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Nowroozzadeh MH, Ghazanfari S, Sanie-Jahromi F. Human Wharton's Jelly Mesenchymal Stem Cell Secretome Modifies the Processes of Neuroprotection and Epithelial-Mesenchymal Transition in Retinal Pigment Epithelium at Transcriptional Level. Mol Biol Rep 2023:10.1007/s11033-023-08496-0. [PMID: 37217618 DOI: 10.1007/s11033-023-08496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Retinal pigment epithelium (RPE) cells are potential targets for treating retinal detachment (RD) and proliferative vitreoretinopathy (PVR), considering the importance of neuroprotection and epithelial-mesenchymal transition (EMT) of RPE in these conditions. This study investigated the effect of human Wharton's jelly mesenchymal stem cell secretome (WJMSC-S) on the expression of genes involved in both neuroprotection and EMT in RPE cells in vitro (TRKB, MAPK, PI3K, BDNF, and NGF). METHODS RPE cells from passages 5-7 were treated with WJMSC-S (or the vehicle culture medium as control) for 24 h at 37◦C and subsequently subjected to RNA extraction and cDNA synthesis. Gene expression level was evaluated using real-time PCR in the treated versus control cells. RESULTS The results of our study showed that WJMSC-S led to a significant downregulation in three out of five studied gene expression (MAPK, TRKB, and NGF), and simultaneously, remarkably upregulated the expression of the BDNF gene. CONCLUSIONS According to the present data, WJMSC-S can affect the EMT and neuroprotection processes at the mRNA level by suppressing EMT and promoting neuroprotection in RPE cells. This finding may have positive clinical implications in the context of RD and PVR.
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Affiliation(s)
- M Hossein Nowroozzadeh
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Shiva Ghazanfari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran
| | - Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Zand Boulevard, Poostchi Street, Shiraz, Iran.
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Abstract
Interest in use of perinatal allogenic tissues including clinical-grade minimally manipulated umbilical cord tissue-derived allograft formulations to treat knee osteoarthritis (OA) patients is increasing. Limited studies have characterized these formulations and evaluated their safety and efficacy in knee OA patients. We developed such formulation and reported the presence of growth factors, cytokines, hyaluronic acid, and exosomes. We reported that its administration is safe, and resulted in 50% pain reduction and improvement in knee injury and osteoarthritis outcome score (over 10%) and 36-item short form survey (25%). Another study reported no adverse events post injection of similar formulation and statistically significant ( P <0.001) improvement in visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores and reduction in medication usage in patients (77.8%). We also summarized the clinical trials registered on ClinicalTrials.gov utilizing umbilical cord tissue for knee OA treatment. In conclusion, available studies are preliminary but pave the way to higher level appropriately powered investigations, and these formulations should be considered as nonoperative alternative to manage knee OA.
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Aratikatla A, Maffulli N, Rodriguez HC, Gupta M, Potty AG, El-Amin SF, Gupta A. Allogenic perinatal tissue for musculoskeletal regenerative medicine applications: a systematic review protocol. J Orthop Surg Res 2022; 17:307. [PMID: 35690774 PMCID: PMC9188718 DOI: 10.1186/s13018-022-03197-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Musculoskeletal ailments impact the lives of millions of people, and at times necessitate surgery followed by physiotherapy, drug treatments, or immobilization. Regenerative musculoskeletal medicine has undergone enormous progress over the last few decades. Sources of tissues used for regenerative medicine purposes can be grouped into autologous or allogenic. Although autologous sources are promising, there is a wide range of limitations with the treatment, including the lack of randomized controlled studies for orthopaedic conditions, donor site morbidity, and highly variable outcomes for patients. Allogenic sources bypass some of these shortcomings and are a promising source for orthopaedic regenerative medicine applications. Methods A systematic search will be performed using PubMed, Elsevier, ScienceDirect, and Google Scholar databases for articles published in English before May 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and guidelines will be used. Studies will be eligible if they apply to acute and chronic orthopaedic musculoskeletal complications or animal or human disease models. Publications must include the use of MSCs and/or tissue obtained from amniotic/chorionic membrane, amniotic fluid, umbilical cord, and/or umbilical cord-derived Wharton’s jelly as an intervention. Placebos, noninjury models, acute injury models, non-injury models, and gold standard treatments will be compared. The study selection will be performed by two independent reviewers using a dedicated reference management software. Data synthesis and meta-analysis will be performed separately for preclinical and clinical studies. Discussion The results will be published in relevant peer-reviewed scientific journals. Investigators will present results at national or international conferences. Trial registration: The Protocol will be registered on PROSPERO international prospective register of systematic reviews prior to commencement.
