Osteoarthritis Cartilage. 2018 Apr;26(4):445-461. doi: 10.1016/j.joca.2018.01.010. Epub 2018 Feb 8.
Intra-articular injection of mesenchymal stem cells in treating knee osteoarthritis: a systematic review of animal studies.
Xing D1, Kwong J2, Yang Z1, Hou Y1, Zhang W1, Ma B3, Lin J4.
Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China; Arthritis Institute, Peking University, Beijing, China.
Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Gansu, China; Chinese GRADE Center, Gansu, China. Electronic address: firstname.lastname@example.org.
Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China; Arthritis Institute, Peking University, Beijing, China. Electronic address: email@example.com.
Mesenchymal stem cells (MSCs) injection has emerged as a novel treatment for knee osteoarthritis (KOA) but with inconsistent results in the experimental studies. Thus, the purpose of the present study is to evaluate the preclinical animal studies of MSCs injection for KOA and to determine the evidence for a role for MSCs in further clinical trials.
A systematic search of KOA animal studies published through Aug 2017 was conducted using the PubMed, Embase and Web of science. Criteria for eligibility were animal studies assessing the therapeutic effects of MSCs intra-articular injection to animals with KOA. The methodological quality of included studies was assessed by the SYRCLE tool for assessing risk of bias in animal intervention studies. Descriptive synthesis was performed. Evidence quality was evaluated based on the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool.
Twenty-three KOA animal studies were eligible for inclusion. According to the SYRCLE's tool, all included studies had high risk of bias. Between-study heterogeneity was substantial. The included studies varied in terms of species, modeling methods, MSCs origin, treatment timing, injections frequency, transplantation type and dose of MSCs. The following outcomes, gross morphology, histological analysis, immunohistochemical analysis, radiological evaluation or behavior analysis, were reported in the primary studies. For all outcomes, the evidence quality was low or very low.
We do not have absolute confidence to recommend use MSCs injection for KOA clinical trials. Based on the internal and external validity of current animal studies, high quality experimental studies and efforts for effective translation from preclinical studies to clinical trials are still required.