Published online Sep 18, 2017. doi: 10.5312/wjo.v8.i9.674
Peer-review started: February 28, 2017
First decision: May 9, 2017
Revised: June 1, 2017
Accepted: June 30, 2017
Article in press: July 3, 2017
Published online: September 18, 2017
Osteoarthritis (OA) is a slowly progressive disease where cartilage of the synovial joint degenerates. It is most common in the elderly where patients experience pain and reduce physical activity. In combination with lack of conventional treatment, patients are often left with no other choices than arthroplasty. Over the last years, multipotent stromal cells have been used in efforts to treat OA. Mesenchymal stem/progenitor cells (MSCs) are stromal cells that can differentiate into bone, fat, and cartilage cells. They reside within bone marrow and fat. MSCs can also be found in synovial joints where they affect the progression of OA. They can be isolated and proliferated in an incubator before being applied in clinical trials. When it comes to treatment, emphasis has hitherto been on autologous MSCs, but allogenic cells from healthy donors are emerging as another source of the cells. The first adaptations of MSCs revolved in the use of cell-rich matrix, delivered as invasive surgical procedure, which resulted in production of hyaline cartilage and fibrocartilage. However, the demand for less invasive delivery of cells has prompted the use of direct intra-articular injections, wherein a large amount of suspended cells are implanted in the cartilage defect.
Core tip: There are several published reviews of the role of multipotent stromal cells in osteoarthritis (OA) of the knee. However, there is also need for additional current therapeutic options and clinical trials of multipotent stromal cells for OA. We review additional therapeutic potentials of mesenchymal stem cells in knee OA using either autogenous or allogenic cells. Direct intra-articular injections of cells in suspension become a delivery method, being both relatively simple and cost effective compared to major surgical procedures. The amount of cells injected is a critical factor; higher numbers of cells resulting in greater pain reduction and increased cartilage volume.