TY - JOUR T1 - Effect of stem cell injections on osteoarthritis-related structural outcomes - a systematic review JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.200021 SP - jrheum.200021 AU - Jennifer Gong AU - Jessica Fairley AU - Flavia M. Cicuttini AU - Sultana Monira Hussain AU - Rakhi Vashishtha AU - Louisa Chou AU - Anita E. Wluka AU - Yuanyuan Wang Y1 - 2020/10/01 UR - http://www.jrheum.org/content/early/2020/09/28/jrheum.200021.abstract N2 - Objective To systematically review the evidence for the efficacy of mesenchymal stem cell (MSC) injections in improving osteoarthritis-related structural outcomes. Methods Ovid Medline and EMBASE were searched from their inception to April 2020 using MeSH terms and key words. Independent reviewers extracted data and assessed methodological quality. Qualitative evidence synthesis was performed due to the heterogeneity in interventions and outcome measures. Results Thirteen randomised controlled trials (phase I or II) were identified, 10 in osteoarthritis populations and three in populations at risk of osteoarthritis, with low (n=9), moderate (n=3) or high (n=1) risk of bias. Seven studies used allogeneic MSCs (bone marrow 4; umbilical cord 1; placenta 1; adipose tissue 1), six studies used autologous MSCs (adipose tissue 3; bone marrow 2; peripheral blood 1). Among the 11 studies examining cartilage outcomes, 10 studies showed a benefit of MSCs on cartilage volume, morphology, quality, regeneration and repair assessed by magnetic resonance imaging, arthroscopy, or histology. The evidence for subchondral bone was consistent with all three studies in populations at risk of osteoarthritis showing beneficial effects. Sixteen unpublished, eligible trials were identified by searching trial registries, eight with actual or estimated completion date before 2016. Conclusion This systematic review of early phase clinical trials showed consistent evidence for a beneficial effect of intra-articular MSC injections on articular cartilage and subchondral bone. Due to the heterogeneity of MSCs, modest sample sizes, methodological limitations, and potential for publication bias, further work is needed before this therapy is recommended in the management of osteoarthritis. ER -