Objective Explore the effectiveness of the combination of human umbilical cord
mesenchymal stem cells (hUC-MSCs) and sodium hyaluronate (HA) in treating knee
osteoarthritis (KOA) and study the in
vivo biological distribution of hUC-MSCs in SD rats.
Methods Mesenchymal stem cells were isolated by using human umbilical cord
tissue as the starting material, and were expanded and characterized before the
injection; The knee osteoarthritis model was established by left anterior
cruciate ligament transection and meniscectomy on SD rats. HA solvent solution
alone and hUC-MSCs suspension together with HA were injected into the joint
cavity at 6 and 9 weeks after the surgery, respectively. All SD rats were
euthanized at 13 weeks after the surgery, and the femoral bones of the knee
joint were isolated for gross morphological observation, histological analysis
and immunohistochemical staining. To study the biological distribution of
hUC-MSCs, the knee osteoarthritis model was established by the same method as
described above. 4 weeks after the surgery, DiR solution and DiR-labeled
hUC-MSCs were injected into the joint cavity. DiR-labeled hUC-MSCs were also
injected into the joint cavity of untreated SD rats as the control group. All
the animals were subjected to in vivo fluorescence imaging at 10 minutes, 4 hours, 24 hours, 3 days, 7 days, 14 days,
21 days, 28 days, 35 days, 42 days, 49 days, and 56 days after the injection. Each
group animals were euthanized at 3, 21, and 56 days post-injection, allowing
for collection of the heart, liver, spleen, lung, kidney, whole blood, brain,
testis, and knee joints (including synovium, cartilage, ligament, and muscle)
to detect the human-specific gene SRGAP2.
Results According to the gross morphological observation andscore, the
combination of high-dose hUC-MSCs and HA exhibits better performance in
repairing the appearance and structural damage of the knee joint in KOA. Based
on the Modified Mankin scoring, both the treatment of HA alone and combinations
of low, medium and high-dose of hUC-MSCs and HA could alleviate cartilage
degeneration in KOA rats; The immunohistochemical staining of the joint tissues
shown that the treatment of HA alone and combinations of low, medium, and
high-dose hUC-MSCs and HA all inhibit the expression of matrix
metalloproteinase 13 (MMP13) and the degradation of collagen II. According to
the in vivo fluorescence imaging,
after injected into the joint cavity of each group, DiR-labeled hUC-MSCs
demonstrated more intensive fluorescence than DiR solution, and the
fluorescence in the site of injection of all animals reached a comparable level
at day 28 and became unobservable after day 56. In the DiR-labeled hUC-MSCs
group, the hUC-MSC genome was detected in the animal's joint cavity (synovium,
cartilage, ligament) on day 3, but not on day 21 and day 56. No transplanted
cells were found in the heart, liver, spleen, lung, kidney, whole blood, brain,
or testis at any of the time points.
Conclusion In summary, this study demonstrates that the combined application of hUC-MSCs
and HA is beneficial in the treatment of knee osteoarthritis. After
intra-articular injection, hUC-MSCs showed no ectopic distribution, indicating
the absence of systemic risk. These results are of great reference value to
clinical practice.