Regenerative vs. Pharmacological Medicine for OA Therapy

Cell-based therapies, particularly those using mesenchymal stem/stromal cells (MSCs), have emerged as a promising treatment option for osteoarthritis (OA). These approaches aim to address the underlying causes of OA by harnessing the regenerative and immunomodulatory properties of MSC. Interestingly enough, MSCs have shown multifaceted potential in mitigating OA symptoms and slowing disease progression through several mechanisms: (i) Pain reduction and improved function: Clinical trials have demonstrated that intra-articular (IA) administration of MSCs can lead to significant pain relief and enhanced joint function in OA patients; (ii) Cartilage protection and repair: MSCs have exhibited chondroprotective effects, helping to preserve existing cartilage and potentially stimulating the regeneration of damaged tissue; (iii) Anti-inflammatory and immunomodulatory actions: MSC secrete various factors that can modulate the inflammatory environment  and affect immune cell functions within the joint. While the exact mechanisms are still being elucidated, it appears that MSCs exert their therapeutic effects primarily through paracrine signaling rather than long-term engraftment in joint tissues.
In addition to MSC, other immunomodulatory/regenerative cell-based therapies have shown promise in preclinical and clinical trials in OA. These innovative approaches include the IA injection of genetically-modified allogeneic chondrocytes or macrophages and of autologous peripheral blood mononuclear cells. Some macrophage derivatives, including their exosomes and cytoplasmic membrane fragments have also been recently tested in OA animal models paving the way towards acellular cell-based therapies.
Although cell-based therapies for OA are still in the experimental preclinical and clinical stages, early results are encouraging. Ongoing research aims to optimize treatment protocols and cell sources to better understand the long-term efficacy and safety of these approaches. This presentation will share a comprehensive overview of recent data related to cell-based therapies for OA with a fully unbiased discussion of their clinical relevance from a patient-oriented perspective.

This speaker in the debate comparing regenerative and drug therapies will cover the benefits of pharmacological therapies in treating osteoarthritis, including the evidence-base for the use of existing pharmacotherapies as well as highlighting some therapies that have achieved phase 2 success.