No evidence for the use of stem cell therapy for tendon disorders: a systematic review

Pas, Haiko I M F L; Moen, Maarten H.; Haisma, Hidde J.; Winters, Marinus

doi:10.1136/bjsports-2016-096794

Cited by 58 publications

(39 citation statements)

References 65 publications

(118 reference statements)

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“…In addition, several experimental studies showed that AD MSCs prevented progression of tendon degeneration , increased the tensile strength and type I collagen in tendon repair , decreased fatty infiltration of muscle after repair , decreased tendon defects in human lateral epicondylosis , and reduced the re‐injury rate in race horses . While a recent systematic review reported no evidence for the use of stem cell therapy for tendon disorders currently , all of the two studies for rotator cuff tear in this review actually did not use MSCs, but use bone marrow mononuclear cells between which there should be a huge gap. We find no clinical trial using injection of AD MSCs for rotator cuff disease in the literature so far.…”

Section: Discussionmentioning

confidence: 88%

Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial

et al. 2018

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Despite relatively good results of current symptomatic treatments for rotator cuff disease, there has been an unmet need for fundamental treatments to halt or reverse the progress of disease. The purpose of this study was to assess the safety and efficacy of intratendinous injection of autologous adipose tissue-derived mesenchymal stem cells (AD MSCs) in patients with rotator cuff disease. The first part of the study consists of three dose-escalation cohorts; the low- (1.0 × 10 cells), mid- (5.0 × 10 ), and high-dose (1.0 × 10 ) groups with three patients each for the evaluation of the safety and tolerability. The second part included nine patients receiving the high-dose for the evaluation of the exploratory efficacy. The primary outcomes were the safety and the shoulder pain and disability index (SPADI). Secondary outcomes included clinical, radiological, and arthroscopic evaluations. Twenty patients were enrolled in the study, and two patients were excluded. Intratendinous injection of AD MSCs was not associated with adverse events. It significantly decreased the SPADI scores by 80% and 77% in the mid- and high-dose groups, respectively. Shoulder pain was significantly alleviated by 71% in the high-dose group. Magnetic resonance imaging examination showed that volume of the bursal-side defect significantly decreased by 90% in the high-dose group. Arthroscopic examination demonstrated that volume of the articular- and bursal-side defects decreased by 83% and 90% in the mid- and high-dose groups, respectively. Intratendinous injection of autologous AD MSCs in patient with a partial-thickness rotator cuff tear did not cause adverse events, but improved shoulder function, and relieved pain through regeneration of rotator cuff tendon. Stem Cells 2018;36:1441-1450.

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Section: Discussionmentioning

confidence: 88%

Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial

et al. 2018

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“…Preclinical studies for tissue‐engineered repair of cartilage and bone have been quite promising, but most clinical procedures either lack controls or have shown long‐term results that are equivocal to standard‐of‐care . Similarly, stem cell therapies have shown significant promise in controlled preclinical animal studies, but have not shown consistent clinical efficacy in prospective and randomized trials …”

Section: Stem Cell Research and Therapy In Orthopedicsmentioning

confidence: 99%

“…17,18 Similarly, stem cell therapies have shown significant promise in controlled preclinical animal studies, [19][20][21] but have not shown consistent clinical efficacy in prospective and randomized trials. [22][23][24] Despite the lack of clear evidence to support these "stem cell" therapies, numerous clinics continue to offer unproven procedures in the United States, with an unknown number of such clinics outside the United States offering various cell therapies as medical tourism. Not only do many of these procedures not involve actual stem cells, there have been a number of serious adverse effects that have been documented due to unproven stem cell therapies, 25 including growth of a mucus-producing nose in the spine, 26 tumor formation, 27 blindness, 28 and infection.…”

Section: Stem Cell Research and Therapy In Orthopedicsmentioning

confidence: 99%

Designer Stem Cells: Genome Engineering and the Next Generation of Cell‐Based Therapies

Guilak

Pferdehirt

Ross

et al. 2019

Journal Orthopaedic Research

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Stem cells provide tremendous promise for the development of new therapeutic approaches for musculoskeletal conditions. In addition to their multipotency, certain types of stem cells exhibit immunomodulatory effects that can mitigate inflammation and enhance tissue repair. However, the translation of stem cell therapies to clinical practice has proven difficult due to challenges in intradonor and interdonor variability, engraftment, variability in recipient microenvironment and patient indications, and limited therapeutic biological activity. In this regard, the success of stem cell‐based therapies may benefit from cellular engineering approaches to enhance factors such as purification, homing and cell survival, trophic effects, or immunomodulatory signaling. By combining recent advances in gene editing, synthetic biology, and tissue engineering, the potential exists to create new classes of “designer” cells that have prescribed cell‐surface molecules and receptors as well as synthetic gene circuits that provide for autoregulated drug delivery or enhanced tissue repair. Published by Wiley Periodicals, Inc. J Orthop Res 37:1287–1293, 2019.

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“…Preclinical research supports the efficacy of MSC in tendon and articular conditions based on the anti-inflammatory and anti-catabolic effect of these therapies. However, current data derived from clinical research are insufficient to establish specific indications and recommendations [60,61]. In fact, media and direct internet marketing have raised expectations around regenerative sports medicine claiming that MSC therapies accelerate return to play without surgery in elite athletes.…”

Section: Are There Research Evidences For Optimal Decision-making?mentioning

confidence: 99%

How far have biological therapies come in regenerative sports medicine?

Andı́a

Maffulli

2018

Expert Opinion on Biological Therapy

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Regular engagement in sports produces many health benefits, but also exposes to increased injury risk. The quality of medical care available is crucial not only for sports trauma but also to avoid overuse syndromes and post-traumatic degenerative conditions. Areas covered: We provide background information on some clinical needs in sport injuries and describe the main families of biological products used in clinical practice. We also discuss limitations of the current clinical experience. Expert opinion: Sport and exercise impairment affects different segments of the population with different needs. The exceptional demands of elite athletes and subsequent media coverage have created hype around regenerative therapies. Statistical evidence, whether weak (cell products) or moderate (PRPs), is not enough to drive medical decisions because of the heterogeneity of the biological products available and their application procedures. Moreover, the specific needs of the different segments of the population along with the available clinical evidence for each musculoskeletal condition should be considered in the decision-making process. There is urgent need to develop regenerative protocols combined with post-intervention rehabilitation, and gather meaningful clinical data on the safety and efficacy of these interventions in the different populations segments.

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No evidence for the use of stem cell therapy for tendon disorders: a systematic review

Cited by 58 publications

References 65 publications

Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial

Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial

Designer Stem Cells: Genome Engineering and the Next Generation of Cell‐Based Therapies

How far have biological therapies come in regenerative sports medicine?

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