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Affiliation(s)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84084, Fisciano, Italy.,San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, 84124, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke-on-Trent, ST5 5BG, UK
| | - Hugo C Rodriguez
- Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL, 33334, USA.,Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, FL, USA
| | - Manu Gupta
- Future Biologics, Lawrenceville, GA, 30043, USA.,Polar Aesthetics Dental & Cosmetic Centre, Noida, Uttar Pradesh, 201301, India
| | - Anish G Potty
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA.,Laredo Sports Medicine Clinic, Laredo, TX, 78041, USA
| | - Saadiq F El-Amin
- El-Amin Orthopaedic & Sports Medicine Institute, Lawrenceville, GA, 30043, USA.,Regenerative Sports Medicine, Lawrenceville, GA, 30043, USA.,BioIntegrate Inc., 2505 Newpoint Pkwy, Suite - 100, Lawrenceville, GA, 30043, USA
| | - Ashim Gupta
- Future Biologics, Lawrenceville, GA, 30043, USA. .,Polar Aesthetics Dental & Cosmetic Centre, Noida, Uttar Pradesh, 201301, India. .,South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA. .,BioIntegrate Inc., 2505 Newpoint Pkwy, Suite - 100, Lawrenceville, GA, 30043, USA. .,Veterans in Pain (V.I.P.), Valencia, CA, 91354, USA. .,Indian Stem Cell Study Group (ISCSG) Association, Lucknow, Uttar Pradesh, 110048, India.
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4
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Gupta A. Allogenic Amniotic Tissue for Treatment of Knee and Hip Osteoarthritis. Pharmaceuticals (Basel) 2022; 15:ph15040404. [PMID: 35455401 PMCID: PMC9031613 DOI: 10.3390/ph15040404] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/31/2022] Open
Abstract
Osteoarthritis (OA) impacts millions of people and places a high burden on healthcare systems in the United States. Current treatment modalities have limitations and do not address underlying pathology. Lately, there has been an immense growth in the use of biologics, including perinatal allogenic tissues for orthopedic regenerative medicine applications. Amniotic tissue is an exciting new alternative for such applications. Despite several published studies that reported its use for treatment of ophthalmic conditions and complex wounds, there are limited clinical studies evaluating its safety and efficacy in treating patients suffering with knee or hip OA. In this manuscript, I focused on three prospective clinical studies which evaluated the safety and efficacy of amniotic tissue in patients suffering with moderate knee or hip OA. The results from these studies presented the scientific community with much needed, well-executed, and prospective clinical trials. Though these trials demonstrated that administration of amniotic tissue in knee or hip joint is safe and potentially effective, more multi-center, prospective, double-blinded, randomized controlled trials are warranted to further establish the efficacy of amniotic tissue to mitigate symptoms of knee and hip OA to ultimately justify its clinical use.
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Affiliation(s)
- Ashim Gupta
- Future Biologics, Lawrenceville, GA 30043, USA;
- BioIntegrate, Lawrenceville, GA 30043, USA
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Veterans in Pain (V.I.P.), Valencia, CA 91354, USA
- General Therapeutics, Cleveland Heights, OH 44118, USA
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5
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Nakanishi K, Higashi K, Toida T, Asai M. Characterization of chondroitin sulfate in stem cells derived from umbilical cord blood in rats. PLoS One 2022; 17:e0262854. [PMID: 35077481 PMCID: PMC8789104 DOI: 10.1371/journal.pone.0262854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022] Open
Abstract
Chondroitin sulfate (CS) and its isomeric variant, dermatan sulfate (DS), are complex glycosaminoglycans (GAGs) which are ubiquitous components of the extracellular matrix in various tissues including the brain. CS and/or DS are known to bind to a variety of growth factors and regulate many cellular events such as proliferation and differentiation. Although the biological activities of CS and/or DS towards neural stem/progenitor cells (NSPCs) have been well investigated, the CS and/or DS of hematopoietic stem cells (HSCs) have not been fully characterized. Here, we analyzed GAGs on mononuclear cells of rat umbilical cord blood cells (UCB-MNCs). CS was detected in vascular intima and media of rat umbilical cord at embryonic day 19 (E19) by immunohistochemistry. The stem-cell-enriched-UCBCs (SCE-UCBCs), which were expanded from rat UCB-MNCs, expressed CS. CS chains are composed of repeating disaccharide units, which are classified into several types such as O-, A-, B-, C-, D-, and E-unit according to the number and positions of sulfation. A disaccharide composition analysis revealed that CS and/or DS were abundant in rat UCB-MNCs as well as in their expanded SCE-UCBCs, while the amount of heparan sulfate (HS) was less. The degree of sulfation of CS/DS was relatively low and the major component in UCB-MNCs and SCE-UCBCs was the A-unit. A colony-forming cell assay revealed that the percentage of colony-forming cells decreased in culture with CS degradation enzyme. The CS and/or DS of UCBCs may be involved in biological activities such as stem cell proliferation and/or differentiation.
