Skip to main content

Advertisement

Log in

Le cellule staminali: impiego clinico

The clinical application of MSCs in orthopaedics

  • Aggiornamenti
  • Published:
LO SCALPELLO-OTODI Educational

Abstract

A systematic review of clinical applications of MSCs in the treatment of knee osteoarthritis (OA). Twenty-three papers were included in the final analysis (10 on BMAC and 13 on SVF). Of these, only 4 were randomised controlled trials (RCTs). The Coleman Score, used for bias risk evaluation, revealed an overall poor quality of the studies. In terms of clinical application, despite the apparent safety and the short-term positive clinical outcomes, clinicians reported different preparation and administration methods. The available literature is not sufficient to make any recommendation on the use of either product in clinical practice, even though they have both shown to be safe and have some short-term beneficial effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Bibliografia

  1. Poole AR (2003) What type of cartilage repair are we attempting to attain? J Bone Jt Surg, Am 85-A(Suppl):40–44

    Google Scholar 

  2. Richards MM, Maxwell JS, Weng L et al. (2016) Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. Phys Sportsmed 44(2):101–108

    PubMed  PubMed Central  Google Scholar 

  3. Heijink A, Gomoll AH, Madry H et al. (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):423–435

    PubMed  Google Scholar 

  4. Vos T, Flaxman AD, Naghavi M et al. (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2163–2196

    PubMed  PubMed Central  Google Scholar 

  5. Yoshimura K, Shigeura T, Matsumoto D et al. (2006) Characterization of freshly isolated and cultured cells derived from the fatty and fluid portions of liposuction aspirates. J Cell Physiol 208(1):64–76

    CAS  PubMed  Google Scholar 

  6. Verbus EA, Kenyon JD, Sergeeva O et al. (2017) Expression of miR-145-5p during chondrogenesis of mesenchymal stem cells. J Stem Cell Res (Overl Park) 1(3):1–10

    Google Scholar 

  7. DiMarino AM, Caplan AI, Bonfield TL (2013) Mesenchymal stem cells in tissue repair. Front Immunol 4:201

    PubMed  PubMed Central  Google Scholar 

  8. Caplan AI (2007) Adult mesenchymal stem cells for tissue engineering versus regenerative medicine. J Cell Physiol 213(2):341–347

    CAS  PubMed  Google Scholar 

  9. Wu L, Cai X, Zhang S et al. (2013) Regeneration of articular cartilage by adipose tissue derived mesenchymal stem cells: perspectives from stem cell biology and molecular medicine. J Cell Physiol 228(5):938–944

    CAS  PubMed  Google Scholar 

  10. Filardo G, Madry H, Jelic M et al. (2013) Mesenchymal stem cells for the treatment of cartilage lesions: from preclinical findings to clinical application in orthopaedics. Knee Surg Sports Traumatol Arthrosc 21(8):1717–1729

    PubMed  Google Scholar 

  11. US Food and Drug Administration (2018) Regulatory considerations for human cells, tissues, and cellular and tissue-based products: minimal manipulation and homologous use. Guidance for industry and Food and Drug Administration Staff www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/CellularandGeneTherapy/UCM585403.pdf. Accessed February 2018

  12. de Girolamo L, Kon E, Filardo G et al. (2016) Regenerative approaches for the treatment of early OA. Knee Surg Sports Traumatol Arthrosc 24(6):1826–1835

    PubMed  Google Scholar 

  13. Pak J, Lee J, Pak N et al. (2018) Cartilage regeneration in humans with adipose tissue-derived stem cells and adipose stromal vascular fraction cells: updated status. Int J Mol Sci 19(7):2146

    PubMed Central  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG (the PRISMA Group) (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    PubMed  PubMed Central  Google Scholar 

  15. Kon E, Verdonk P, Condello V (2009) Matrix-assisted autologous chondrocyte transplantation for the repair of cartilage defects of the knee systematic clinical data review. Am J Sports Med 2009:156–166

