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Review
. 2023 Jan 20;27(1):31.
doi: 10.1186/s13054-022-04287-4.

The safety and efficacy of mesenchymal stromal cells in ARDS: a meta-analysis of randomized controlled trials

Fengyun Wang #  1   2 , Yiming Li #  1   2 , Bingqing Wang  1   2 , Jianguo Li  1   2 , Zhiyong Peng  3   4   5
Affiliations
Review

The safety and efficacy of mesenchymal stromal cells in ARDS: a meta-analysis of randomized controlled trials

Fengyun Wang et al. Crit Care. .

Abstract

Mesenchymal stromal cells (MSC) have shown potential efficacy in both animal and human trials of acute respiratory distress syndrome (ARDS). Especially during the COVID-19 pandemic, MSC was intensely studied for treating COVID-19-induced ARDS. The purpose of this study is to evaluate the safety and efficacy of MSC in ARDS via a meta-analysis of randomized controlled trials (RCTs). Therefore, a meta-analysis of RCTs of MSC as a therapy for ARDS was conducted. The protocol of this review was registered on Open Science Framework. With no language restriction and according to the "PICOs" principle, searches were conducted on Pubmed and Embase to retrieve any clinical literature on MSC for ARDS. Any RCT, which compared MSC to controls for ARDS, where MSC and controls were intravenously infused, of any dosage, was eligible for inclusion. A total of 13 RCTs, which evaluated MSC versus control for treating ARDS, enrolling a total of 655 cases, met the inclusion criteria and appeared in this meta-analysis. A heterogeneity assessment was carried out using the χ2 test, where a P value less than 0.05 was considered significant. The choice of a fixed-effect or a random-effect model was decided by the I2 value in each of the analyses. This meta-analysis indicated that there was no significant difference in terms of adverse events between MSC and control for ARDS (OR = 0.64, 95% CI [0.34, 1.20], P = 0.17, and I2 = 0%). In comparison with control, MSC could reduce the mortality of ARDS (OR = 0.66, 95% CI [0.46, 0.96], P = 0.03, and I2 = 10%). Based on the results of our meta-analysis, the safety of MSC was demonstrated to be non-inferior to that of standard treatment, and MSC may reduce the mortality rate of ARDS. Though the heterogeneity in the main results was low (I2 < 25%), more high-quality and large-scale clinical trials are needed to further confirm our findings.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Cell transplantation; Coronavirus disease 2019; Mesenchymal stromal cells.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The flow diagram of the literature search process
Fig. 2
Fig. 2
The meta-analyses of adverse events, comparing MSC with the control: A the comparison of MSC with control in general ARDS; B the comparison of MSC with control in COVID-19-induced ARDS. The size of each square represents the proportion of information given by each trial. Crossing with the vertical line suggests no difference between the two groups
Fig. 3
Fig. 3
The meta-analyses of mortality, comparing MSC with the control: A the comparison of MSC with control in general ARDS; B the comparison of MSC with control in COVID-19-induced ARDS. The size of each square represents the proportion of information given by each trial. Crossing with the vertical line suggests no difference between the two groups
Fig. 4
Fig. 4
The assessment of possible bias: A The risk of bias summary graph: review authors' judgements about each risk of bias item for each included study. B The funnel plot for adverse events. C The funnel plot for mortality
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References

    1. Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–2533. - PubMed
    1. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315:788–800. doi: 10.1001/jama.2016.0291. - DOI - PubMed
    1. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338:347–354. doi: 10.1056/NEJM199802053380602. - DOI - PubMed
    1. Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015;372:747–755. doi: 10.1056/NEJMsa1410639. - DOI - PubMed
    1. Mancebo J, Fernandez R, Blanch L, et al. A multicenter trial of prolonged prone ventilation in severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;173:1233–1239. doi: 10.1164/rccm.200503-353OC. - DOI - PubMed