Review Article

Umbilical Cord Mesenchymal Stromal Cells for Cartilage Regeneration Applications

Table 4

In vivo studies of cartilage repair with UC-MSCs or their secretome.

PathologySourceHostStudy designResultsRef.

IVD degenerationHuman UC-MSCsRabbit UC-MSCs injected into degenerated IVDIncrease in cellularity and a relative preservation of architectureLeckie et al., 2013 [137]
Human UC-MSCsRabbit UC-MSCs or UC-MSC-derived CPCs injected into degenerated IVDImprovement in the histology, cellularity, ECM proteins, water, and GAGs contents and higher expression of NP specific markers SOX9, ACAN, COL2, FOXF1, and KRT19 with CPCsBeeravolu et al., 2018 [138]
Human UC-MSCsRabbit UC-MSC-derived NPCs injected into degenerated IVDImprovement in the histology, cellularity, sulfated GAGs, and water contents of the NP. Expression of SOX9, ACAN, COL2, FOXF1, KRT19, PAX6, CA12, and COMPPerez-Cruet et al., 2019 [139]
Human UC-MSCsRat UC-MSCs or UC-MSC-derived CPCs injected into degenerated IVDExpression of chondrogenic markers and downregulation of pain and inflammatory genes. Differentiation of transplanted UC-MSCs and CPCs in functional NPCs. Better survival, homing, and distribution in IVD with CPCs.Ekram et al., 2021 [140]
OAEquine UC-MSCsRabbitEarly (day 3) or delayed (day 15) intra-articular injection of 3,5.106 UC-MSCsEarly IA injection of UC-MSCs exerted better anti-inflammatory and anticatabolic effects (reduction of MMPs -1, -3, -13, and TNF-a)Saulnier et al., 2015 [141]
AM/UC particulateRatIntra-articular injection of 50 or 100 μg/μL AM/UC particulate decellularizedAttenuation of cartilage destruction, significant increase in cartilage thickness and volume, significant decrease in total lesion area with high dose at 4 weeks postinjectionRaines et al., 2017 [142]
Human UC-MSCsMouseIntra-articular injection of UC-MSCsRegeneration and repair of cartilage, recovery from movement impairment, amelioration of cartilage apoptosis via caspase 3 pathwayChang et al., 2018 [143]
CanineUC-MSCsDogIntra-articular injection of UC-MSCs on days 1 and 3Repair of cartilage and patella, improvement of the healing of the surrounding tissue, reduction of joint effusion and inflammation (reduction of TNF-α, IL-6, and IL-7 blood levels)Zhang et al., 2018 [144]
Canine UC-MSCsDogIntra-articular injection of UC-MSCsImprovement of clinical signs related to OA in treated dogsKim et al., 2019 [145]
Human UC-MSCsRabbitIntra-articular injection of , or UC-MSCsChondrogenesis induction, upregulation of the expression of growth factors, ECM markers, and anti-inflammatory cytokines, and reduced expression of proinflammatory cytokines. Medium dose exerted the best effectsKim et al., 2019 [83]
Human UC-MSCsRatIntra-articular injection of UC-MSCs overexpressing miR-140-5pUC-MSCs overexpressing miR-140-5p significantly enhanced articular cartilage self-repairing in comparison to normal UC-MSCsGeng et al., 2019 [146]
Human UC-MSCsMinipigIntra-articular injection of a UC-MSCs (5 × 106 cells) and HA composite (4%)Significant gross and histological improvements in hyaline cartilage regenerationWu et al., 2019 [147]
Equine UC-MSCsHorse1 or 2 intra-articular injections (at 1-month interval) of UC-MSCsimprovement of lameness and total clinical score. No apparent clinical benefit of repeated intra-articular administrationMagri et al., 2019 [148]
Human UC-MSCsMouseIntra-articular injection of UC-MSCs at 3 or 6 weeksSignificantly reduction of the loss of joint space and no evidence of an inflammatory responsePerry et al., 2020 [149]
Human UC-MSCsRatSingle (day 1) or three (on days 1, 7 and 14) intra-articular injections of 2.5 x 105 UC-MSCsAmelioration of cartilage erosion, alleviation of inflammatory cells infiltration and hyperplasia of the synovium by repeated injections. Increase number of SFCs on the articular cartilage surfaceTong et al., 2020 [81]
Human UC-MSCsRatIntra-articular injection of UC-MSCs in 100 μL HATemporary effects that decelerate the progression of cartilage degeneration, but may not inhibit OA progression in the long-term.Xing et al., 2020 [150]
Human UC-MSCsMouseIntra-articular injection of low-dose UC-MSCs or UC-MSC-loaded GMs ( cells) or high-dose UC-MSCs (3 × 105 cells)UC-MSC-GMs promoted cartilage regeneration and inhibited macrophage-mediated synovitis better than low-dose and similar to high-dose UC-MSCsZhang et al., 2021 [42]
Human UC-MSCsRatintra-articular injection of UC-MSCs once a week for 3 weeksUC-MSCs prevent cartilage degradation, restore the proliferation of chondrocytes, and inhibit the inflammatory responseZhang et al., 2021 [82]
Human UC-MSCsRabbitIntra-articular injection of UC-MSCs with GO granular lubricantUC-MSCs loaded with the GO granular lubricant reduce the inflammatory level and improve the level of biochemical environment in the jointWang et al., 2021 [151]
RAHuman UC-MSCsMouseIntraperitoneal injection of UC-MSCs each day for 5 daysReduction of the severity of RA, reduced levels of proinflammatory cytokines and chemokines (TNF-α, IL-6, and MCP-1) and increased levels of the anti-inflammatory cytokine (IL-10), Th1/Th2 type responses shifting and Tregs inductionLiu et al., 2010 [152]
