The biology of mesenchymal stem/stromal cells in the treatment of osteoarthritis

Abstract

Introduction: Osteoarthritis affects the whole joint and is usually treated using pain relief for many years followed by arthroplasty. Mesenchymal stem/stromal cells have the potential to form cartilage and bone and have been investigated for their capacity to repair these tissues, but until recently there has been no strong rationale for their use in the treatment of age-related, idiopathic osteoarthritis. Objectives: The aim of this review is to explore the origins of cell therapy for joint diseases and how the early work in cartilage repair has built toward the possibility of an injectable mesenchymal cell approach for osteoarthritis. Methods: A broad selection of publications has been identified relating to cartilage repair, mesenchymal cell biology, meniscal cartilage repair, and osteoarthritis therapeutics. Primary studies as well as several systematic reviews and meta-analyses have been included. Results: Cell therapies for cartilage lesions have been shown to be successful for traumatic injury but will be difficult to adapt for the treatment of idiopathic osteoarthritis. However the biological understanding of mesenchymal cells as a reservoir for trophic factors has led to their use as an injectable therapy. These studies have provided good evidence that sustained pain reduction can be achieved by injecting mesenchymal cells into the osteoarthritic joint, with some evidence also for functional improvement. Exosomes derived from mesenchymal may provide a scalable alternative to the cell therapy approach in future. Conclusions: Mesenchymal cells have potential as a possible injectable cell therapy for idiopathic osteoarthritis and should be further explored through larger-scale, carefully designed clinical trials.

Keywords

• Cartilage
• Osteoarthritis
• Mesenchymal stem cells
• Tissue engineering