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Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

06.03.2018 | Knee

Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis

verfasst von: Ricardo Bastos, Marcelo Mathias, Renato Andrade, Raquel Bastos, Alex Balduino, Vinicius Schott, Scott Rodeo, João Espregueira-Mendes

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 11/2018

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Abstract

Purpose

To compare the effectiveness and safety of intra-articular injections of autologous expanded mesenchymal stromal stem cells alone (MSCs), or in combination with platelet-rich plasma (MSCs + PRP), in patients with knee osteoarthritis.

Methods

Eighteen patients (57.6 ± 9.6 years) with radiographic symptomatic knee osteoarthritis (Dejour grades II–IV) were randomized to receive intra-articular injections of MSCs (n = 9) or MSCs + PRP (n = 9). Injections were performed 2–3 weeks after bone marrow aspiration (± 80–100 ml) which was obtained from both posterior iliac crests.

Results

The Knee Injury and Osteoarthritis Outcome Score (KOOS) improved significantly throughout the 12 months for both groups (p < 0.05). No statistically significant differences between groups were found in KOOS subscales and global score improvements at 12-month end-point (n.s.). The MSCs group showed significant improvements in the pain, function and daily living activities, and sports and recreational activities subscales (p < 0.05). Similarly, the MSCs + PRP group showed significant improvements in the pain, function and daily living activities and quality of life subscales (p < 0.05). The average number of fibroblast colony forming units (CFU-F) was 56.8 + 21.9 for MSCs group and 50.7 ± 21.7 for MSCs + PRP group. Minimal adverse effects were seen in both groups (10 adverse events, in 5 patients).

Conclusions

Intra-articular injections of expanded MSCs alone or in combination with PRP are safe and have a beneficial effect on symptoms in patients with symptomatic knee osteoarthritis. Adding PRP to the MSCs injections did not provide additional benefit. These results are encouraging and support the recommendation of this minimally invasive procedure in patients with knee osteoarthritis, without requiring hospitalization. The CFU-F results may be used as reference for future research.

Level of evidence

Prospective cohort study, Level II.

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Amable PR, Carias RBV, Teixeira MVT, da Cruz Pacheco Í, do Amaral RJFC., Granjeiro JM et al (2013) Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors. Stem Cell Res Ther 4:67CrossRef

Bastos Filho R, Magnussen RA, Duthon V, Demey G, Servien E, Granjeiro JM et al (2013) Total knee arthroplasty after high tibial osteotomy: a comparison of opening and closing wedge osteotomy. Int Orthop 37:427–431CrossRef

Buckwalter JA, Saltzman C, Brown T (2004) The impact of osteoarthritis: implications for research. Clin Orthop Relat Res 427:S6-S15

Campbell KA, Saltzman BM, Mascarenhas R, Khair MM, Verma NN, Bach BR et al (2015) Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 31:2213–2221CrossRef

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

Caplan AI (1991) Mesenchymal stem cells. J Orthop Res 9:641–650CrossRef

Carstairs A, Genever P (2014) Stem cell treatment for musculoskeletal disease. Curr Opin Pharmacol 16:1–6CrossRef

da Silva Meirelles L, Sand TT, Harman RJ, Lennon DP, Caplan AI (2008) MSC frequency correlates with blood vessel density in equine adipose tissue. Tissue Eng Part A 15:221–229CrossRef

Dejour H, Carret J, Walch G (1991) Les Gonarthroses. 7émes Journées Lyonnaises de Chirurgie de Genou. 7émes Journées Lyonnaises de Chirurgie de Genou, Les Gonarthroses

10.

do Amaral RJFC., da Silva NP, Haddad NF, Lopes LS, Ferreira FD, Cappelletti PA et al (2016) Platelet-rich plasma obtained with different anticoagulants and their effect on platelet numbers and mesenchymal stromal cells behavior in vitro. Stem Cells Int. https://doi.org/10.1155/2016/7414036 CrossRefPubMedPubMedCentral

11.

Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA (2009) Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 37:2259–2272CrossRef

12.

Freitag J, Bates D, Boyd R, Shah K, Barnard A, Huguenin L et al (2016) Mesenchymal stem cell therapy in the treatment of osteoarthritis: reparative pathways, safety and efficacy—a review. BMC Musculoskelet Disord 17:230CrossRef

13.

Gomoll A, Filardo G, De Girolamo L, Esprequeira-Mendes J, Marcacci M, Rodkey W et al (2012) Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc 20:450–466CrossRef

14.

Goncalves R, Cabri J, Pinheiro J, Ferreira P, Gil J (2010) Reliability, validity and responsiveness of the Portuguese version of the Knee injury and Osteoarthritis Outcome Score—Physical Function Short-form (KOOS-PS). Osteoarthritis Cartilage 18:372–376CrossRef

15.

Goyal D, Keyhani S, Lee EH, Hui JHP (2013) Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy 29:1579–1588CrossRef

16.

Haas DA, Kaplan RS (2017) Variation in the cost of care for primary total knee arthroplasties. Arthroplast Today 3:33–37CrossRef

17.

Heijink A, Gomoll AH, Madry H, Drobnič M, Filardo G, Espregueira-Mendes J et al (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:423–435CrossRef

18.

Ishiguro N, Kojima T, Poole AR (2002) Mechanism of cartilage destruction in osteoarthritis. Nagoya J Med Sci 65:73–84PubMed

19.

Jo CH, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC et al (2014) Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial. Stem cells 32:1254–1266CrossRef

20.

Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D et al (2013) The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy 29:2037–2048CrossRef

21.

