Mesenchymal stem cells injections for knee osteoarthritis: a systematic overview
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Numerous systematic reviews investigating the effects of mesenchymal stem cells (MSCs) in treating knee osteoarthritis (OA) have been published with controversial conclusion. The purpose of the overview was (1) to perform an overview of systematic reviews investigating MSCs for knee OA and (2) to synthesize evidence qualitatively to assess confidence in the review findings. A systematic search of systematic reviews published through Aug 2017 was conducted using the MEDLINE, EMBASE and Cochrane Library. The methodological quality and risk of bias of included systematic reviews was assessed by AMSTAR instrument and ROBIS tool, respectively. Best evidence choice procedure was conducted according to the Jadad decision algorithm. The systematic reviews with high methodological quality and low risk of bias were selected ultimately for further evidence synthesis based on the CERQual tool. Four systematic reviews were eligible for inclusion. According to the ROBIS tool, there was one systematic review with low risk of bias and three with high risk of bias. Thus, only one systematic review conducted by Pas et al. with highest AMSTAR score and low risk of bias was selected. For all outcomes after evidence synthesis via the CERQual tool, confidence for decision making was either low (self-reported measurement and MRI/histological outcome) or moderate (adverse events). The present study demonstrates that moderate confidence could be placed in safety of MSCs therapy for knee OA, but with low confidence in efficacy outcomes due to limitations of the current evidence. Further high-quality studies with high internal and external validity are still required.
KeywordsMesenchymal stem cell Knee osteoarthritis CERQual Overview ROBIS
The authors thank Professor Joey Kwong from Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan for her great advice on methodology in interpreting the evidence. We also thank Professor Wei Liu from Department of Biomedical Engineering, School of Medicine, Tsinghua University for his sharing knowledge about basic research in mesenchymal stem cells.
Project conceptualization: D Xing and JH Lin. Study design: D Xing, Q Wang and JH Lin. Data collection/validation: D Xing, Q Wang, ZY Yang and JH Lin. Data analysis: D Xing, Q Wang and YF Hou. Result interpretation: D Xing, Q Wang, Q Liu and YF Hou. Reporting & editing: D Xing, YF Hou and W Zhang. Final approval of the version to be submitted: D Xing, Q Wang and JH Lin. Project guarantor: YL Chen and JH Lin.
Compliance with ethical standards
This study was supported by grants from the National Natural Science Foundation of China (No. 81501919) and Peking University People's Hospital Scientific Research Development Funds (No. RDH2017-05).
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
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