Title:Various Cell Therapy Approaches for Bone Diseases in the Controlled Clinical Trials: A Systematic Review and Meta-analysis Study
Volume: 16
Issue: 4
Author(s): Mahboubeh Bouhlouli, Neda Izadi and Arash Khojasteh*
Affiliation:
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, TehranDepartment of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1985717443,Iran
Keywords:
Cell therapy, more-than minimal manipulation, minimal manipulation, bone tissue regeneration, and adverse
events, periosteum.
Abstract: The objective of this review was to answer two critical questions in the cell-based bone
defect therapies that were as follows: 1) does cell therapy associate with the increase in the occurrence
of adverse events in the patients compared to control groups, 2) does the use of various cell
therapy approaches, including More-than Minimal Manipulation (MMM) and Minimal Manipulation
(MM), affect the occurrence of adverse events? An electronic literature search was performed
in five databases. The controlled clinical trial studies were selected according to the eligibility criteria.
Then, they were categorized into MMM and MM approaches, and a meta-analysis of the controlled
clinical trials on the occurrence of adverse events was conducted. 23 controlled clinical
trials, including 10 MMM (n=341 patients) and 13 MM (n=503 patients) approaches were assessed
in this study. Bone defects were oral-maxillofacial defects (7MMM and 8MM), osteonecrosis of
the femoral head (1MMM and 5MM), long bone shaft fracture (1MMM), and bone defect during
revision total hip arthroplasty (1MMM). Cells were isolated from various tissues such as bone marrow
(5MMM and 10MM), the dental pulp (2MMM and 2MM), adipose tissue (2MMM), periosteum
(1MMM), and peripheral blood (1MMM). Notably, the adverse events were reported in 37 patients,
and 3 patients in MMM and MM approaches, respectively. A meta-analysis demonstrated
that there was no association between cell therapy and the occurrence of adverse events. Also, the
MMM approach (OR: 1.46) has a higher chance of the occurrence of adverse events compared to
the MM approach (OR: 0.71). These results suggested that cell therapy, specifically the MM approach,
is safe to improve bone regeneration. Also, future systematic reviews should evaluate the
efficacy of these cell therapy approaches.
