Cell therapy based on the trophic, mitogenic, and immunomodulatory capacity of mesenchymal stem cells is a promising treatment modality for degenerative musculoskeletal conditions. Local anesthetics have been commonly used in interventional procedures for alleviating pain, but local anesthetics may have negative impact on MSC dosing because of cytotoxicity or other biological effects. Because previous studies have not reached consensus yet on the potential complications of local anesthetics in cell therapy, we reviewed 11 studies that involve in vitro experimentation with MSCs using aminoamide-type anesthetics including lidocaine, ropivacaine, mepivacaine, bupivacaine, articaine, and prilocaine. Three studies that compare the effects of different types of local anesthetic agents showed that ropivacaine has the least detrimental effects on mesenchymal stem cell populations, whereas lidocaine seems to have the most significant effects on stem cell viability. Concentration- and time-dependent effects on cell viability were reported with bupivacaine, ropivacaine, lidocaine, and mepivacaine. We conclude that local anesthetic agents have time- and concentration-dependent detrimental effects on MSCs. However, in vivo studies will be required to understand the interactions of these agents with MSCs, because in vitro studies cannot replicate the pharmacokinetics of anesthetics in vivo or the recovery of MSCs in a more physiological environment.
From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (TW, JS, WQ); Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota (HN, AJvW); Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (ZW); Medical Library, Mayo Clinic, Rochester, Minnesota (PJE); Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota (WQ); and Spine Center, Mayo Clinic, Rochester, Minnesota (WQ).
All correspondence and requests for reprints should be addressed to: Wenchun Qu, MD, PhD, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Mayo Building 14-03, 200 First Street SW, Rochester, MN 55905; Andre J. van Wijnen, PhD, Department of Orthopedic Surgery, Mayo Clinic, Medical Sciences Building 3-69, 200 First Street SW, Rochester, MN 55905.
This study was supported by the generous philanthropic support of William and Karen Eby and funding by National Institutes of Health through National Institute of Arthritis and Musculoskeletal and Skin Diseases Grant Number R01 AR049069 (to AJvW).
Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.