    Google Scholar 

  16. Themistocleous GS, Chloros GD, Kyrantzoulis IM et al.(2018) Effectiveness of a single intra-articular bone marrow aspirate concentrate (BMAC) injection in patients with grade 3 and 4 knee osteoarthritis. Heliyon 4(10):e00871

    PubMed  PubMed Central  Google Scholar 

  17. Shaw B, Darrow M, Derian A (2018) Short-term outcomes in treatment of knee osteoarthritis with 4 bone marrow concentrate injections. Clin Med Insights Arthritis Musculoskelet Disord. https://doi.org/10.1177/1179544118781080

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rodriguez-Fontan F, Piuzzi NS, Kraeutler MJ, Pascual-Garrido C (2018) Early clinical outcomes of intra-articular injections of bone marrow aspirate concentrate for the treatment of early osteoarthritis of the hip and knee: a cohort study. Phys Med Rehabil J 10(12):1353–1359

    Google Scholar 

  19. Shapiro SA, Arthurs JR, Heckman MG et al. (2019) Quantitative T2 MRI mapping and 12-month follow-up in a randomized, blinded, placebo controlled trial of bone marrow aspiration and concentration for osteoarthritis of the knees. Cartilage 10(4):432–443

    CAS  PubMed  Google Scholar 

  20. Sampson S, Vincent H, Aufiero D (2016) Intra-articular bone marrow concentrate injection protocol: short-term efficacy in osteoarthritis. Regen Med 11:511–520

    CAS  PubMed  Google Scholar 

  21. Centeno CJ, Al-Sayegh H, Bashir J et al. (2015) A dose response analysis of a specific bone marrow concentrate treatment protocol for knee osteoarthritis. BMC Musculoskelet Disord 16:258

    PubMed  PubMed Central  Google Scholar 

  22. Centeno C, Pitts J, Al-Sayegh H, Freeman M (2014) Efficacy of autologous bone marrow concentrate for knee osteoarthritis with and without adipose graft. BioMed Res Int 2014:370621

    PubMed  PubMed Central  Google Scholar 

  23. Kim J-D, Lee GW, Jung GH et al. (2014) Clinical outcome of autologous bone marrow aspirates concentrate (BMAC) injection in degenerative arthritis of the knee. Eur J Orthop Surg Traumatol 24:1505–1511

    PubMed  Google Scholar 

  24. Vad V, Barve R, Linnell E, Harrison J (2016) Knee osteoarthritis treated with percutaneous chondral-bone interface optimization: a pilot trial. Surg Sci 7:1–12

    Google Scholar 

  25. Hernigou P, Auregan JC, Dubory A et al. (2018) Subchondral stem cell therapy versus controlateral total knee arthroplasty for osteoarthritis following secondary osteonecrosis of the knee. Int Orthop 42:2563–2571

    PubMed  Google Scholar 

  26. Hudetz D, Bori I, Rod E et al. (2017) The effect of intra-articular injection of autologous microfragmented fat tissue on proteoglycan synthesis in patients with knee osteoarthritis. Genes (Basel) 8(10):E270

    Google Scholar 

  27. Yokota N, Yamakawa M, Shirata T, Kimura T (2017) Clinical results following intra-articular injection of adipose-derived stromal vascular fraction cells in patients with osteoarthritis of the knee. Regen Ther 6:108–112

    PubMed  PubMed Central  Google Scholar 

  28. Jones IA, Wilson M, Togashi R et al. (2018) A randomized, controlled study to evaluate the efficacy of intra-articular, autologous adipose tissue injections for the treatment of mild-to-moderate knee osteoarthritis compared to hyaluronic acid: a study protocol. BMC Musculoskelet Disord 19(1):383

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Roato I, Belisario DC, Compagno M et al. (2018) Concentrated adipose tissue infusion for the treatment of knee osteoarthritis: clinical and histological observations. Int Orthop 43(1):15–23

    PubMed  Google Scholar 

  30. Bansal H, Comella K, Leon J et al. (2017) Intra-articular injection in the knee of adipose derived stromal cells (stromal vascular fraction) and platelet rich plasma for osteoarthritis. J Transl Med 15(1):141