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Affiliation(s)
- Keiko Nakanishi
- Department of Disease Model, Institute for Developmental Research, Aichi Developmental Disability Center, Kasugai, Aichi, Japan
- Department of Pediatrics, Central Hospital, Aichi Developmental Disability Center, Kasugai, Aichi, Japan
- * E-mail:
| | - Kyohei Higashi
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda, Chiba, Japan
| | - Toshihiko Toida
- Center for Preventive Medical Sciences, Chiba University, Chuo-ku, Chiba, Japan
| | - Masato Asai
- Department of Disease Model, Institute for Developmental Research, Aichi Developmental Disability Center, Kasugai, Aichi, Japan
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Main BJ, Maffulli N, Valk JA, Rodriguez HC, Gupta M, El-Amin SF, Gupta A. Umbilical Cord-Derived Wharton's Jelly for Regenerative Medicine Applications: A Systematic Review. Pharmaceuticals (Basel) 2021; 14:ph14111090. [PMID: 34832872 PMCID: PMC8618385 DOI: 10.3390/ph14111090] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 01/14/2023] Open
Abstract
Musculoskeletal ailments affect millions of people around the world and place a high burden on healthcare. Traditional treatment modalities are limited and do not address underlying pathologies. Mesenchymal stem cells (MSCs) have emerged as an exciting therapeutic alternative and Wharton’s jelly-derived mesenchymal stem cells (WJSCs) are some of these. This review reports the clinical and functional outcomes of the applications of WJSCs in orthopedic surgery. A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The studies that used culture-expanded, mesenchymal stem or stromal cells, MSCs and/or connective tissues procured from Wharton’s jelly (WJ), from January 2010 to October 2021, were included. Conventional non-operative therapies and placebos were used as comparisons. Six studies that directly discussed WJSCs use in an animal model or the basic scientific testing using an injury model were identified. Five publications studied cartilage injury, three studied degenerative disc disease, one was related to osteoarthritis, and one was related to osteochondral defects. The results of these studies suggested the benefits of WJSCs in the management of these orthopedic pathologies. To adequately assess the safety and efficacy of WJSCs in orthopedic surgery, further randomized controlled clinical studies are necessary.
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Affiliation(s)
- Benjamin J. Main
- Department of Orthopaedic Surgery, Beaumont Hospital Farmington Hills, Farmington Hills, MI 48336, USA; (B.J.M.); (J.A.V.)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy;
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK
| | - Josiah A. Valk
- Department of Orthopaedic Surgery, Beaumont Hospital Farmington Hills, Farmington Hills, MI 48336, USA; (B.J.M.); (J.A.V.)
