Kong Yajie, Wang Yuzhong, Yang Yujia, Hou Yu, Yu Jingjing, Liu Meiling, Xie Siyi, Song Yongzhou
Department of Orthopedics, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, People's Republic of China.
Hebei Medical University National University of Ireland Galway Stem Cell Research Center, Hebei Medical University, Shijiazhuang, 050017, Hebei Province, People's Republic of China.
J Orthop Surg Res. 2024 Dec 18;19(1):834. doi: 10.1186/s13018-024-05227-4.
In recent years, the increasing incidence of osteoarthritis (OA) has attracted widespread public attention; however, the available effective treatments are limited. As a result, new therapeutic approaches, including stem cell and exosome therapies, have been proposed and are gradually gaining popularity. Because exosomes are immunocompatible, there is thought to be more potential for their use in clinical settings. This study summarizes the efficacy of exosomes in the treatment of OA.
In total, we conducted a comprehensive search of the PubMed, Web of Science, and Embase databases using medical subject headings terms to identify studies published from their inception until November 2023 that investigated the use of stem cell-derived exosomes in treating OA. We focused on specific outcomes including osteophyte score, chondrocyte count, pain level, qPCR and histological assessments such as the OARSI (Osteoarthritis research society international) score to measure cartilage degeneration. For data extraction, we used GetData Graph Digitizer to retrieve values from graphs, and the meta-analysis was conducted using RevMan 5.3 software. We chose mean difference (MD) as the primary effect measure since all included studies reported the same outcomes. Ultimately, 20 articles met the inclusion criteria and were included in the meta-analysis.
We evaluated 20 studies comprising a total of 400 subjects. Compared with control groups, the exosome-treated groups showed significantly improved histological outcomes, as measured by the OARSI score (n = 400; MD = -3.54; 95% CI = [-4.30, -2.79]; P < 0.00001; I = 98%). This indicates a marked reduction in cartilage degeneration and OA severity in the exosome-treated groups. Notably, exosome therapy was more effective when administered during the early stages of OA. Additionally, a once-weekly dosing schedule yielded better results compared to more frequent administrations. Of the three exosome isolation methods assessed, kit-based extraction demonstrated a trend toward superior therapeutic efficacy.
Exosome treatment improved OA compared to placebo treatment.
近年来，骨关节炎（OA）发病率不断上升，引起了公众的广泛关注；然而，现有的有效治疗方法有限。因此，包括干细胞和外泌体疗法在内的新治疗方法已被提出并逐渐受到欢迎。由于外泌体具有免疫相容性，人们认为它们在临床应用中具有更大的潜力。本研究总结了外泌体在治疗OA中的疗效。
我们使用医学主题词对PubMed、Web of Science和Embase数据库进行了全面检索，以识别从数据库建立至2023年11月发表的研究干细胞衍生外泌体治疗OA的研究。我们关注特定结果，包括骨赘评分、软骨细胞计数、疼痛程度、qPCR以及组织学评估，如用于测量软骨退变的OARSI（国际骨关节炎研究学会）评分。对于数据提取，我们使用GetData Graph Digitizer从图表中检索数值，并使用RevMan 5.3软件进行荟萃分析。由于所有纳入研究均报告了相同的结果，我们选择平均差（MD）作为主要效应指标。最终，20篇文章符合纳入标准并被纳入荟萃分析。
我们评估了20项研究，共400名受试者。与对照组相比，外泌体治疗组的组织学结果有显著改善，通过OARSI评分衡量（n = 400；MD = -3.54；95% CI = [-4.30, -2.79]；P < 0.00001；I = 98%）。这表明外泌体治疗组的软骨退变和OA严重程度显著降低。值得注意的是，外泌体疗法在OA早期给药时更有效。此外，与更频繁给药相比，每周给药一次的方案产生了更好的结果。在评估的三种外泌体分离方法中，基于试剂盒的提取显示出治疗效果更佳的趋势。
与安慰剂治疗相比，外泌体治疗改善了OA。
