India
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
| | - Manish Khanna
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
- Department of Orthopaedics, Dr KNS Mayo Institute of Medical Sciences, Lucknow, 225001 Uttar Pradesh India
| | - Ashim Gupta
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA
- Regenerative Orthopaedics, Noida, 201301 Uttar Pradesh India
- Future Biologics, Lawrenceville, GA 30043 USA
- BioIntegrate, Lawrenceville, GA 30043 USA
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Perez OF, Warburton C, Philippon MC, Philippon MJ, Best TM. The Efficacy of Bone Marrow Stem Cell Therapy in Hip Osteoarthritis: A Scoping Review. HSS J 2024:15563316241259035. [PMID: 39564400 PMCID: PMC11572593 DOI: 10.1177/15563316241259035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/07/2024] [Indexed: 11/21/2024]
Abstract
Background Hip osteoarthritis (HOA) is a prevalent degenerative joint disease with various treatment approaches. Biological agents, such as bone-marrow derived stem cells (BM-MSC) therapy, have recently been proposed as a treatment option in the management of HOA. Purpose We sought to further analyze the use of BM-MSC therapy by investigating the following questions. What is the standard preparation and practice? Does a dose response exist between stem cell therapy and clinical outcome? Does BM-MSC therapy alone produce effective clinical outcomes? Methods We conducted a scoping review using the Methodological Expectations of Cochrane Intervention Reviews Manual and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for scoping reviews. A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Scopus, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection was performed in June 2023 of studies using exclusively BM-MSC injections for the treatment of HOA. Study characteristic, injection preparation and dosage, clinical outcome measures, and adverse effect data were extracted and interpreted by 3 reviewers. Results Seven studies with a total of 72 patients met the inclusion criteria. Clinical outcome following intra-articular injection of BM-MSCs was measured using the numerical pain scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the visual analogue scale, and other scores, all of which showed reduction in pain and increase in functional ability across studies. Conclusions This scoping review found that the efficacy of BM-MSC therapy alone in the treatment of HOA appeared beneficial, improving clinical outcomes in each study. All 7 studies used "low-dose" injections with variable follow-up times; thus, a clear dose-response relationship cannot be drawn. Future studies using high doses and analyzing long-term effects of BM-MSC injections in HOA are needed.
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Affiliation(s)
- Olivia F Perez
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | | | - Marc J Philippon
- Center for Regenerative and Personalized Medicine (CRPM), Steadman Philippon Research Institute, Vail, CO, USA
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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Ehioghae M, Vippa TK, Askins D, Slusarczyk S, Bobo E, Montoya A, Anderson D, Robinson CL, Kaye AD, Urits I. Exploring Orthopedic Stem-Cell Approaches for Osteoarthritis Management: Current Trends and Future Horizons. Curr Pain Headache Rep 2024; 28:27-35. [PMID: 38010488 DOI: 10.1007/s11916-023-01191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Osteoarthritis (OA) is a prevalent and debilitating condition characterized by joint degeneration and pain. Current treatment options aim to alleviate symptoms and slow disease progression but lack curative potential. Stem cell therapies have emerged as a promising alternative. This article explores the epidemiology, pathophysiology, clinical manifestations of hip and knee OA, and the evolving role of stem cell therapies in their treatment. RECENT FINDINGS The global prevalence of OA, with knee OA being the most common form, has fueled the demand for stem cell therapies. Despite limited robust evidence supporting their efficacy, clinical trials investigating stem-cell treatments for OA have reported encouraging radiological and clinical improvements. Stem cell therapies offer potential disease-modifying benefits through immunomodulatory actions, growth factor secretion, and chondrogenic capabilities. Adipose-derived mesenchymal stem cells (ADMSCs) have shown promise in clinical trials for OA treatment, offering potential pain relief and functional improvement. ADMSCs possess advantages such as accessibility and a favorable safety profile, making them a viable option for OA management. Although other stem-cell types, including human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs), have been used in OA treatment, ADMSCs have demonstrated superior outcomes. By providing a comprehensive overview of the evolving landscape of stem cell therapies for hip and knee OA, this article highlights the potential of stem-cell treatments to address the limitations of current therapies. However, further research is required to establish their long-term efficacy, identify optimal stem-cell types, and develop standardized protocols.