    PubMed  PubMed Central  Google Scholar 

  31. Bui KH, Duong TD, Nguyen NT et al. (2014) Symptomatic knee osteoarthritis treatment using autologous adipose derived stem cells and platelet-rich plasma: a clinical study. Biomed Res Ther 2014(1):02

    Google Scholar 

  32. Koh Y, Kwon O, Kim Y, Choi Y (2014) Comparative outcomes of open-wedge high tibial osteotomy mesenchymal stem cell treatment: a prospective study. Arthroscopy 30(11):1453–1460

    PubMed  Google Scholar 

  33. Hong Z, Chen J, Zhang S et al. (2018) Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial. Int Orthop 43(5):1123–1134

    PubMed  Google Scholar 

  34. Kim YS, Hospital YS, Suh DS et al. (2015) Mesenchymal stem cell implantation in osteoarthritic knees: is fibrin glue effective as a scaffold? Am J Sports Med 43(1):176–185

    PubMed  Google Scholar 

  35. Koh YG, Choi YJ, Kwon OR (2014) Second-look arthroscopic evaluation of cartilage lesions after mesenchymal stem cell implantation in osteoarthritic knees. Am J Sports Med 42(7):1628–1637

    PubMed  Google Scholar 

  36. Kwon YK (2013) Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 23(5):1308–1316

    PubMed  Google Scholar 

  37. Nguyen PD, Tran TD-X, Nguyen HT-N et al. (2016) Comparative clinical observation of arthroscopic microfracture in the presence and absence of a stromal vascular fraction injection for osteoarthritis. Stem Cells Transl Med 6:187–195

    PubMed  PubMed Central  Google Scholar 

  38. Koh Y-G, Jo S-B, Kwon O-R et al. (2013) Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy 29(4):748–755

    PubMed  Google Scholar 

  39. Di Matteo B, Kon E (2019) Editorial commentary: biologic products for cartilage regeneration—time to redefine the rules of the game? Arthroscopy 35(1):260–261

    PubMed  Google Scholar 

  40. Hadley CJ, Shi WJ, Murphy H et al. (2019) The clinical evidence behind biologic therapies promoted at annual orthopaedic meetings: a systematic review. Arthroscopy 35(1):251–259

    PubMed  Google Scholar 

  41. Di Matteo B, Marcacci M, Kon E (2018) Letter to the editor concerning the article: “Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial” (Hong et al. International Orthopaedics doi:10.1007/s00264-018-4099-0). Int Orthop 43(3):751–752

    PubMed  Google Scholar 

  42. Gimble JM, Katz AJ, Bunnell BA (2007) Adipose-derived stem cells for regenerative medicine. Circ Res 100(9):1249–1260

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Zuk PA, Zhu M, Ashjian P et al. (2002) Human adipose tissue is a source of multipotent stem cells. Mol Biol Cell 13(12):4279–4295

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Aust L, Devlin B, Foster SJ et al. (2004) Yield of human adipose-derived adult stem cells from liposuction aspirates. Cytotherapy 6(1):7–14

    CAS  PubMed  Google Scholar 

  45. Oedayrajsingh-Varma MJ, van Ham SM, Knippenberg M et al. (2006) Adipose tissue-derived mesenchymal stem cell yield and growth characteristics are affected by the tissue-harvesting procedure. Cytotherapy 8(2):166–177

    CAS  PubMed  Google Scholar 

  46. Vezzani B, Shaw I, Lesme H et al. (2018) Higher pericyte content and secretory activity of microfragmented human adipose tissue compared to enzymatically derived stromal vascular fraction. Stem Cells Transl Med 2018:876–886

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Vandenbulcke.

Ethics declarations

Conflitto di interesse

Gli autori F. Vandenbulcke, G. Beltrame, N.D. Vitale, B. Di Matteo e E. Kon dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vandenbulcke, F., Beltrame, G., Vitale, N.D. et al. Le cellule staminali: impiego clinico. LO SCALPELLO 33, 237–242 (2019). https://doi.org/10.1007/s11639-019-00345-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11639-019-00345-9

Navigation