Introduction
We read with interest the review of Chen et al. “The Use of Peripheral Blood-Derived Stem Cells for Cartilage Repair and Regeneration In Vivo: A Review” (Chen et al., 2020). Meta-analyses are a key component of evidence-based health care that by pooling together selected randomized controlled trials (RCTs) calculate an overall estimate or of the effect of the intervention under consideration (Moher and Olkin, 1995). The present review only includes one human RCT.
Materials and Methods
We believe that our RCT in 60 early osteoarthritis patients (of which 40 were actively treated with autologous hG-CSF activated PBSC and 20 received conventional hyaluronic acid treatment) (Turajane et al., 2017) should have been included. Our RCT showed statistically significant avoidance of total knee arthroplasty, and potent, early, and sustained symptom alleviation. Furthermore, our in vitro investigation (Turajane et al., 2014) shed light on the autologous PBSC mechanism of action by confirming chondrogenic differentiation potential for autologous PBSC through potentiated Sox9 transcription resulting in sequential COL-2 and aggrecan mRNA increases that ultimately resulted in histologically confirmed increased proteoglycan and glycosaminoglycan content in newly formed hyaline cartilage.
Discussion
We thus believe that the results presented in the current metanalysis are incomplete since the omitted patient number is half of the included (55 omitted vs. 130 included) (Jancewicz et al., 2004; Saw et al., 2011; Skowroński et al., 2012; Saw et al., 2013; Skowroński and Rutka, 2013; Turajane et al., 2013; Fu et al., 2014a; Saw et al., 2015). Comprising the 2017 RCT of Turajane et al. (Turajane et al., 2017) would have included a second RCT in the review, thus considerably strengthening the conclusion that autologous PBSCs show superiority in procurement, safety, and positive therapeutic effects in clinical settings where cartilage repair and regeneration are required.
Author Contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of Interest
KP was employed by THAI StemLife Co., Ltd.
The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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