Warning over stem cell therapy for musculoskeletal diseases

The use of mesenchymal stem cell therapies in clinical practice without a solid scientific evidence base has the potential to risk patient safety and the credibility of the medical profession, says a leading rheumatologist.

Professor David Hunter, Professor of Medicine at University of Sydney and the Royal North Shore Hospital and Consultant Rheumatologist at North Sydney Orthopaedic and Sports Medicine Centre, has welcomed the release of a position statement from the Australian College of Sports Physicians on the use of mesenchymal stem/stromal cell therapies in the Clinical Journal of Sports Medicine .

The statement backs away from supporting the therapy, saying there is currently insufficient evidence to support the use of autologous MSCs for the treatment of musculoskeletal conditions.

Its application in this area is “currently unproven and therefore has not yet been determined to be safe or efficacious for clinical use,” the position statement says.

A lack of credible long-term data to support clinical application meant robust clinical trials with rigorous long-term follow-up were required.

There was also a need to protect patients from known and as yet unknown harms arising from new and unproven interventions, the statement noted.

“Not only must we consider the potential harms to an individual patient or research participant, but harms to the integrity of the medical profession and erosion of public trust in medical research,” it said.

Professor Hunter said he believed there were a number of rheumatologists who were “appropriately concerned about the widespread use of these therapies in clinical practice and would be supportive of the position statement.”

“This position statement is important as there are a number of health professionals (sports physicians highly represented among them) who are using stem cell therapy widely, particularly in an osteoarthritis context,” he told the limbic.

“The recommendations made by the statement are appropriately cautious-recommending further investigation and evidence before widespread clinical use. Unfortunately at present, clinical practice is running way ahead of the scientific evidence base potentially to the detriment of patient safety and the credibility of the medical profession.”

He said it was very early days in the investigation into the use of MSCs for OA treatment, although so far there was no substantive or robust data to support stem cell use in this context.

“It may have so in the future but that will require rigorous investigation to support its use,” he said.

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