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.
- 13.Castro-Manrreza ME, Montesinos JJ (2015) Immunoregulation by mesenchymal stem cells: biological aspects and clinical applications. J Immunol Res 2015:394917Google Scholar
- 19.Wong KL, Lee KB, Tai BC et al (2013) Injectable cultured bone marrow-derived mesenchymal stem cells in varus knees with cartilage defects undergoing high tibial osteotomy: a prospective, randomized controlled clinical trial with 2 years’ follow-up. Arthroscopy 29:2020–2028CrossRefPubMedGoogle Scholar
- 36.Kristjánsson B, Honsawek S (2014) Current perspectives in mesenchymal stem cell therapies for osteoarthritis. Stem Cells Int 2014:194318Google Scholar
- 38.Tan YH, Jiang MM, Yu HY et al (2013) Therapeutic effect of arthroscopy combined with autologous bone marrow stem cell grafting on knee osteoarthritis. J Trad 25(10):35–38Google Scholar
- 41.Akgun I, Unlu MC, Erdal OA et al (2015) Matrix-induced autologous mesenchymal stem cell implantation versus matrix-induced autologous chondrocyte implantation in the treatment of chondral defects of the knee: a 2-year randomized study. Arch Orthop Trauma Surg 135(2):251–263CrossRefPubMedGoogle Scholar
- 42.Liang HS, Huang K, Lin L et al (2015) Arthroscopic microfracture surgery combined with autologous bone marrow mesenchymal stem cells transplant in the treatment of knee cartilage defect. Chin J Mod Drug App 9(9):1–3Google Scholar
- 43.Lv XX, Huang C, Yin Z et al (2015) Effectiveness of autologous bone marrow mesenchymal stem cell transplant for knee osteoarthritis. Chin J Cell Stem Cell 5(2):28–32Google Scholar
- 46.Gan FY, Tang C, Guo DB et al (2014) The treatment of mesenchymal stem cell transplantation for knee osteoarthritis: a clinical observation study. Modern Diagn Treat 1(15):3512–3513Google Scholar
- 52.Turajane T, Chaweewannakorn U, Larbpaiboonpong V et al (2013) Combination of intra-articular autologous activated peripheral blood stem cells with growth factor addition/ preservation and hyaluronic acid in conjunction with arthroscopic microdrilling mesenchymal cell stimulation Improves quality of life and regenerates articular cartilage in early osteoarthritic knee disease. J Med Assoc Thai 96(5):580–588PubMedGoogle Scholar