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Mesenchymal Stem Cell-Enriched Hydrogels for the Treatment of Knee Joint Disorders: A Systematic Review

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Abstract

Purpose

The knee is a complex joint that can be harmed by injuries including osteochondral defects and degenerative diseases such as osteoarthritis (OA). In this context, one of the most promising treatments is the use of hydrogels enriched with mesenchymal stem cells (MSC). Therefore, the aim of this study was to perform a systematic literature review to identify the main biological changes caused by MSC-enriched hydrogels for the treatment of osteochondral defects and osteoarthritic knees using in vivo experimental models.

Methods

This review was carried out between January and June 2023 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the SYRCLE risk of bias tool was used to assess study quality.

Results

A total of 1254 articles were retrieved from the Embase, Cochrane, Web of Science, PubMed, and Lilacs databases. After sorting the ar7ticles, 11 were included in this work. It is possible to observe that there is heterogeneity of materials used for the hydrogel manufacturing and the use of MSCs from different origins. It is also possible to observe that the groups treated with MSC-enriched hydrogel had smooth cartilaginous tissue surfaces and a higher amount of glycosaminoglycan (GAG) deposition. Also, a higher immunostaining of collagen II, GAG, and aggrecan and lower levels of collagen X and pro-inflammatory cytokines were observed.

Conclusion

In conclusion, this review demonstrates that MSC-enriched hydrogels presented very positive effects on the process of cartilage healing.

Lay Summary

A systematic literature review was conducted to identify the biological changes caused by mesenchymal stem cell (MSC)-enriched hydrogels in the treatment of osteochondral defects and osteoarthritic knees. Out of 1254 retrieved articles, 11 were included in the review. The study found a variety of materials used for hydrogel manufacturing and MSCs from different sources. The groups treated with MSC-enriched hydrogel showed smoother cartilaginous tissue surfaces; increased glycosaminoglycan (GAG) deposition; higher immunostaining of collagen II, GAG, and aggrecan; and lower levels of collagen X and pro-inflammatory cytokines. Overall, the review concludes that MSC-enriched hydrogels have positive effects on cartilage healing.

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Data Availability

The data supporting the results of this study will be made available by the corresponding author upon reasonable request.

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Funding

This study was financed by the São Paulo Research Foundation (FAPESP), grants #2019/10228–5 and #2022/13515–8.

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Authors and Affiliations

  1. Department of Biosciences, Federal University of São Paulo (UNIFESP), Silva Jardim Street, Santos, SP, 13611015020, Brazil

    Mirian Bonifacio, Homero Garcia-Motta, Cintia Cristina Santi Martignago, Lais Caroline Souza-Silva, Julia Risso Parisi, Daniel Araki Ribeiro & Ana Cláudia Rennó

  2. Metropolitan University of Santos (UNIMES), General Francisco Glicério Avenue, 8, Santos, SP, 11045-002, Brazil

    Julia Risso Parisi

  3. Department of Biomedical Engineering, Institute of Science and Technology of Brazil University (UB), São Paulo, Brazil

    Ana Laura Martins Andrade & Lívia Assis

Authors
  1. Mirian Bonifacio
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Contributions

All authors contributed to the conception and design of the study. Material preparation, data collection, and data analysis were performed by MB, LCSS, and HGM. The analyses of the levels of evidence and methodological quality of the included studies were performed by JRP and ALMA. Authors CCSM, LA, and ACMR were responsible for study writing and review. Also, DAR assisted in the review. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ana Cláudia Rennó.

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Ethical Approval

The research was not submitted to an ethics committee, as it was a review study. This systematic review has been registered on PROSPERO with CRD4202339451.

Conflict of Interest

The authors declare no competing interests.

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Bonifacio, M., Garcia-Motta, H., Martignago, C.C.S. et al. Mesenchymal Stem Cell-Enriched Hydrogels for the Treatment of Knee Joint Disorders: A Systematic Review. Regen. Eng. Transl. Med. (2024). https://doi.org/10.1007/s40883-024-00339-z

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  • DOI: https://doi.org/10.1007/s40883-024-00339-z

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