Human UC-MSCsMouseIntra-articular injection of UC-MSCs and/or 100 μg/mL TNF-α inhibitorInhibition of TNF-α decreases cartilage destruction by suppressing the immunogenicity of UC-MSCsWu et al., 2012 [153]
Human UC-MSCsRatTail vein injection of UC-MSCsMarkedly increased percentage of Tregs and antithrombin levels, decrease of IL-1, IL-17, TNF-α, VEGF, and tissue factor levelsGu et al., 2015 [154]
Human UC-MSCsMouseTail vein injection of UC-MSCs or BM-MSCs or SHEDUC-MSCs exert the best therapeutic effect in reducing bone resorption, joint destruction, and inflammatory factor expressionZhang et al. 2019 [155]
Human UC-MSCsRatIntravenous injection of UC-MSCsImprovement arthritis, delay of radiological progression, and inhibition of synovial hyperplasia by downregulation of RORγt and upregulation of Foxp3 expression, inhibition of IL-17 and promotion of TGF-β expression, inhibition of proliferation and promotion of apoptosis in T lymphocytes and increased Tregs ratioMa et al., 2019 [156]
Human UC-MSCsRatIntraperitoneal injection of UC-MSCsSlow down the progression of disease activity and reversal of arthritic processes along with triggering of joint tissue repair mechanismsVohra et al., 2020 [157]
Human UC-MSC-sEVsRatNDAmeliorate arthritis and inhibit synovial hyperplasia in a dose-dependent manner by inhibiting T lymphocyte proliferation and promoting their apoptosis, decreasing Th17 cell proportion and increasing that of Tregs, decreasing serum IL-17, and enhanced IL-10 and TGF-β expression, decreasing RORγt and increased FOXP3 expressionXu et al., 2021 [158]
Cartilage defectsHuman WJ- ECMRabbit rabbit chondrocytes seeded in decellularized WJ-ECM scaffold inserted into the cartilage defectsAll defects were filled completely with repaired tissue, and most of which were hyaline cartilage compared to WJ-ECM alone in which the defects filled partially with repaired tissueZhao et al., 2018 [159]
Human WJ-MSCsGoat WJ-MSCs seeded in ACECM-oriented scaffold implanted into the articular cartilage defectThe WJ-MSCs-ACECM scaffold complex achieved better quality repair and regeneration of hyaline cartilage compared to microfracture (predominant clinical treatment strategy for damaged cartilage)Zhang et al., 2018 [160]
Human WJ-MSCsGoat WJ-MSCs and pACs mixed in 3 ratios: 100:0, 0:100 and 50:50 and seeded into ACECM-oriented scaffolds implanted into the articular cartilage defect50:50 ratio was more similar to native cartilage and better integrated with the surrounding tissue, more abundant cartilage-specific content and significantly higher mechanical strength, no significant joint effusion or bone marrow edema signal. WJ-MSCs possessed low immunogenicity and escaped destruction by the immune systemZhang et al., 2020 [161]
Human UC-MSCs-ExosomesRabbitIntra-articular injection of of 2D or 3D culture in hollow-fiber bioreactor of UC-MSCs exosomesEnhanced gross appearance and attenuated cartilage defect; 3D-cultured exosomes showed a superior therapeutic effectYan et al., 2020 [162]
Human UC-MSCsRatWJ/CS composite scaffold loaded with UC-MSCs implanted into the articular cartilage defectThe composite scaffold loaded with UC-MSCs repaired cartilage defects better than did the WJ scaffold loaded with UC-MSCs. Both the scaffold and UC-MSCs showed low immunogenicityLi et al., 2021 [163]
Osteochondral defectsRabbit UC-MSCsRabbitPLGA scaffold with a continuous gradient transition between TGF-β1 and BMP-2 seeded with UC-MSCs implanted into articular osteochondral defectBeneficial effect for bone and cartilage regenerationDomer et al., 2012 [164]
Human WJ-MSCsRabbit undifferentiated or chondrogenically induced WJ-MSCs seeded in ECM of swine cartilage-derived scaffoldsTissues repair observed over 16 months, with a hyaline-like neocartilage layer and regenerated subchondral bone. No immune rejection.
WJ-MSCs were superior to those differentiated
Liu et al., 2017 [165]
Human WJ-MSCs exosomesRat and RabbitRat: 25 μg/mL of WJ-MSC exosomes injected in joint cavity (5 times, every 7 days)
Rabbit: ACECM scaffold implanted into osteochondral defect with 25 μg/mL of WJ-MSCs exosomes injected in joint cavity, 5 times every 7 days
WJ-MSC exosomes enhance the effect of the ACECM scaffold and promote osteochondral regeneration, regulate the microenvironment of the articular cavity promoting the polarization of macrophages toward the M2 phenotype and inhibiting the inflammatory response. WJ-MSC exosomes contain many miRNAs that can promote the regeneration of hyaline cartilageJiang et al., 2021 [166]

ACECM: acellular cartilage extracellular matrix; AM/UC: amniotic membrane/ umbilical cord; CPCs: chondroprogenitor cells; GMs: gelatin microcryogels; GO: graphene oxide; HA: hyaluronic acid; IVD: intervertebral disc; NP: nucleus pulposus; NPCs: NP-like cells; OA: osteoarthritis; pAC: primary cartilage cells; PLGA: poly(D,L-lactic-co-glycolic acid); RA: rheumatoid arthritis; sEVs: small extracellular vesicles; SFC: cartilage superficial; SHED: stem cells derived from human exfoliated deciduous teeth layer cells; WJ/CS: Wharton’s jelly and chondroitin sulfate.