RT Journal Article SR Electronic T1 Effect of Stem Cell Injections on Osteoarthritis-related Structural Outcomes: A Systematic Review JF The Journal of Rheumatology JO J Rheumatol FD The Journal of Rheumatology SP 585 OP 597 DO 10.3899/jrheum.200021 VO 48 IS 4 A1 Jennifer Gong A1 Jessica Fairley A1 Flavia M. Cicuttini A1 Sultana Monira Hussain A1 Rakhi Vashishtha A1 Louisa Chou A1 Anita E. Wluka A1 Yuanyuan Wang YR 2021 UL http://www.jrheum.org/content/48/4/585.abstract AB Objective To systematically review the evidence for the efficacy of mesenchymal stem cell (MSC) injections in improving osteoarthritis (OA)-related structural outcomes.Methods Ovid Medline and EMBASE were searched from their inceptions 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 of interventions and outcome measures.Results Thirteen randomized controlled trials (phase I or II) were identified: 10 in OA populations and 3 in populations at risk of OA, with low (n = 9), moderate (n = 3), or high (n = 1) risk of bias. Seven studies used allogeneic MSCs (4 bone marrow, 1 umbilical cord, 1 placenta, 1 adipose tissue), 6 studies used autologous MSCs (3 adipose tissue, 2 bone marrow, 1 peripheral blood). Among the 11 studies examining cartilage outcomes, 10 found 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 in all 3 studies in populations at risk of OA, showing beneficial effects. Sixteen unpublished, eligible trials were identified by searching trial registries, including 8 with actual or estimated completion dates before 2016.Conclusion Our systematic review of early-phase clinical trials demonstrated consistent evidence of a beneficial effect of intraarticular 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 OA.