PRISMA-Compliant Meta-Analysis of Randomized Controlled Trials on Osteoarthritis of Knee Managed with Allogeneic vs Autologous MSCs: Efficacy and Safety Analysis

Abstract
Study Design Meta-analysis.
Objectives Our objective is to review the randomized controlled trials (RCTs) that have been conducted previously on the
topic of osteoarthritis of the knee to assess and compare the efcacy and safety of autologous and allogeneic sources of
mesenchymal stromal cells (MSCs) in the treatment of osteoarthritis.
Materials and methods We searched the electronic databases PubMed, Embase, Web of Science, and the Cochrane Library
until August 2021 for randomised controlled trials (RCTs) analysing the efcacy and safety of autologous and allogeneic
sources of MSCs in the management of knee osteoarthritis. These searches were conducted independently and in duplicate. The outcomes that were taken into consideration for analysis were the visual analogue score (VAS) for pain, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), the Lysholm score, and adverse events. The OpenMeta [Analyst] software was utilised to carry out the analysis in the R platform.
Results In total, 21 studies with a total of 936 patients were considered for this analysis. Because none of the studies made
a direct comparison of the autologous and allogeneic sources of MSCs, we pooled the results of all of the included stud-
ies of both sources and made a comparative analysis of how the two types of MSCs fared in their respective applications.
Although both allogeneic and autologous sources of MSCs demonstrated signifcantly better VAS improvement after 6
months (p=0.006, p=0.001), this trend was not maintained after 1 year for the allogeneic source (p=0.171, p=0.027).When compared to their respective controls based on WOMAC scores after 1 year, autologous sources (p=0.016) of MSCs performed better than allogeneic sources (p=0.186).A similar response was noted between the sources at 2 years in their Lysholm scores (p=0.682, p=0.017), respectively. Moreover, allogeneic sources (p=0.039) of MSCs produced signifcant adverse events than autologous sources (p=0.556) compared to their controls.
Conclusion Our analysis of literature showed that autologous sources of MSCs stand superior to allogeneic sources of MSC
with regard to their consistent efcacy for pain, functional outcomes, and safety. However, we strongly recommend that fur-ther studies be conducted that are of a high enough quality to validate our fndings and reach a consensus on the best source of MSCs for use in cellular therapy treatments for knee osteoarthritis.