| | | | - Manu Gupta
- Polar Aesthetics Dental & Cosmetic Centre, Noida 201301, Uttar Pradesh, India;
| | - Saadiq F. El-Amin
- El-Amin Orthopaedic and Sports Medicine Institute, Lawrenceville, GA 30043, USA;
- BioIntegrate, Lawrenceville, GA 30043, USA
| | - Ashim Gupta
- BioIntegrate, Lawrenceville, GA 30043, USA
- Future Biologics, Lawrenceville, GA 30043, USA
- Correspondence:
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7
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Gupta A, Maffulli N, Rodriguez HC, Mistovich RJ, Delfino K, Cady C, Fauser AM, Cundiff ED, Martinez MA, Potty AG. Cell-free stem cell-derived extract formulation for treatment of knee osteoarthritis: study protocol for a preliminary non-randomized, open-label, multi-center feasibility and safety study. J Orthop Surg Res 2021; 16:514. [PMID: 34416898 PMCID: PMC8377854 DOI: 10.1186/s13018-021-02672-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022] Open
Abstract
Background Musculoskeletal conditions are highly prevalent, and knee OA is most common. Current treatment modalities have limitations and either fail to solve the underlying pathophysiology or are highly invasive. To address these limitations, attention has focused on the use of biologics. The efficacy of these devices is attributed to presence of growth factors (GFs), cytokines (CKs), and extracellular vesicles (EVs). With this in mind, we formulated a novel cell-free stem cell-derived extract (CCM) from human progenitor endothelial stem cells (hPESCs). A preliminary study demonstrated the presence of essential components of regenerative medicine, namely GFs, CKs, and EVs, including exosomes, in CCM. The proposed study aims to evaluate the safety and efficacy of intraarticular injection of the novel cell-free stem cell-derived extract (CCM) for the treatment of knee OA. Methods and analysis This is a non-randomized, open-label, multi-center, prospective study in which the safety and efficacy of intraarticular CCM in patients suffering from grade II/III knee OA will be evaluated. Up to 20 patients with grade II/III OA who meet the inclusion and exclusion criteria will be consented and screened to recruit 12 patients to receive treatment. The study will be conducted at up to 2 sites within the USA, and the 12 participants will be followed for 24 months. The study participants will be monitored for adverse reactions and assessed using Numeric Pain Rating Scale (NPRS), Patient-Reported Outcomes Measurement Information System (PROMIS) Score, Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS Jr.), 36-ietm short form survey (SF-36), Single Assessment Numeric Evaluation (SANE), physical exams, plain radiography, and magnetic resonance imaging (MRI) with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score for improvements in pain, function, satisfaction, and cartilage regeneration. Discussion This prospective study will provide valuable information into the safety and efficacy of intraarticular administration of cell-free stem cell-derived extract (CCM) in patients suffering with grade II/III knee OA. The outcomes from this initial study of novel CCM will lay the foundation for a larger randomized, placebo-controlled, multi-center clinical trial of intraarticular CCM for symptomatic knee OA. Trial registration Registered on July 21, 2021. ClinicalTrials.gov NCT04971798
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Affiliation(s)
- Ashim Gupta
- General Therapeutics, 2956 Washington Blvd, Cleveland Heights, OH, 44118, USA. .,Future Biologics, Lawrenceville, GA, USA. .,South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, USA. .,Veterans in Pain (V.I.P.), Los Angeles, CA, USA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy.,San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Salerno, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
| | - Hugo C Rodriguez
- Future Biologics, Lawrenceville, GA, USA.,South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, USA.,School of Osteopathic Medicine, University of The Incarnate Word, San Antonio, TX, USA.,Future Physicians of South Texas, San Antonio, TX, USA
| | - R Justin Mistovich
- General Therapeutics, 2956 Washington Blvd, Cleveland Heights, OH, 44118, USA.,Department of Orthopaedics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kristin Delfino
- Southern Illinois University, School of Medicine, Springfield, IL, USA
| | - Craig Cady
- General Therapeutics, 2956 Washington Blvd, Cleveland Heights, OH, 44118, USA.,Bohlander Stem Cell Research Laboratory, Department of Biology, Bradley University, Peoria, IL, USA
| | - Anne-Marie Fauser
- Bohlander Stem Cell Research Laboratory, Department of Biology, Bradley University, Peoria, IL, USA
| | - Echo D Cundiff
- General Therapeutics, 2956 Washington Blvd, Cleveland Heights, OH, 44118, USA
| | | | - Anish G Potty
- General Therapeutics, 2956 Washington Blvd, Cleveland Heights, OH, 44118, USA.,South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, USA.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Laredo Sports Medicine Clinic, Laredo, TX, USA
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8
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Generation and Evaluation of Novel Biomaterials Based on Decellularized Sturgeon Cartilage for Use in Tissue Engineering. Biomedicines 2021; 9:biomedicines9070775. [PMID: 34356839 PMCID: PMC8301329 DOI: 10.3390/biomedicines9070775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022] Open
Abstract
Because cartilage has limited regenerative capability, a fully efficient advanced therapy medicinal product is needed to treat severe cartilage damage. We evaluated a novel biomaterial obtained by decellularizing sturgeon chondral endoskeleton tissue for use in cartilage tissue engineering. In silico analysis suggested high homology between human and sturgeon collagen proteins, and ultra-performance liquid chromatography confirmed that both types of cartilage consisted mainly of the same amino acids. Decellularized sturgeon cartilage was recellularized with human chondrocytes and four types of human mesenchymal stem cells (MSC) and their suitability for generating a cartilage substitute was assessed ex vivo and in vivo. The results supported the biocompatibility of the novel scaffold, as well as its ability to sustain cell adhesion, proliferation and differentiation. In vivo assays showed that the MSC cells in grafted cartilage disks were biosynthetically active and able to remodel the extracellular matrix of cartilage substitutes, with the production of type II collagen and other relevant components, especially when adipose tissue MSC were used. In addition, these cartilage substitutes triggered a pro-regenerative reaction mediated by CD206-positive M2 macrophages. These preliminary results warrant further research to characterize in greater detail the potential clinical translation of these novel cartilage substitutes.
