São Paulo State University, UNESP - Campus de Assis, Assis, Brazil.
Stem Cell Res Ther. 2020 Aug 5;11(1):340. doi: 10.1186/s13287-020-01859-5.
In the clinical study by Le Thi Bich et al., allogeneic expanded umbilical cord-derived mesenchymal stem cells (UC-MSCs) were intravenously infused to treat patients with chronic obstructive pulmonary disease (COPD). No severe or significant adverse effects were observed, while a significant improvement in COPD patients' quality of life was reported up to 6 months. In addition, the authors argue that bone marrow-derived cells are not suitable to treat COPD based on the "failure" of 3 clinical trials (NCT01110252, NCT01306513, and NCT00683722). In fact, Le Thi Bich et al. and the three above-mentioned studies reported similar clinical outcomes, id est., no significant improvement in the pulmonary function of COPD patients. Therefore, since no COPD treatment involving cells either from bone marrow or umbilical cord was detrimental or provided lung regeneration in human patients, in our view, it is too early to point failures of cellular sources. Instead, it is a valuable opportunity to reflect on the poorly understood therapeutic mechanism of MSCs and the pathophysiology of COPD. In respect of cellular sources, only controlled trials with a strict comparison between different tissues might determine the suitability and efficacy of specific cell types to treat COPD. Finally, further studies are still required to determine whether and via which mechanism MSCs are able to provide structural and functional restoration of gas exchange in COPD patients.
在 Le Thi Bich 等人的临床研究中，静脉输注同种异体扩增脐带间充质干细胞 (UC-MSCs) 治疗慢性阻塞性肺疾病 (COPD) 患者。未观察到严重或显著的不良反应，而据报道，多达 6 个月时 COPD 患者的生活质量得到显著改善。此外，作者认为骨髓来源的细胞不适合治疗 COPD，这是基于 3 项临床试验 (NCT01110252、NCT01306513 和 NCT00683722) 的“失败”。事实上，Le Thi Bich 等人和上述 3 项研究报告了类似的临床结果，即 COPD 患者的肺功能没有显著改善。因此，由于没有涉及骨髓或脐带细胞的 COPD 治疗方法对人体有害或提供肺再生，在我们看来，现在指出细胞来源的失败还为时过早。相反，这是一个反思间充质干细胞治疗机制和 COPD 病理生理学了解甚少的宝贵机会。就细胞来源而言，只有在不同组织之间进行严格比较的对照试验，才能确定特定细胞类型治疗 COPD 的适宜性和疗效。最后，仍需要进一步研究来确定间充质干细胞是否以及通过何种机制能够为 COPD 患者提供气体交换的结构和功能恢复。
