The use of stromal vascular fraction (SVF), platelet-rich plasma (PRP) and stem cells in the treatment of osteoarthritis: an overview of clinical trials

Figures & data

Table 1. Chronological list of studies regarding the application of SVF, PRP and MSCs in patients with knee OA.

Type of therapy	Publication Year	Study type	Patient population	Study design	Follow-up	Outcome	References
SVF therapy	2011	Case-series	3 women 1 man	ADSC HA PRP Calcium chloride	3 months	Positive changes in MRI; Improvements in pain, physical therapy outcomes and functional status	[36]
	2012	Therapeutic case-control level III	25	SVF + PRP	12 months	Improved Lysholm, Tegner and VAS scores; no adverse side effects	[34]
	2013	Case-series	18	SVF + PRP	24.3 months	Improved WOMAC, Lysholm, VAS and whole-organ MRI scores	[39]
	2013	Retrospective cohort study	91	SVF + PRP	26.62 ± 0.32 months	SVF is safe; no tumor formation; self-limited tendonitis and swelling	[37]
	2014	Case-series	21	SVF + PRP	8.5 months	Improved joint function; Decreased pain score; Increased Lysholm score; Improved MRI findings; No serious side effects	[38]
	2015	Comparative study	30	SVF	3, 12, 24 months	Improved clinical outcomes after 2-year follow-up	[77]
	2015	Case-series	30	SVF + PRP	24 months	Improved clinical results and cartilage status under second-look arthroscopic analysis	[40]
	2015	Multi-center case-control study	1114	SVF	17.2 months	Improved pain score and functional status	[42)
	2016	Case report	3	SVF + PRP + HA + ECM	3.5 months	Improved FRI, ROM and VAS	[43]
	2016	Case report	6	SVF	12 months	Improved pain, functional status; no MRI evidence of cartilage regeneration	[44]
	2017	Clinical trial	10	SVF + PRP	3 months	Reduced WOMAC score; Improved cartilage thickness; safety of treatment	[35]
PRP therapy	2012	Case-series	50	PRP	12 months	Improved pain, clinical scores and quality of life	[51]
	2013	Prospective cohort study	22	PRP	12 months	Improved pain, functional and clinical scores	[78]
	2013	Randomized controlled trial	78	PRP	6 months	Improved WOMAC score	[52]
	2014	Systematic review and meta-analysis	1543	PRP vs. HA	6 to 24 months	Improved function; more effective than HA	[53]
	2017	Meta-analysis	1069	PRP	Variable	Similar pain relief and functional improvement at 6 months; better improvements for PRP at 12 months; PRP is safe	[54]
	2018	Meta-analysis	1520	PRP vs. HA	6, 12 months	Similar effectiveness between PRP and HA	[55]
	2018	Randomized clinical trial	89	PRP vs. HA	3, 6 months	Better improvement in pain and functional status for PRP; Improved synovial hypertrophy and vascularity scores	[56]
	2018	Randomized clinical trial	42	PRP vs. PRL	6 months	PRP is more effective than PRL regarding pain, stiffness and functional limitations	[57]
	2018	Pilot study	132	Prior MP injection vs. PRP alone	1, 3, 6, 12 months	Better clinical outcomes in prior MP injection	[58]
Stem cell  therapy	2013	Double blinded controlled trial	40	Autologous Ad-MSCs	6 months	Similar effectiveness in pain score compared to placebo	[70]
	2014	Double-blinded controlled trial	46	BM-MSCs	12, 24 and 36 weeks	Significant clinical improvement after MSC treatment	[66]
	2014	Double-blinded controlled trial	55	Allogenic MSCs	12 months	Meniscus regeneration and improved pain	[79]
	2014	Clinical trial	18	Ad-MSCs	6 months	Safety; Improved WOMAC score; decreased cartilage defect	[71]
	2015	Double-blinded controlled trial	30	Allogenic BM-MSC	12 months	Significant improvements in functional indices; more convenient than autologous MSCs	[67]
	2016	Clinical trial	60	BM-MSCs	1, 3, 6, 12 months	Reduced pain in patients and repaired damaged cartilage in rats	[68]
	2016	Phase I/II multicenter randomized clinical trial	30	Autologous BM-MSCs	12 months	Safety, clinical and functional improvement	[69]
	2016	Phase I Dose-Escalation Trial	18	Ad-MSCs	6 months	Safety; Significant improvements in pain and function	[80]

SVF: stromal vascular fraction; PRP: platelet-rich plasma; HA: hyaluronic acid; MRI: magnetic resonance imaging; VAS: visual analog scale; ECM: extracellular matrix; MSC: mesenchymal stem cell; ADSC: adipose-derived stem cell; WOMAC: Western Ontario and McMaster Universities osteoarthritis; FRI: functional rating index; ROM: range of motion; BM: bone-marrow; MP: methyl prednisone.

Figure 1. Steps for PRP preparation. The first step is to collect around 20 mL of whole blood in anticoagulated vacutainer tubes. Then, place the blood-filled tubes on a specially prepared centrifuge to spin at 600 ×g for 7 minutes. This results in formation of two phases, which the upper phase should be transferred to empty sterile tubes. In the next spinning stage, tubes are centrifuged at 2000 ×g for 5 minutes. First RBCs and then platelets are deposited at the bottom of the tubes and one can homogenize the platelet layer to available plasma to make PRP.

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