Koh Y-G, Choi Y-J (2012) Infrapatellar fat pad-derived mesenchymal stem cell therapy for knee osteoarthritis. Knee 19:902–907CrossRef

22.

Koh Y-G, Jo S-B, Kwon O-R, Suh D-S, Lee S-W, Park S-H et al (2013) Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy 29:748–755CrossRef

23.

Koh Y-G, Kwon O-R, Kim Y-S, Choi Y-J (2014) Comparative outcomes of open-wedge high tibial osteotomy with platelet-rich plasma alone or in combination with mesenchymal stem cell treatment: a prospective study. Arthroscopy 30:1453–1460CrossRef

24.

Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis Rheum 58:26–35CrossRef

25.

Lohmander LS, Roos EM (2007) Clinical update: treating osteoarthritis. Lancet 370:2082–2084CrossRef

26.

Mazor M, Lespessailles E, Coursier R, Daniellou R, Best T, Toumi H (2014) Mesenchymal stem-cell potential in cartilage repair: an update. J Cell Mol Med 18:2340–2350CrossRef

27.

Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD (2016) Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 32:495–505CrossRef

28.

Mifune Y, Matsumoto T, Takayama K, Ota S, Li H, Meszaros LB et al (2013) The effect of platelet-rich plasma on the regenerative therapy of muscle derived stem cells for articular cartilage repair. Osteoarthritis Cartilage 21:175–185CrossRef

29.

Mishra A, Tummala P, King A, Lee B, Kraus M, Tse V et al (2009) Buffered platelet-rich plasma enhances mesenchymal stem cell proliferation and chondrogenic differentiation. Tissue Eng Part C Methods 15:431–435CrossRef

30.

Osborne H, Anderson L, Burt P, Young M, Gerrard D (2015) Australasian College of Sports Physicians—position statement: the place of mesenchymal stem/stromal cell therapies in sport and exercise medicine. Br J Sports Med 50:1237–1244CrossRef

31.

Owen M, Friedenstein A (1988) Stromal stem cells: marrow-derived osteogenic precursors. Ciba Found Symp 136:42–60PubMed

32.

Pas HI, Winters M, Haisma HJ, Koenis MJ, Tol JL, Moen MH (2017) Stem cell injections in knee osteoarthritis: a systematic review of the literature. Br J Sports Med 51:1125–1133CrossRef

33.

Peeters C, Leijs MJ, Reijman M, van Osch G, Bos P (2013) Safety of intra-articular cell-therapy with culture-expanded stem cells in humans: a systematic literature review. Osteoarthritis Cartilage 21:1465–1473CrossRef

34.

Pers Y-M, Ruiz M, Noël D, Jorgensen C (2015) Mesenchymal stem cells for the management of inflammation in osteoarthritis: state of the art and perspectives. Osteoarthritis Cartilage 23:2027–2035CrossRef

35.

Rubio-Azpeitia E, Andia I (2014) Partnership between platelet-rich plasma and mesenchymal stem cells: in vitro experience. Musc Ligaments Tendons J 4:52–62

36.

Saw K-Y, Anz A, Jee CS-Y, Merican S, Ng RC-S, Roohi SA et al (2013) Articular cartilage regeneration with autologous peripheral blood stem cells versus hyaluronic acid: a randomized controlled trial. Arthroscopy 29:684–694CrossRef

37.

Tan Y, Jiang M, Yu H, Li J, Qing Z (2013) Therapeutic effect of arthroscopy combined with autologous bone marrow stem cell grafting on knee osteoarthritis. J Tradit Chin Orthop Traumatol 10:35–38

38.

Vega A, Martín-Ferrero MA, Del Canto F, Alberca M, García V, Munar A et al (2015) Treatment of knee osteoarthritis with allogeneic bone marrow mesenchymal stem cells: a randomized controlled trial. Transplantation 99:1681–1690CrossRef

39.

Vinatier C, Mrugala D, Jorgensen C, Guicheux J, Noël D (2009) Cartilage engineering: a crucial combination of cells, biomaterials and biofactors. Trends Biotechnol 27:307–314CrossRef

40.

Wolfstadt JI, Cole BJ, Ogilvie-Harris DJ, Viswanathan S, Chahal J (2015) Current concepts: the role of mesenchymal stem cells in the management of knee osteoarthritis. Sports Health 7:38–44CrossRef

41.

Wong KL, Lee KBL, Tai BC, Law P, Lee EH, Hui JH (2013) Injectable cultured bone marrow—derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy 29:2020–2028CrossRef

42.

Xia P, Wang X, Lin Q, Li X (2015) Efficacy of mesenchymal stem cells injection for the management of knee osteoarthritis: a systematic review and meta-analysis. Int Orthop 39:2363–2372CrossRef

43.

Xie X, Wang Y, Zhao C, Guo S, Liu S, Jia W et al (2012) Comparative evaluation of MSCs from bone marrow and adipose tissue seeded in PRP-derived scaffold for cartilage regeneration. Biomaterials 33:7008–7018CrossRef

44.

Zhang W, Moskowitz R, Nuki G, Abramson S, Altman R, Arden N et al (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 16:137–162CrossRef

Titel: Intra-articular injections of expanded mesenchymal stem cells with and without addition of platelet-rich plasma are safe and effective for knee osteoarthritis
verfasst von: Ricardo Bastos
Marcelo Mathias
Renato Andrade
Raquel Bastos
Alex Balduino
Vinicius Schott
Scott Rodeo
João Espregueira-Mendes
Publikationsdatum: 06.03.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 11/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-4883-9

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