Adipose-Derived MSCs Show Promise as Nonsurgical Option for Knee OA, With Moshiur Rahman Khasru, MBBS, MSc

Two-dose adipose-derived mesenchymal stem cells (AdMSC) therapy significantly outperformed hyaluronic acid (HA) and single-dose AdMSC in improving pain, function, and cartilage structure in people with knee osteoarthritis (KOA).

These findings were presented at the American College of Rheumatology (ACR) Convergence 2025, held October 24–29 in Chicago, Illinois, by Moshiur Rahman Khasru, MBBS, MSc, PhD candidate at University of Manchester, and Musculoskeletal Medicine and Interventional Physiatry Division, Bangladesh Medcial University, Dhaka, Bangladesh.

For people with KOA who are either ineligible or unwilling to undergo surgery, there is a need for safe, nonsurgical interventions that address not only symptoms but also cartilage degeneration itself. HA remains a widely used intra-articular treatment, but benefits are modest and short-lived, typically lasting just 3–6 months. Evidence directly comparing HA with regenerative approaches has also been lacking.

Khasru and colleagues conducted a phase IIb, evaluator-blinded trial in Bangladesh to compare intermediate molecular-weight HA with autologous AdMSCs—including both single- and 2-dose regimens—to determine relative efficacy, safety, and potential dose responsiveness. Seventy-three patients with refractory primary KOA were randomized and assessed at baseline and at 6 months using VAS pain, KOOS function, ultrasound-measured femoral cartilage thickness, and MRI-evaluated MOAKS cartilage defects.

Interim 6-month results showed that 2-dose AdMSC therapy produced significantly greater clinical and structural improvements than HA, including a 3.2-point reduction in VAS pain versus 1.3 points with HA and a 21.24-point improvement in KOOS function compared with 11.31 points in the HA group (P <.001). Structural endpoints showed similar dose-dependent advantages: femoral cartilage thickness increased by 0.25 ± 0.18 mm and MRI-assessed cartilage defects (MOAKS) improved by 9.13% in the two-dose AdMSC arm, whereas the HA group demonstrated structural decline with cartilage thinning of –0.06 ± 0.14 mm and a 0.75% worsening in cartilage defects.

The single-dose AdMSC group also outperformed HA, showing superior pain reduction, functional gains, and favorable cartilage changes, though to a lesser extent than the 2-dose regimen. Across all arms, no baseline predictors of response were identified, and all treatments were well-tolerated, supporting the safety of both HA and autologous AdMSCs in this phase IIb trial.

"Most [patients] are doing the reasonably well with conservative treatment, but a significant proportion of the patients, they do not respond to the conservative treatment, which includes painkillers, lifestyle modification, including weight reduction, therapeutic exercise, physical therapies... even though they show modification, still, then they do not respond well and live with pain and functional limitations," Khasru said in an interview with HCPLive, where he sat down with his coinvestigator Mahbuba Shirin, MD, Professor, Mahbuba Shirin Department of Radiology and Imaging, Bangladesh Medical University, Dhaka, Bangladesh.

Khasru had no relevant disclosures to report.

Reference

Khasru MR, Islam MT, Jubery AGMZN, et al.Adipose-Tissue Derived Mesenchymal Stem Cells vs Hyaluronic Acid in Refractory Knee Osteoarthritis in a low-resource setting: A Phase IIb RCT. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Abstract #LB07