Background: Despite constant advances in the supportive care of patients with acute respiratory distress syndrome, their mortality rate is still very high. This pathology is defined by severe lung damage characterized by failure of oxygenation and hypoxemia, pulmonary oedema, and then multiorgan failure. It is most often the result of viral or bacterial infections, which lead to a delayed immune response or. cytokine storms. Research has shown that mesenchymal / stromal stem cells regulate immune responses, improve lung epithelial and endothelial regeneration, promote microbial clearance and alveolar fluid clearance, and thus contribute to improved lung, distal organ function, and patient survival. To confirm the efficacy and safety of this type of cell therapy, we performed a systematic review and meta-analysis with studies published so far.
Methods: A systematic review of the literature was performed using the free bibliographic online databases MEDLINE, Clinicaltrials.gov, the EU Clinical trials register and Google Scholar. We selected studies where mesenchymal/ stromal stem cells or their exosomes were used to treat acute respiratory distress syndrome and COVID-19 disease. We did not define the plan of the included studies, nor did we set any restrictions on standard patient care and the method of cell therapy application. Using data obtained from clinical trials with a control group, we performed a meta-analysis using the RevMan program.
Results: With a systematic review, we obtained one already performed meta-analysis and a total of 16 studies. Of these, 5 were clinical trials with a control group, 2 with dose escalation, 6 case series and 3 case reports. Meta-analysis showed a reduction in mortality in patients with acute respiratory distress syndrome and COVID-19 disease in the experimental group, compared with the control group, RR = 0,43, 95% CI (0.22-0.85). We did not prove statistically significant differences in the number of intensive care free days and ventilator free days between the groups. We also did not demonstrate differences in the efficacy of the different doses of cellular preparations used. None of the studies we obtained reported the occurrence of serious adverse effects associated with cell therapy. In all studies where the concentrations of soluble inflammatory factors were monitored, a decrease in their concentrations was demonstrated but meta-analysis was not possible due to the heterogeneity of the studies.
Conclusion: The obtained results confirm the safety of the use of mesenchymal/ stromal stem cells and indicate the effectiveness of this type of treatment for acute respiratory distress and COVID-19.
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