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Affiliation(s)
| | | | | | | | - Elena Bobo
- Tulane University School of Medicine, New Orleans, USA
| | - Alexis Montoya
- University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | | | | | - Alan D Kaye
- Louisiana State University Health Shreveport, Shreveport, USA
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8
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Zaffagnini M, Boffa A, Andriolo L, Raggi F, Zaffagnini S, Filardo G. Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review. J Clin Med 2022; 11:jcm11226663. [PMID: 36431138 PMCID: PMC9699182 DOI: 10.3390/jcm11226663] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the evidence about the safety and efficacy of these products. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the RoB 2.0 for randomized controlled trials (RCTs) and the modified Coleman Methodology Score (mCMS) for all studies. A total of 20 clinical studies (735 patients) was identified, 12 on PRP injections and eight on cell-based therapies (five from bone marrow, two from adipose tissue, and one from amniotic fluid). The publication trend increased over time, with over 50% of articles published from 2019. The literature analysis showed only six RCTs, all on PRP injections. The mCMS showed an overall fair methodology (mean score 59.4). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results, with the treatment success being inversely proportional to the severity of OA. Further high-level controlled trials are needed before drawing more definitive conclusions on the real potential of orthobiologics for the injective treatment of patients affected by hip OA.
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Affiliation(s)
- Marco Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-0516-366-072
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Raggi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Hart DA, Nakamura N. Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System. Biomedicines 2022; 10:1570. [PMID: 35884875 PMCID: PMC9313221 DOI: 10.3390/biomedicines10071570] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Following most injuries to a musculoskeletal tissue which function in unique mechanical environments, an inflammatory response occurs to facilitate endogenous repair. This is a process that usually yields functionally inferior scar tissue. In the case of such injuries occurring in adults, the injury environment no longer expresses the anabolic processes that contributed to growth and maturation. An injury can also contribute to the development of a degenerative process, such as osteoarthritis. Over the past several years, researchers have attempted to use cellular therapies to enhance the repair and regeneration of injured tissues, including Platelet-rich Plasma and mesenchymal stem/medicinal signaling cells (MSC) from a variety of tissue sources, either as free MSC or incorporated into tissue engineered constructs, to facilitate regeneration of such damaged tissues. The use of free MSC can sometimes affect pain symptoms associated with conditions such as OA, but regeneration of damaged tissues has been challenging, particularly as some of these tissues have very complex structures. Therefore, implanting MSC or engineered constructs into an inflammatory environment in an adult may compromise the potential of the cells to facilitate regeneration, and neutralizing the inflammatory environment and enhancing the anabolic environment may be required for MSC-based interventions to fulfill their potential. Thus, success may depend on first eliminating negative influences (e.g., inflammation) in an environment, and secondly, implanting optimally cultured MSC or tissue engineered constructs into an anabolic environment to achieve the best outcomes. Furthermore, such interventions should be considered early rather than later on in a disease process, at a time when sufficient endogenous cells remain to serve as a template for repair and regeneration. This review discusses how the interface between inflammation and cell-based regeneration of damaged tissues may be at odds, and outlines approaches to improve outcomes. In addition, other variables that could contribute to the success of cell therapies are discussed. Thus, there may be a need to adopt a Precision Medicine approach to optimize tissue repair and regeneration following injury to these important tissues.