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9
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Safety and efficacy of umbilical cord-derived Wharton's jelly compared to hyaluronic acid and saline for knee osteoarthritis: study protocol for a randomized, controlled, single-blind, multi-center trial. J Orthop Surg Res 2021; 16:352. [PMID: 34059080 PMCID: PMC8165766 DOI: 10.1186/s13018-021-02475-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Background Osteoarthritis (OA) is the most common joint disorder in the United States of America (USA) with a fast-rising prevalence. Current treatment modalities are limited, and total knee replacement surgeries have shown disadvantages, especially for grade II/III OA. The interest in the use of biologics, including umbilical cord (UC)-derived Wharton’s jelly (WJ), has grown in recent years. The results from a preliminary study demonstrated the presence of essential components of regenerative medicine, namely growth factors, cytokines, hyaluronic acid (HA), and extracellular vesicles, including exosomes, in WJ. The proposed study aims to evaluate the safety and efficacy of intra-articular injection of UC-derived WJ for the treatment of knee OA symptoms. Methods A randomized, controlled, single-blind, multi-center, prospective study will be conducted in which the safety and efficacy of intra-articular administration of UC-derived WJ are compared to HA (control) and saline (placebo control) in patients suffering from grade II/III knee OA. A total of 168 participants with grade II or III knee OA on the KL scale will be recruited across 53 sites in the USA with 56 participants in each arm and followed for 1 year post-injection. Patient satisfaction, Numeric Pain Rating Scale, Knee Injury and Osteoarthritis Outcome Score, 36-Item Short Form Survey (SF-36), and 7-point Likert Scale will be used to assess the participants. Physical exams, X-rays, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue score will be used to assess improvement in associated anatomy. Discussion The study results will provide valuable information into the safety and efficacy of intra-articular administration of Wharton’s jelly for grade II/III knee osteoarthritis. The results of this study will also add to the treatment options available for grade II/III OA as well as help facilitate the development of a more focused treatment strategy for patients. Trial registration ClinicalTrials.gov, NCT04711304. Registered on January 15, 2021
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Gupta A, Shivaji K, Kadam S, Gupta M, Rodriguez HC, Potty AG, El-Amin SF, Maffulli N. Immunomodulatory extracellular vesicles: an alternative to cell therapy for COVID-19. Expert Opin Biol Ther 2021; 21:1551-1560. [PMID: 33886388 DOI: 10.1080/14712598.2021.1921141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: SARS-CoV-2 induces a cytokine storm and can cause inflammation, fibrosis and apoptosis in the lungs, leading to acute respiratory distress syndrome (ARDS). ARDS is the leading cause of mortality and morbidity the associated to COVID-19, and the cytokine storm is a prominent etiological factor. Mesenchymal stem cell-derived extracellular vesicles are an alternative therapy for the management of inflammatory and autoimmune conditions due to their immunosuppressive properties. The immunomodulatory and tissue regeneration capabilities of extracellular vesicles may support their application as a prospective therapy for COVID-19.Areas Covered: We explored the clinical evidence on extracellular vesicles as antiviral agents and in mitigating ARDS, and their therapeutic potential in COVID-19.Expert Opinion: Clinical trials using extracellular vesicles are registered against COVID-19 associated complications, with some evidence of safety and efficacy. Extracellular vesicles present an alternative potential for cell therapy for COVID-19 management, but further preclinical and clinical investigations are needed.
