首页|Culture-expanded mesenchymal stromal cell therapy:does it work in knee osteoarthritis?A pathway to clinical success

Culture-expanded mesenchymal stromal cell therapy:does it work in knee osteoarthritis?A pathway to clinical success

扫码查看
原文链接
  • 万方数据
Osteoarthritis(OA)is a degenerative multifactorial disease with concomitant structural,inflammatory,and metabolic changes that fluctuate in a temporal and patient-specific manner.This complexity has contributed to refractory responses to various treatments.MSCs have shown promise as multimodal therapeutics in mitigating OA symptoms and disease progression.Here,we evaluated 15 randomized controlled clinical trials(RCTs)and 11 nonrandomized RCTs using culture-expanded MSCs in the treatment of knee OA,and we found net positive effects of MSCs on mitigating pain and symptoms(improving function in 12/15 RCTs relative to baseline and in 11/15 RCTs relative to control groups at study endpoints)and on cartilage protection and/or repair(18/21 clinical studies).We examined MSC dose,tissue of origin,and autologous vs.allogeneic origins as well as patient clinical phenotype,endotype,age,sex and level of OA severity as key parameters in parsing MSC clinical effectiveness.The relatively small sample size of 610 patients limited the drawing of definitive conclusions.Nonetheless,we noted trends toward moderate to higher doses of MSCs in select OA patient clinical phenotypes mitigating pain and leading to structural improvements or cartilage preservation.Evidence from preclinical studies is supportive of MSC anti-inflammatory and immunomodulatory effects,but additional investigations on immunomodulatory,chondroprotective and other clinical mechanisms of action are needed.We hypothesize that MSC basal immunomodulatory"fitness"correlates with OA treatment efficacy,but this hypothesis needs to be validated in future studies.We conclude with a roadmap articulating the need to match an OA patient subset defined by molecular endotype and clinical phenotype with basally immunomodulatory"fit"or engineered-to-be-fit-for-OA MSCs in well-designed,data-intensive clinical trials to advance the field.

MSCOsteoarthritisCell therapymesenchymal stromal cellRCT

Griffin Copp、Kevin P.Robb、Sowmya Viswanathan

展开 >

Osteoarthritis Research Program,Division of Orthopedic Surgery,Schroeder Arthritis Institute,University Health Network,Toronto,ON,Canada

Krembil Research Institute,University Health Network,Toronto,ON,Canada

Institute of Biomedical Engineering,University of Toronto,Toronto,ON,Canada

Department of Medicine,Division of Hematology,University of Toronto,Toronto,ON,Canada

展开 >

Canadian Institutes of Health Research(CIHR)Natural Sciences and Engineering Research Council of Canada(NSERC)Schroeder Arthritis Institute via the Toronto General and Western Hospital Foundation

PJT-166089RGPIN-2018-05737

2023

10.1038/s41423-023-01020-1

中国免疫学杂志(英文版)
中国免疫学会

中国免疫学杂志(英文版)

CSTPCDCSCDSCI
影响因子：0.731
ISSN：1672-7681
年,卷(期)：2023.20(6)
  • 238