Medical University of South Carolina Medical School, Charleston, SC.
Pain Physician. 2020 Aug;23(4S):S421-S432.
There are as yet no effective strategies to treat the novel COVID-19 and to stem its symptoms, including ARDS. This review examines recent research studies in humans to determine whether mesenchymal stem cells (MSCs) may be used effectively and safely to target potentially deadly lung damage that may follow infection.
A literature search was conducted to find published manuscripts on the treatment of ARDS and COVID-19 symptoms, disease presentation, and available treatment regimens. Electronic data bases of scientific articles and records of printed documents of JAMA journals were searched to find research publications on MSC treatment of ARDS and COVID-19. Outcome variables included mortality over varying time periods, hospital days, days on ventilator, and biological factors.
Two randomized double-blind clinical trials, 2 pilot studies, and 2 case reports described MSC use to treat ARDS with specific focus on COVID-19 and lung symptoms of cytokine storm. The MSCs were well-tolerated across studies. No significant differences in treatment outcome were found in randomized double-blind trials; however, results of 1 pilot study and 1 case report showed that MSCs led to lung symptom resolution and survival in severely ill treatment patients.
There is little published research on disease and survival outcomes among patients suffering severe lung disease associated with ARDS and COVID-19, and studies available are limited by lack of consistency in design and numerous flaws and limitations. Comparisons across studies are difficult. Nevertheless, it is documented that 8 ARDS patients with COVID-19 experienced symptom recovery and survival subsequent to MSC administration. MSCs are potentially life-saving treatment approaches for some patients who exhibit severe lung distress and have not responded to standard treatments. This is an obviously exciting research and treatment option for COVID-19 and other life-threatening diseases.
目前尚无有效策略来治疗新型冠状病毒病并阻止其症状，包括急性呼吸窘迫综合征（ARDS）。本综述检查了最近的人体研究，以确定间充质干细胞（MSCs）是否可有效且安全地用于靶向可能因感染而发生的潜在致命性肺损伤。
对治疗 ARDS 和 COVID-19 症状、疾病表现和现有治疗方案的已发表文献进行了文献检索。搜索了科学文章的电子数据库和 JAMA 期刊的印刷文献记录，以查找有关 MSC 治疗 ARDS 和 COVID-19 的研究出版物。结果变量包括不同时间段的死亡率、住院天数、呼吸机使用天数和生物学因素。
两项随机双盲临床试验、两项试点研究和两项病例报告描述了 MSC 用于治疗 ARDS 的情况，特别关注 COVID-19 和细胞因子风暴引起的肺部症状。研究中 MSC 均具有良好的耐受性。在随机双盲试验中未发现治疗结果有显著差异；然而，一项试点研究和一项病例报告的结果表明，MSC 可导致重症治疗患者的肺部症状缓解和生存。
与 ARDS 和 COVID-19 相关的严重肺部疾病患者的疾病和生存结果的研究很少，而且现有的研究受到设计缺乏一致性以及许多缺陷和限制的限制。跨研究的比较很困难。尽管如此，有 8 名患有 COVID-19 的 ARDS 患者在接受 MSC 治疗后出现症状缓解和存活。对于表现出严重肺部窘迫且对标准治疗无反应的某些患者，MSC 是潜在的救生治疗方法。这是 COVID-19 和其他危及生命的疾病的一个明显令人兴奋的研究和治疗选择。
