MSCs present in the tissues of an adult have powerful anti-inflammatory, regenerative, and immunomodulatory effects, which help reduce inflammation intensity in the joint affected by osteoarthritis, prevent its further destruction, and promote the restoration of motor function.

A convenient source of MSCs in adults is subcutaneous adipose tissue.

MSCs isolated from AT and cultured under laboratory conditions can be used for effective treatment of degenerative joint lesions and restoration of full-thickness defects of articular cartilage at stages II, II-III (according to Kellgren-Lawrence) with articular cartilage damage of stages III-IV (according to Outerbridge).

The treatment method involves intra-articular transplantation of BMCP based on the patient’s own MSCs (autologous) or donor MSCs (allogeneic).

Allogeneic MSCs obtained from young and healthy donors can provide a more pronounced therapeutic effect compared to the patient’s own MSCs in patients suffering from many chronic diseases.

MSCs introduced into the joint activate the process of cartilage tissue restoration, transforming into a regenerate similar in its morphological and functional properties to the surrounding hyaline cartilage, and also secrete substances that reduce inflammation and prevent further cartilage tissue destruction.

Histologically, there is a regression of reactive subchondral bone marrow edema and consolidation of cartilage fissures, and within 3-6 months, the defect crater in the cartilage is completely filled with regenerate.

Due to the longlasting paracrine effect, MSCs modify the course of the pathological degenerative process in the joint.

CT of OA of large joints is considered biological prosthetics and can serve as a temporary alternative to radical surgical intervention.

It is indicated for patients with:

• traumatic lesions of articular cartilage,
• chronic and degenerative lesions of articular cartilage,
• osteochondritis dissecans,
• osteoarthritis of the hip, knee, and other joints.

Treatment Scheme

The biomaterial for obtaining native MSCs is AT.

The collection (explantation) of AT is a minimally invasive surgical procedure performed on an outpatient basis under local anesthesia by lipectomy (through a 2 cm skin incision) or by lipoaspiration (through a skin puncture) of 5-10 g of subcutaneous adipose tissue in the abdominal or upper thigh area.

The total dose of MSCs in the BMCP and the frequency of transplantations are determined individually.

A course of CT for large joints (hip, knee, ankle, shoulder) requires 100 to 200 million MSCs, transplanted symmetrically into both joints, usually in 2-3 sessions.

The procedure of local injection transplantation of BMCP is minimally invasive, performed on an outpatient basis in an operating room under local anesthesia by joint puncture under ultrasound guidance.

Therapeutic doses of BMCP are administered together with a hyaluronic acid preparation (an analogue of synovial fluid), which further improves the physiological status of the affected joint.

After each transplantation, the patient is observed for 1-2 hours in the day hospital ward of the CTD.

The intervention does not restrict movement in the affected joint; the patient is advised to temporarily limit the load and engage in therapeutic exercises.

The period between the collection of AT and the administration of the first dose of BMCP is usually 30-35 days.

The interval between therapeutic dose transplantations is set individually and varies from 5-7 to 10-15 days or more.

Thus, a course of CT using autologous MSCs lasts about a month, and when using allogeneic MSCs, one visit is sufficient.

Effectiveness

The clinical outcome of CT is the relief of pain and improvement of joint functional capabilities, as well as the slowing of OA progression.

The severity and duration of the regenerative effect are determined by the degree of joint damage.

The criteria for evaluating the effectiveness of CT can include functional test indicators, the Lequesne algofunctional index, and comparative MRI data of the joints.

Global experience shows that patients can be relieved from chronic joint pain for 3-5 years, their quality of life improves, and the need for joint endoprosthesis can be delayed indefinitely.

Safety and Complications

Various congenital and genetic diseases, autoimmune and infectious diseases, oncological diseases (including those successfully treated in the past) significantly reduce the effectiveness of cell therapy.

It is unrealistic to expect good clinical results in the presence of chronic heart diseases, coagulation system disorders, or alcohol and drug dependency.

The safety of the method concerning autoimmune, allergic, and infectious complications is ensured by using the patient’s own cells, or biological material from specially selected donors.

Low immunogenicity of MSCs allows them to be used without selecting a donor-recipient pair.

Currently, there are no reported cases of oncological diseases resulting from the use of autologous MSCs in scientific literature.