Page 95 - Mesenchymal Stem cells, Exosomes and vitamins in the fight aginst COVID

Pain Physician: August 2020 COVID-19 Special Issue 23:S391-S420

A total of 16 studies , many of
stem cells; UC MSC, umbilical cord mesenchymal stem cells; PVI, portal vein injection; IV, intravenous injection; HAI, hepatic artery injection; CLD, chronic liver disease; PBC, primary biliary
cholangitis; ESLD, end-stage liver disease; AFP, alpha-fetoprotein; PCNA, proliferating cell nuclear antigen; P111P, procollagen-III peptide; LFT, liver function test; MELD, Model for End-Stage
antibodies; TB, mycobacterium tuberculosis; ABMSC, autologous bone marrow stem cells; Treg/Th17, T regulatory cell/ T helper 17 cell; IL6, interleukin 6; IL 17, interleukin 17; TNF-α, tumor
necrosis factor-alpha; pre-ALB, pre-albumin blood test; HGB, hemoglobin; PBS, (L17); AST, aspartate aminotransferase; IgM, serum immunoglobulins; DBIL, (L17); IL10, interleukin 10; PTT,
alkaline phosphatase; MRS, Mayo risk score; PTA, percutaneous transluminal angioplasty; ALT, alanine transaminase; TGF-b1, transforming growth factor-beta; a-SMA, alpha-smooth muscle
Liver Disease; INR, international normalized ratio; TBIL, bilirubin; PT, prothrombin time; ALB, albumin blood test; CP, ceruloplasmin test; CHE, serum cholinesterase; PLTS, platelets; ALP,
which are RCTs, have assessed the
PCT, prospective controlled trial; NA, not applicable; BM MNC, bone marrow mononuclear cells; BM MSC, bone marrow mesenchymal stem cells; WJ MSC, Wharton's jelly mesenchymal
partial thromboplastin time; Cr, creatinine; WBC, white blood cells; GGT, gamma-glutamyl transferase, BMA, Bone marrow aspirate; SC, stem cells; Pas, passage number; HCV, hepatitis C
Decrease in bilirubin and MELD and Bilirubin decreased up to 1 year. ALB increased for 2 years. PT lowered for 6 change in MELD. ALB increased for 1 year. TB no change. PT improved for 9 months. HGB and and in 5 IA. All studies evaluated
treat cerebral strokes of ischemic
and nonischemic etiology. These
Findings decreased incidence of infection with higher months. PLT CT increased for 4 years. No Child Pugh score improved for 12 months. Increase in liver volume at 6 months along with decreased portal/septal/fibrillar tissue ability of intravascular stem cells to
are tabulated in Table 4. In 10 trials,
MSCs were infused intravenously
the efficacy of MSCs in ischemic
survival rates.
stroke, except one that was in
collagen.
hemorrhagic stroke. Cultured bone
marrow MSCs and nonexpanded
bone marrow mononuclear cells
Condition Acute on chronic liver failure Cirrhosis Cirrhosis were used in 6 studies each; one
study used both. One study utilized
umbilical cord MSCs. Ten of the 15
studies showed improved neuro-
Follow-Up (months) neurofunctional tests. Five of the
logic functions, many measured by
15 trials showed improvement in
60
24
6
National Institutes of Health Stroke
Result Yes Yes Yes Scale, 4 out of the 15 trials showed
improvement in Barthel index and
modified Rankin score. Some trials
Delivery Method have shown measurable increase in
modulatory cells or trophic factors
IV
IV
IV
in the treated patients. No clinical
Type of Stem Cell BM MSC (Pas 5–6) Mostly UC MSC (Pas 2–5) BM MNC response was seen in 6 studies, and
nonexpanded bone marrow mono-
nuclear cells were used in most of
Number of SC 0.1–1 million/kg x 4 1 million/ kg 92 million/ kg these trials. There were no serious
adverse effects that were noticed
during the postprocedural period
on these patients. In one study
BMA (mL) Not reported NA 500–750 (64), there was a higher number of
Table 3 con't. MSC therapy studies treating liver failure.
safety measures in the treatment
group, including deep vein throm-
No. of Patients in Treatment Group 54 26 19 bosis, pulmonary embolism, sei-
zures, and rehospitalizations. Al-
though these adverse events were
not adjudicated as study-related,
Type of Study RCT Case series Case series their increased frequency raises
the possibility that they could have
been associated with the interven-
Year 2017 2017 2017 virus; PLT, platelets; CT, computed tomography. tion. There were no long-term
teratogenic effects, and radiologic
imaging has not shown any change

of any new procedural-related le-
Author Lin et al, Hepatology 2017; 66:209-219 Liang et al, Int J Rheum Dis 2017; 20:1219-1226 Kim et al, Cell Transplant 2017; 26:1059-1066 in existing lesions or development
sions in any of these trials.

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