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Review
. 2021 Aug 21;12(1):469.
doi: 10.1186/s13287-021-02542-z.

Mesenchymal stem cell-based therapy and exosomes in COVID-19: current trends and prospects

Mai Abdelgawad #  1 , Nourhan Saied Bakry #  1 , Ahmed A Farghali  2 , Ahmed Abdel-Latif  3   4 , Ahmed Lotfy  5
Affiliations
Review

Mesenchymal stem cell-based therapy and exosomes in COVID-19: current trends and prospects

Mai Abdelgawad et al. Stem Cell Res Ther. .

Abstract

Novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2. The virus causes an exaggerated immune response, resulting in a cytokine storm and acute respiratory distress syndrome, the leading cause of COVID-19-related mortality and morbidity. So far, no therapies have succeeded in circumventing the exacerbated immune response or cytokine storm associated with COVID-19. Mesenchymal stem cells (MSCs), through their immunomodulatory and regenerative activities, mostly mediated by their paracrine effect and extracellular vesicle production, have therapeutic potential in many autoimmune, inflammatory, and degenerative diseases. In this paper, we review clinical studies on the use of MSCs for COVID-19 treatment, including the salutary effects of MSCs on the pathophysiology of COVID-19 and the immunomodulation of the cytokine storm. Ongoing clinical trial designs, cell sources, dose and administration, and populations are summarized, and the paracrine mode of benefit is discussed. We also offer suggestions for optimizing MSC-based therapies, including genetic engineering, strategies for cell surface modification, nanotechnology applications, and combination therapies.

Keywords: COVID-19; Cytokine storm; Exosomes; Immunomodulation; Mesenchymal stem cell; Mesenchymal stromal cell; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The immunomodulatory role of MSCs in COVID-19. Schematic showing the cytokine storm produced as a consequence of SARS-CoV-2 infection with clarification of the immunomodulatory role of the administrated MSCs in the inflamed lung tissue. The cytokine storm is formed via inflammatory signaling and cytokines and chemokines recruitment. Also, macrophages, dendritic cells and monocytes are activated, leading to severe inflammation, and tissue dysfunction. After MSCs administration, MSCs migrate to the affected tissue and significant secretions of immunomodulatory biomolecules, and cytokines are observed. MSCs can be employed to reduce the produced inflammation via contact-dependent process and paracrine factors’ secretion
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