Research Progress on the Prevention and Treatment of Osteoarthritis with Mesenchymal Stem Cells

Osteoarthritis (OA) is characterized by degeneration of joint cartilage and inflammation of the synovium. Current drugs or surgeries only provide symptomatic treatment and cannot reverse cartilage damage. Moreover, long-term use of these treatments carries a high risk of cardiovascular problems. Mesenchymal stem cells (MSCs) can differentiate in situ into chondrocytes and secrete bioactive factors such as exosomes. By virtue of their self-renewal, multipotent differentiation and paracrine properties, they directly promote chondrocyte proliferation, inhibits apoptosis and matrix degradation, thereby restoring cartilage homeostasis. Furthermore, exosomal delivery of miRNAs and mRNAs repairs mitochondrial damage, induces M2 macrophage polarization, balances pro- and anti-inflammatory cytokines, and modulates autophagy, thereby reshaping the immune microenvironment. This review summarizes recent advances in the use of MSCs to retard osteoarthritis progression and mitigate pain, providing new insights for the development of safe, effective, and non-invasive cell-based and cell-free therapeutic strategies.