Zeng Liuting, Yu Ganpeng, Yang Kailin, Xiang Wang, Li Jun, Chen Hua
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
People's Hospital of Ningxiang City, Ningxiang city, Hunan Province, China.
Stem Cells Int. 2022 Mar 24;2022:9463314. doi: 10.1155/2022/9463314. eCollection 2022.
To evaluate the efficacy and safety of mesenchymal stem cell (MSC) transplantation in the treatment of autoimmune diseases.
The Chinese and English databases were searched for clinical research on the treatment of autoimmune diseases with mesenchymal stem cells. The search time range is from a self-built database to October 1, 2021. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and evaluated the bias of the included studies. RevMan 5.3 analysis software was used for meta-analysis.
A total of 18 RCTs involving 5 autoimmune diseases were included. The 5 autoimmune disease were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease, ankylosing spondylitis, and multiple sclerosis. For RA, the current randomized controlled trials (RCTs) still believe that stem cell transplantation may reduce disease activity, improve the clinical symptoms (such as DAS28), and the percentage of CD4+CD 25+Foxp3+Tregs in the response group increased and the percentage of CD4+IL-17A+Th17 cells decreased. The total clinical effective rate of RA is 54%. For SLE, the results showed that mesenchymal stem cell transplantation may improve SLEDAI [-2.18 (-3.62, -0.75), = 0.003], urine protein [-0.93 (-1.04, -0.81), < 0.00001], and complement C3 [0.31 (0.19, 0.42), < 0.00001]. For inflammatory bowel disease, the results showed that mesenchymal stem cell transplantation may improve clinical efficacy [2.50 (1.07, 5.84), = 0.03]. For ankylosing spondylitis, MSC treatment for 6 months may increase the total effective rate; reduce erythrocyte sedimentation rate, intercellular adhesion molecules, and serum TNF-; and improve pain and activity. For multiple sclerosis, the current research results are still controversial, so more RCTs are needed to amend or confirm the conclusions. No obvious adverse events of mesenchymal stem cell transplantation were found in all RCTs.
MSCs have a certain effect on different autoimmune diseases, but more RCTs are needed to further modify or confirm the conclusion.
评估间充质干细胞（MSC）移植治疗自身免疫性疾病的疗效和安全性。
检索中英文数据库中关于间充质干细胞治疗自身免疫性疾病的临床研究。检索时间范围为自建数据库至2021年10月1日。两名研究者根据纳入和排除标准独立筛选文献、提取数据，并评估纳入研究的偏倚。使用RevMan 5.3分析软件进行荟萃分析。
共纳入18项涉及5种自身免疫性疾病的随机对照试验（RCT）。这5种自身免疫性疾病为类风湿关节炎（RA）、系统性红斑狼疮（SLE）、炎症性肠病、强直性脊柱炎和多发性硬化症。对于RA，目前的随机对照试验仍认为干细胞移植可能降低疾病活动度，改善临床症状（如DAS28），反应组中CD4+CD25+Foxp3+调节性T细胞百分比增加，CD4+IL-17A+辅助性T细胞17百分比降低。RA的总临床有效率为54%。对于SLE，结果显示间充质干细胞移植可能改善SLE疾病活动指数[-2.18（-3.62，-0.75），P = 0.003]、尿蛋白[-0.93（-1.04，-0.81），P < 0.00001]和补体C3[0.31（0.19，0.42），P < 0.00001]。对于炎症性肠病，结果显示间充质干细胞移植可能提高临床疗效[2.50（1.07，5.84），P = 0.03]。对于强直性脊柱炎，MSC治疗6个月可能提高总有效率；降低红细胞沉降率、细胞间黏附分子和血清肿瘤坏死因子；改善疼痛和活动能力。对于多发性硬化症，目前的研究结果仍存在争议，因此需要更多的RCT来修正或证实结论。在所有RCT中均未发现间充质干细胞移植明显的不良事件。
MSCs对不同的自身免疫性疾病有一定作用，但需要更多的RCT来进一步修正或证实该结论。