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Affiliation(s)
- David A. Hart
- Department of Surgery, Faculty of Kinesiology, McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB T2N 4N1, Canada
- Bone & Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Norimasa Nakamura
- Institute of Medical Science in Sport, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka 530-0043, Japan;
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10
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Fotouh AA, Hamdy M, Ali F, Mohamed EF, Allam A, Hassan WA, Elsaman A, El-Najjar A, Amer MA, Mosad D, Tharwat S, El Bakry SA, Saleh H, Zaghloul A, Mahmoud M, Mohammed RHA, El-Saadany H, Fathi HM, Hammam N, Raafat HA, Moharram AN, Gheita TA, On behalf of the Egyptian College of Rheumatology (ECR) Musculoskeletal Ultrasound Study Group. The Emerging Era of Interventional Imaging in Rheumatology: An Overview During the Coronavirus Disease-2019 (COVID-19) Pandemic. Open Access Rheumatol 2022; 14:43-56. [PMID: 35449707 PMCID: PMC9018128 DOI: 10.2147/oarrr.s355140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Imaging has long been taking its place in the diagnosis, monitor, and prognosis of rheumatic diseases. It plays a vital role in the appraisal of treatment. Key progress in the clinical practice of rheumatology is the innovation of advanced imaging modalities; such as musculoskeletal ultrasound (MSUS), computerized tomography (CT) and magnetic resonance imaging (MRI). These modalities introduced a promising noninvasive method for visualizing bone and soft tissues to enable an improved diagnosis. The use of MSUS in rheumatology is considered a landmark in the evolution of the specialty and its ease of use and many applications in rheumatic diseases make it a forerunner instrument in the practice. The use of MSUS among rheumatologists must parallel the development rate of the excellence revealed in the specialty. Moreover, innovative interventional imaging in rheumatology (III-R) is gaining fame and key roles in the near future for a comprehensive management of rheumatic diseases with precision. This review article throws light on the emergence of these robust innovations that may reshape the guidelines and practice in rheumatology, in particular, efforts to enhance best practice during the coronavirus disease 2019 (COVID-19) pandemic are endorsed.
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Affiliation(s)
| | - Mona Hamdy
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Fatma Ali
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, AlAzhar Girls, Cairo, Egypt
| | - Abdallah Allam
- Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Waleed A Hassan
- Rheumatology Department, Faculty of Medicine, Benha University, Banha, Egypt
| | - Ahmed Elsaman
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Amany El-Najjar
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Marwa A Amer
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doaa Mosad
- Rheumatology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samar Tharwat
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samah A El Bakry
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hanan Saleh
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Zaghloul
- Interventional Pain Management and Anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Mahmoud
- Orthopedic and Microsurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem H A Mohammed
- Rheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan El-Saadany
- Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hanan M Fathi
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hala A Raafat
- Rheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf N Moharram
- Orthopedic and Microsurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer A Gheita
- Rheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - On behalf of the Egyptian College of Rheumatology (ECR) Musculoskeletal Ultrasound Study Group
- Cairo University Hospital, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, AlAzhar Girls, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Rheumatology Department, Faculty of Medicine, Benha University, Banha, Egypt
- Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Rheumatology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Interventional Pain Management and Anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
- Orthopedic and Microsurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
- Rheumatology and Clinical Immunology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
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Methodological Flaws in Meta-Analyses of Clinical Studies on the Management of Knee Osteoarthritis with Stem Cells: A Systematic Review. Cells 2022; 11:cells11060965. [PMID: 35326416 PMCID: PMC8946093 DOI: 10.3390/cells11060965] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Conclusions of meta-analyses of clinical studies may substantially influence opinions of prospective patients and stakeholders in healthcare. Nineteen meta-analyses of clinical studies on the management of primary knee osteoarthritis (pkOA) with stem cells, published between January 2020 and July 2021, came to inconsistent conclusions regarding the efficacy of this treatment modality. It is possible that a separate meta-analysis based on an independent, systematic assessment of clinical studies on the management of pkOA with stem cells may reach a different conclusion. (2) Methods: PubMed, Web of Science, and the Cochrane Library were systematically searched for clinical studies and meta-analyses of clinical studies on the management of pkOA with stem cells. All clinical studies and meta-analyses identified were evaluated in detail, as were all sub-analyses included in the meta-analyses. (3) Results: The inconsistent conclusions regarding the efficacy of treating pkOA with stem cells in the 19 assessed meta-analyses were most probably based on substantial differences in literature search strategies among different authors, misconceptions about meta-analyses themselves, and misconceptions about the comparability of different types of stem cells with regard to their safety and regenerative potential. An independent, systematic review of the literature yielded a total of 183 studies, of which 33 were randomized clinical trials, including a total of 6860 patients with pkOA. However, it was not possible to perform a scientifically sound meta-analysis. (4) Conclusions: Clinicians should interpret the results of the 19 assessed meta-analyses of clinical studies on the management of pkOA with stem cells with caution and should be cautious of the conclusions drawn therein. Clinicians and researchers should strive to participate in FDA and/or EMA reviewed and approved clinical trials to provide clinically and statistically valid efficacy.
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