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Affiliation(s)
- Ashim Gupta
- Future Biologics, Lawrenceville, USA.,BioIntegrate, Lawrenceville, USA.,South Texas Orthopedic Research Institute (STORI Inc), Laredo, USA.,Veterans in Pain, Los Angeles, USA
| | - Kashte Shivaji
- Department of Stem Cell & Regenerative Medicine, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Institution Deemed to Be University), Kolhapur, India
| | - Sachin Kadam
- Department of Stem Cell & Regenerative Medicine, Centre for Interdisciplinary Research, D. Y. Patil Education Society (Institution Deemed to Be University), Kolhapur, India.,Advancells Group, Noida, India
| | | | - Hugo C Rodriguez
- Future Biologics, Lawrenceville, USA.,South Texas Orthopedic Research Institute (STORI Inc), Laredo, USA.,Future Physicians of South Texas, San Antonio, USA.,School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, USA
| | - Anish G Potty
- South Texas Orthopedic Research Institute (STORI Inc), Laredo, USA.,School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, USA.,The Institute of Musculoskeletal Excellence (TIME Orthopaedics), Laredo, USA
| | - Saadiq F El-Amin
- BioIntegrate, Lawrenceville, USA.,El-Amin Orthopaedic & Sports Medicine Institute, Lawrenceville, USA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy.,San Giovanni Di Dio E Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Salerno, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, London, England
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11
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Gupta A, Maffulli N, Rodriguez HC, Lee CE, Levy HJ, El-Amin SF. Umbilical cord-derived Wharton's jelly for treatment of knee osteoarthritis: study protocol for a non-randomized, open-label, multi-center trial. J Orthop Surg Res 2021; 16:143. [PMID: 33602286 PMCID: PMC7890617 DOI: 10.1186/s13018-021-02300-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 12/15/2022] Open
Abstract
Background Osteoarthritis (OA) is the most common joint disorder in the USA, and knee OA has the highest prevalence. Inflammation and decrease in vascularization are key factors in the degeneration of articular cartilage and the associated pain and decrease in function. To combat this process, the use of biologics including umbilical cord-derived Wharton’s Jelly (UC-derived WJ) has grown. UC-derived WJ contains large quantities of regenerative factors, including growth factors (GFs), cytokines (CKs), hyaluronic acid (HA), and extracellular vesicles (EVs). The proposed study evaluates the safety and efficacy of intraarticular injection of UC-derived WJ for treatment of knee OA symptoms. Methods and analysis This is a non-randomized, open-label, multi-center, prospective study in which the safety and efficacy of intraarticular UC-derived WJ in patients suffering from grade II/III OA will be assessed. Twelve patients with grade II/III OA who meet the inclusion and exclusion criteria will be recruited for this study which will be conducted at up to two sites within the USA. The participants will be followed for 1 s. Participants will be assessed using the Numeric Pain Rating Scale (NPRS), Knee Injury and Osteoarthritis Outcome Score (KOOS), 36-item short form survey (SF-36), Single Assessment Numeric Evaluation (SANE), physical exams, plain radiography, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score for improvements in pain, satisfaction, function, and cartilage regeneration. Discussion This prospective study will contribute to the limited amount of data on UC-derived WJ, particularly with regard to its safety and efficacy. The outcomes from this study will also lay the groundwork for a large placebo-controlled trial of intraarticular UC-derived WJ for symptomatic knee OA. Trial registration ClinicalTrials.gov NCT04719793. Registered on 22 January 2021
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Affiliation(s)
- Ashim Gupta
- BioIntegrate, Lawrenceville, GA, USA.,Future Biologics, Lawrenceville, GA, USA.,South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, USA.,Veterans in Pain (V.I.P.), Los Angeles, CA, USA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy.,San Giovanni di Dio e Ruggi D'Aragona Hospital "Clinica Orthopedica" Department, Hospital of Salerno, Salerno, Italy.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
| | - Hugo C Rodriguez
- Future Biologics, Lawrenceville, GA, USA.,South Texas Orthopedic Research Institute (STORI Inc.), Laredo, TX, USA.,School of Osteopathic Medicine, University of The Incarnate Word, San Antonio, TX, USA.,Future Physicians of South Texas, San Antonio, TX, USA
| | - Cassidy E Lee
- El-Amin Orthopaedic and Sports Medicine Institute, 2505 Newpoint Pkwy, Suite 100B, Lawrenceville, GA, 30043, USA
| | - Howard J Levy
- BioIntegrate, Lawrenceville, GA, USA.,Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Saadiq F El-Amin
- BioIntegrate, Lawrenceville, GA, USA. .,El-Amin Orthopaedic and Sports Medicine Institute, 2505 Newpoint Pkwy, Suite 100B, Lawrenceville, GA, 30043, USA.
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