Articular Cartilage Regeneration with Autologous Peripheral Blood Stem Cells and Adjuvant Hyaluronic Acid: An Animal Study in Sheep Model

Articular Cartilage Regeneration with Autologous Peripheral Blood Stem Cells and Adjuvant Hyaluronic Acid: An Animal Study in Sheep Model

Khay-Yong Saw, MB ChB, MCh Orth, FRCS(Edin), MALAYSIA Caroline Siew-Yoke Jee, BEng, PhD, MALAYSIA Alisha Ramlan, BSc, MALAYSIA Razana Ali, MBBS, MPATH , MALAYSIA Hui Cheng Chen , DVM, MVM, DVSc, MMCVS, MALAYSIA Nurul Hayah Khairuddin , DVM (UPM), PhD (Glasgow Uni), MALAYSIA Amal Mohd Dawam, BSc, MALAYSIA Yan Chang Saw, Medical Student , UNITED KINGDOM

Kuala Lumpur Sports Medicine Center, Kuala Lumpur, WP, MALAYSIA


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Treatment / Technique

Anatomic Structure

Diagnosis / Condition

Patient Populations

Diagnosis Method


Summary: Intra-articular injections of autologous peripheral blood stem cells (PBSC) combined with hyaluronic acid (HA) demonstrated superior histological outcomes in articular cartilage regeneration compared to control and HA-only groups in a sheep model, suggesting potential therapeutic efficacy for cartilage repair.


Introduction

The purpose of this study was to assess histologically whether intra-articular injections of autologous peripheral blood stem cells (PBSC) resulted in better regeneration of articular cartilage.

MATERIALS & METHODS:
Fifteen sheep were equally divided into three groups. An 8mm diameter full thickness articular cartilage defect was created, followed by subchondral drilling into the left stifle joint. Group A (Control group) underwent surgery only; Group B (HA group) received 2 mL of hyaluronic acid (Ostenil®, TRB Chemedica AG, Germany) post-surgery; and Group C (PBSC+HA group) received injections of 2 mL PBSC along with 2 mL HA post-surgery. Three injections were administered: on the day of surgery and 1 weekly injection for 2 consecutive weeks. PBSC in Group C were harvested via apheresis one month before surgery. All animals were sacrificed at 24 weeks post-surgery. The stifle joints were harvested and examined macroscopically and histologically, utilizing the ICRS Visual Assessment Scale II. Statistical analysis was conducted using SPSS, with comparative analysis being two-tailed, and the level of statistical significance set at p < 0.05.

Results

All animals in the study survived throughout its duration. Higher ICRS II scores indicate better regenerated cartilage. Group C showed a statistically significant difference compared to Group A (p=0.014) and Group B (p=0.016), highlighting its superior regenerative outcomes.

Discussions:
Macroscopic evaluation showed cartilage regeneration in all groups, but incomplete filling of chondral defects due to the short joint harvesting duration. Histological images from PBSC-treated group depicted cartilage most closely resembling normal cartilage, consistent with prior clinical study findings.­ It is also observed that Group C has more Collagen type II stains indicating better cartilage formation as compared to Groups A and B.

Conclusion

Intra-articular injections with PBSC resulted in better articular cartilage regeneration based on histological evaluation.