Umbilical cord-derived mesenchymal stem cells for treating osteoarthritis of the knee: a single-arm, open-label study

Abstract

Background

Despite being a common cause of quality-of-life impairment, there are no efficacious therapies that could prevent the progression of knee osteoarthritis (KOA). We conducted an open-label trial of human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) and hyaluronic acid (HA) for treating KOA.

Methods

This open-label study was conducted from July 2015 to December 2018 at Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Patients diagnosed with KOA were injected three times, comprising of 10 × 106 units of hUC-MSCs in 2-ml secretome implantation and 2-ml hyaluronic acid (HA) injection in the first week, followed with 2-ml HA injection twice in the second and third week.

Results

Twenty-nine subjects (57 knees) were recruited. Seventeen (58.6%) subjects were male, and the mean age was 58.3 ± 9.6 years. Thirty-three (57.9%) knees were classified into Kellgren–Lawrence grade I–II KOA (mild OA). hUC-MSCs significantly decreased pain measured by visual analogue scale in severe KOA from initial to 6th month follow-up [5 ± 2.97 to 3.38 ± 2.44 (p = 0.035)]. The International Knee Documentation Committee score significantly increased at 6th month follow-up (53.26 ± 16.66 to 65.49 ± 13.01, p < 0.001, in subjects with grade I–II and 48.84 ± 18.41 to 61.83 ± 18.83, p = 0.008, in subjects with severe KOA). The Western Ontario and McMaster Universities Osteoarthritis decreased significantly in both groups from initial to 6th month follow-up (from 22.55 ± 15.94 to 13.23 ± 10.29, p = 0.003, and from 27.57 ± 15.99 to 17.92 ± 19.1, p = 0.003, in those with mild and severe KOA, respectively).

Conclusions

hUC-MSCs could be a potentially new regenerative treatment for KOA. The maximum effect of hUC-MSCs was achieved after 6 months of injection.

Level of evidence

Therapeutic level II.

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Acknowledgements

We would like to thank Boenyamin Setiawan, PhD and National Innovation System Research Incentive Program (INSINAS) for funding our research, as well as Tri Kurniawati, BSc for her assistance throughout the grant administration process.

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Correspondence to Ismail Hadisoebroto Dilogo.

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Ismail Hadisoebroto Dilogo, Anissa Feby Canintika, Alberto Lastiko Hanitya, Jeanne Adiwinata Pawitan, Isabella Kurnia Liem and Jacub Pandelaki declare that they have no conflict of interests.

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Dilogo, I.H., Canintika, A.F., Hanitya, A.L. et al. Umbilical cord-derived mesenchymal stem cells for treating osteoarthritis of the knee: a single-arm, open-label study. Eur J Orthop Surg Traumatol 30, 799–807 (2020). https://doi.org/10.1007/s00590-020-02630-5

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Keywords

  • Umbilical cord
  • Mesenchymal stem cells
  • Osteoarthritis