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, experts say.

The comments come in response to the recent 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 David Hunter a consultant rheumatologist at North Sydney Orthopaedic and Sports Medicine Centre said he believed there were a number of rheumatologists who were “appropriately concerned about the widespread use of these therapies in clinical practice.”

“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.

Leading gene and stem cell expert Professor John Rasko who has extensively reviewed the literature on the topic agrees that there is no evidence to suggest the use of mesenchymal stem/stromal cell therapies improves joint injuries or conditions.

“It may have some utility in the future but that will require rigorous investigation to support its use,” he told the limbic.

“In the mean time there are people who have never done any research or background in this field who are simply offering false hope to people and charging a large amount of money,” he said.

It’s a difficult situation for clinicians to be in says Professor Rasko who is a clinical haematologist and Head of Cell and Molecular Therapies at the Royal Prince Alfred Hospital in Sydney.

Particularly for rheumatologists and orthopaedic surgeons who are most likely bearing the brunt of enquiries from patients.

“The challenge is to have to explain to people that the marketing is simply false… I would challenge anybody to produce data that proves that any of these cell based therapies that they are actively promoting show efficacy,” he said.

“We certainly shouldn’t be charging patients for having what is clearly premature cell based interventions that currently have no evidence they do anything,” he said.

 

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