Background: Acute graft-versus-host disease (aGvHD) is a condition in which donor T cells, in response to recipient alloantigens, cause dysregulation of the cytokine cascade and act cytotoxicly on recipient tissues. It represents one of the most common, in certain cases even life-threatening complications after allogeneic hematopoietic stem cell transplantation. Chronic inflammatory bowel diseases (IBD) are recurrent lifelong pathological conditions in which activated immune cells and inflammatory cytokines cause intestinal tissue damage and an abnormal systemic immune response. The results of many studies have shown a high level of efficiency and safety of mesenchymal/stromal stem cells (MSC) in the treatment of tissue damage and regulation of the immune response, mainly due to their immunomodulatory as well as multipotent regenerative properties. Particularly important here is their ability to target damaged tissues, where they then produce anti-inflammatory paracrine factors. The aim of our work was to confirm the safety and effectiveness of MSC treatment through a systematic review of published research and a meta-analysis of their results.
Methods: We conducted a systematic review of the literature in accessible online databases. From the obtained results, according to previously defined criteria, we selected studies with control groups, case series, and individual case reports. Both adult and pediatric patient populations were included in the selected studies. Meta-analyses were performed using the software Review Manager 5.4, and the results were presented in the form of tree diagrams.
Results: In the meta-analysis of the results of clinical studies with a control group, we included 4 studies in the case of aGvHD and 5 studies in the case of IBD. We were able to demonstrate a statistically significant reduction in mortality in patients who received MSCs for the treatment of aGvHD, while comparisons of other selected parameters did not show statistically significant differences. We also failed to demonstrate statistically significant differences when comparing various parameters in the case of IBD treatment with MSCs. Also important is the fact that, due to the heterogeneity of the research, we could not include all of them in the meta-analysis of each individual parameter.
Conclusion: MSC therapies can undoubtedly help in the treatment of aGvHD and IBD. However, it is important to highlight the fact that the condition of the patients has a significant impact on the determination of the doses of the cellular drug and the way in which they are administered, which is particularly noticeable in the case of IBD.
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