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中华细胞与干细胞杂志(电子版) ›› 2021, Vol. 11 ›› Issue (06) : 365 -371. doi: 10.3877/cma.j.issn.2095-1221.2021.06.007

综述

间充质干细胞治疗膝骨性关节炎的临床研究进展
吕林洁1, 王长生2, 王晓冰1, 李忠3,(), 钱其军4   
  1. 1. 201805 上海细胞治疗集团医学中心
    2. 201112 上海交通大学附属仁济医院急诊科
    3. 201805 上海细胞治疗集团医学中心;201805 上海细胞治疗研究院;261044 潍坊,山东省潍坊市中医药研究院
    4. 201805 上海细胞治疗集团医学中心;201805 上海细胞治疗研究院;201805 上海大学附属孟超肿瘤医院
  • 收稿日期:2021-02-25 出版日期:2021-12-01
  • 通信作者: 李忠

Clinical progression of mesenchymal stem cells in the treatment of knee osteoarthritis

Linjie Lv1, Changsheng Wang2, Xiaobing Wang1, Zhong Li3,(), Qijun Qian4   

  1. 1. Medical Center of Shanghai Cell Therapy Group, Shanghai 201805, China
    2. Department of Emergency, Renji Hospital Affiliated to Shanghai Jiaotong Uiversity, Shanghai 201112, China
    3. Medical Center of Shanghai Cell Therapy Group, Shanghai 201805, China; Shanghai Cell Therapy Research Institute, Shanghai 201805, China; Weifang Institute of Traditional Chinese Medicine, Weifang 261044, China
    4. Medical Center of Shanghai Cell Therapy Group, Shanghai 201805, China; Shanghai Cell Therapy Research Institute, Shanghai 201805, China; Shanghai Mengchao Cancer Hospital, Shanghai University, Shanghai 201805, China
  • Received:2021-02-25 Published:2021-12-01
  • Corresponding author: Zhong Li
引用本文:

吕林洁, 王长生, 王晓冰, 李忠, 钱其军. 间充质干细胞治疗膝骨性关节炎的临床研究进展[J/OL]. 中华细胞与干细胞杂志(电子版), 2021, 11(06): 365-371.

Linjie Lv, Changsheng Wang, Xiaobing Wang, Zhong Li, Qijun Qian. Clinical progression of mesenchymal stem cells in the treatment of knee osteoarthritis[J/OL]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2021, 11(06): 365-371.

膝骨性关节炎是一种关节软骨退行性疾病,多见于中老年,表现为关节软骨退化、半月板磨损和骨赘形成。关节软骨因缺乏神经和关节微血管滋养,在发生退行性改变后很难自愈或修复。通常保守治疗收效甚微,晚期严重者只能采用关节置换。间充质干细胞(MSCs)因具有多向分化潜能和强大的旁分泌能力,被认为是理想的组织再生及修复物质。MSCs可来自脂肪、骨髓和脐带。一般经体外分离和扩增,通过MSCs的膝关节腔注射来改善关节炎症状。多年来,大量关于MSCs治疗膝骨性关节炎的临床试验验证了MSCs改善膝关节症状和功能的作用。本文通过Pubmed、国内万方数据库和clinicaltrials.gov,收集了2017 ~ 2020年MSCs治疗膝骨性关节炎的临床试验文献,就临床研究结果、治疗效果、存在的问题和发展前景进行了综述。

Knee osteoarthritis characterized by articular cartilage degeneration, meniscus wear and osteophyte formation is a degenerative disease of articular cartilage that is common in middle-aged and elderly people. Because of the lack of nourishment of nerves and joint microvasculature, articular cartilage can hardly heal or repair itself after undergoing degenerative changes. The effect of conservative treatment is unsatisfactory, and joint replacement has to be taken in late-stage and severe cases. Mesenchymal stem cells (MSCs) are reliable materials for tissue regeneration and repair because of multilineage differentiation potential and strong paracrine capacity. MSCs can be derived from fat, bone marrow and umbilical cord. Generally, it is separated and amplified in vitro, and injected into the knee joint cavity to improve arthritic symptoms. Numerous clinical trials of MSCs in the treatment of knee osteoarthritis have demonstrated its efficacy. This article collects literature and clinical trials of MSCs in the treatment of knee osteoarthritis from 2017 to 2020, through Pubmed, domestic literature database and clinicaltrials.gov. We also review the clinical research results, treatment effects, existing problems and development prospects.

图1 2008 ~ 2020年注册的以关节腔内注射MSCs治疗KOA的临床试验项数(来源于clinicaltrial.gov网站)
图2 不同细胞来源在93项关节腔内注射间充质干细胞治疗膝骨性关节炎的临床试验数量(源自clinicaltrial.gov)
表1 2017 ~ 2020年骨髓来源MSCs关节腔内注射治疗KOA的临床试验
表2 2017 ~ 2020年脂肪来源MSCs关节腔内注射治疗KOA的临床试验
细胞来源 入组人数 分组方式及使用细胞量 随访期 评估方式 研究结果 参考文献
自体脂肪 18 低剂量1×107个MSCs
中剂量2×107个MSCs
高剂量5×107个MSCs
12/24/48/96周 WOMAC评分,SF-36调查表,NRS-11量表 高剂量组WOMAC↓,SF-36和NRS-11改善 27
自体脂肪 18 低剂量1×107个MSCs
中剂量5×107个MSCs
高剂量10×107个MSCs
1/2/3/6个月,1/2年 WOMAC评分,KSS评分,KOOS评分,VAS评分,MRI影像 高剂量组所有评价指标改善 28
自体脂肪 30 1×108个MSCs,单次注射
1×108个MSCs,两次注射,间隔6个月
4×106个MSC,五次注射,基线/1/2/3/6个月
1/3/6/12个月 NPRS评分,KOOS评分,WOMAC评分,MRI影像 两个剂量组所有评分改善,MRI影响观察到疾病缓解 29
自体脂肪 24 1×108个MSCs 6个月 WOMAC评分,MRI影像 WOMAC↓;实验组软骨损伤无变化,对照组软骨损伤加重 30
自体脂肪 53 2次5×107个MSCs,间隔3周 6/12/24个月 VAS评分,WOMAC评分,SF-36评分,MRI影像 WOMAC↓;实验组软骨体积增加 31
异体脂肪 18 低剂量1×107个MSCs
中剂量2×107个MSCs
高剂量5×107个MSCs
1/3/4/8/12/24/36/48周 多模态磁共振成像;WOMAC评分;SF-36调查表 多模态MRI所有序列中改善;WOMAC↓;SF-36改善 32
异体脂肪 20 低剂量3.9×106个MSCs高剂量6.7×106个MSCs 第7/28天,3/6/9/12个月 VAS评分,WOMAC评分,MRI影像 VAS↓,WOMAC↓ 33
异体脂肪 22 低剂量1×107个MSCs
中剂量2×107个MSCs
高剂量5×107个MSCs
在第0周和第3周分别接受1次注射
12/24/48周 VAS评分,WOMAC评分,SF-36评分,软骨体积MRI 所有剂量组量表评分均改善,低剂量组改善较明显;低剂量组软骨体积轻微改善 34
表3 2017 ~ 2020年脐带源MSCs关节腔内注射治疗膝骨性关节炎的临床试验
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