Multi-omics data fusion reveals divergent molecular signatures of intra-articular micro-fragmented adipose tissue and hyaluronic acid treatment in inflammatory-phenotype knee osteoarthritis

Knee osteoarthritis (KOA) affects an estimated 374 million people worldwide and has no approved disease-modifying treatment. Intra-articular micro-fragmented adipose tissue (MFAT) outperformed hyaluronic acid (HA) on patient-reported outcomes in our recent double-blind randomized trial (ISRCTN88966184), yet the molecular basis of this differential efficacy is unknown, and the two interventions have not previously been compared at the level of their in vivo molecular response in human KOA. Here we apply an interpretable artificial-intelligence data-fusion framework, based on non-negative matrix tri-factorization, to longitudinally collected plasma from this cohort, integrating proteomics, N-glycomics, miRNA transcriptomics and patient genetics with prior protein-protein and miRNA-gene regulatory networks at baseline, one and six months. The framework jointly decomposes all data modalities at each timepoint into shared, interpretable factors, from which we derive data-driven pathways of genes and of miRNAs and recover new patient-gene and patient-miRNA associations. These pathways were biologically coherent, showing significant enrichment in Gene Ontology Biological Process and Reactome Pathway annotations. By six months, the two treatments left clearly distinct molecular signatures: HA remained dominated by canonical OA pathogenic processes, including cartilage-degrading effectors such as MMP13 and LIMK2 and markers of synovial inflammation, whereas MFAT shifted the systemic landscape toward chondroprotection, anti-inflammatory signalling and bone-cartilage homeostasis, with prioritized effectors including SIRT7 and NDUFC1. To our knowledge, these are the first systems-level molecular data directly comparing the in vivo response to the two treatments in human KOA, providing initial evidence that MFAT acts as a disease-modifying intervention and demonstrating the value of interpretable data fusion for uncovering treatment mechanisms in small translational cohorts.