Valdis Goncars1, Eriks Jakobsons2, Kristaps Blums3, Ieva Briede4, Liene Patetko2, Kristaps Erglis2, Martins Erglis2, Konstantins Kalnberzs5, Indrikis Muiznieks6, Andrejs Erglis7. 1. Faculty of Medicine, University of Latvia, Riga, Latvia; Latvian State Hospital for Traumatology and Orthopaedics, Riga, Latvia. Electronic address: valdis.goncars@traumatologs.lv. 2. Research Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia; Cell Transplantation Centre Pauls, Scientific Institute, Stradins Clinical University Hospital, Riga, Latvia. 3. Faculty of Medicine, Riga Stradins University, Riga, Latvia. 4. Cell Transplantation Centre Pauls, Scientific Institute, Stradins Clinical University Hospital, Riga, Latvia; Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia. 5. Faculty of Medicine, University of Latvia, Riga, Latvia; Latvian State Hospital for Traumatology and Orthopaedics, Riga, Latvia. 6. Division of Microbiology and Biotechnology, Department of Biology, University of Latvia, Riga, Latvia. 7. Research Institute of Cardiology and Regenerative Medicine, University of Latvia, Riga, Latvia; Cell Transplantation Centre Pauls, Scientific Institute, Stradins Clinical University Hospital, Riga, Latvia; Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia.
Abstract
OBJECTIVE: The aim of this study was to compare treatment methods of the knee joint degenerative osteoarthritis, using autologous bone marrow-derived mononuclear cells and hyaluronic acid injections and observe prevalence of adverse effects in both groups. MATERIALS AND METHODS: A prospective randomized controlled clinical trial was carried out. The analysis of pain and changes in osteoarthritis symptoms after a single intra-articular bone marrow-derived mononuclear cell injection into the knee joint in the Kellgren-Lawrence stage II-III osteoarthritis during the 12-month period were performed. The results were compared with the control group treated routinely by hyaluronic acid injections therapy. A therapy group of patients (n=28) received single bone marrow-derived mononuclear cell intra-articular injections. A control group of patients (n=28) was treated with a total of three sodium hyaluronate intra-articular injections each one performed a week apart. The clinical results were obtained using the Knee Osteoarthritis Outcome Score (KOOS) and the Knee Society Score (KSS) before and 3, 6, and 12 months after injection. RESULTS: A statistically significant improvement was observed in the mononuclear cell group over the starting point in all scores. At the endpoint at month 12, the KOOS score improved significantly (P<0.05) on the pain subscale (+25.44), activity and daily living subscale (+21.36), quality of life subscale (+28.83), and total KOOS (+18.25). The KSS score also demonstrated a significant improvement on the symptoms subscale (+25.42) and the function subscale (+38.32) (P<0.001). The KOOS symptoms and sports subscales improved without statistical significance. The difference between the control group treated with hyaluronic acid versus the bone marrow-derived mononuclear cells group at time points 6 and 12 months demonstrated a statistically significant (P<0.05) superiority in the KOOS pain subscale over the hyaluronic acid group. In both groups serious adverse effects were not observed. CONCLUSIONS: The intra-articular injection of bone marrow-derived mononuclear cells is a safe manipulation with no side effects during the 12-month period. This treatment provides statistically significant clinical improvement between the starting point and 1, 3, 6, and 12 months after. When compared to hyaluronic acid treatment, better pain relief in the long-term period of mononuclear cell group was observed.
RCT Entities:
OBJECTIVE: The aim of this study was to compare treatment methods of the knee joint degenerative osteoarthritis, using autologous bone marrow-derived mononuclear cells and hyaluronic acid injections and observe prevalence of adverse effects in both groups. MATERIALS AND METHODS: A prospective randomized controlled clinical trial was carried out. The analysis of pain and changes in osteoarthritis symptoms after a single intra-articular bone marrow-derived mononuclear cell injection into the knee joint in the Kellgren-Lawrence stage II-III osteoarthritis during the 12-month period were performed. The results were compared with the control group treated routinely by hyaluronic acid injections therapy. A therapy group of patients (n=28) received single bone marrow-derived mononuclear cell intra-articular injections. A control group of patients (n=28) was treated with a total of three sodium hyaluronate intra-articular injections each one performed a week apart. The clinical results were obtained using the Knee Osteoarthritis Outcome Score (KOOS) and the Knee Society Score (KSS) before and 3, 6, and 12 months after injection. RESULTS: A statistically significant improvement was observed in the mononuclear cell group over the starting point in all scores. At the endpoint at month 12, the KOOS score improved significantly (P<0.05) on the pain subscale (+25.44), activity and daily living subscale (+21.36), quality of life subscale (+28.83), and total KOOS (+18.25). The KSS score also demonstrated a significant improvement on the symptoms subscale (+25.42) and the function subscale (+38.32) (P<0.001). The KOOS symptoms and sports subscales improved without statistical significance. The difference between the control group treated with hyaluronic acid versus the bone marrow-derived mononuclear cells group at time points 6 and 12 months demonstrated a statistically significant (P<0.05) superiority in the KOOS pain subscale over the hyaluronic acid group. In both groups serious adverse effects were not observed. CONCLUSIONS: The intra-articular injection of bone marrow-derived mononuclear cells is a safe manipulation with no side effects during the 12-month period. This treatment provides statistically significant clinical improvement between the starting point and 1, 3, 6, and 12 months after. When compared to hyaluronic acid treatment, better pain relief in the long-term period of mononuclear cell group was observed.
Authors: Bruno C Menarim; Hossam El-Sheikh Ali; Shavahn C Loux; Kirsten E Scoggin; Theodore S Kalbfleisch; James N MacLeod; Linda A Dahlgren Journal: Front Immunol Date: 2021-12-08 Impact factor: 7.561
Authors: Christoph Schmitz; Christopher Alt; David A Pearce; John P Furia; Nicola Maffulli; Eckhard U Alt Journal: Cells Date: 2022-03-11 Impact factor: 6.600