Xu Xiongjie, Liang Zeyan, Lin Yike, Rao Jian, Lin Fabin, Yang Zhelun, Wang Rui, Chen Chunmei
Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China.
Front Cell Neurosci. 2022 Apr 4;16:860131. doi: 10.3389/fncel.2022.860131. eCollection 2022.
To compare the safety and effectiveness of transplanted cells from different sources for spinal cord injury (SCI).
A systematic review and Bayesian network meta-analysis.
Medline, Embase, and the Cochrane Central Register of Controlled Trials.
We included randomized controlled trials, case-control studies, and case series related to cell transplantation for SCI patients, that included at least 1 of the following outcome measures: American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS grade), ASIA motor score, ASIA sensory score, the Functional Independence Measure score (FIM), International Association of Neurorestoratology Spinal Cord Injury Functional Rating Scale (IANR-SCIFRS), or adverse events. Follow-up data were analyzed at 6 and 12 months.
Forty-four eligible trials, involving 1,266 patients, investigated 6 treatments: olfactory ensheathing cells (OECs), neural stem cells/ neural progenitor cells (NSCs), mesenchymal stem cells (MSCs), Schwann cells, macrophages, and combinations of cells (MSCs plus Schwann cells). Macrophages improved the AIS grade at 12 months (mean 0.42, 95% credible interval: 0-0.91, low certainty) and FIM score at 12 months (42.83, 36.33-49.18, very low certainty). MSCs improved the AIS grade at 6 months (0.42, 0.15-0.73, moderate certainty), the motor score at 6 months (4.43, 0.91-7.78, moderate certainty), light touch at 6 (10.01, 5.81-13.88, moderate certainty) and 12 months (11.48, 6.31-16.64, moderate certainty), pinprick score at 6 (14.54, 9.76-19.46, moderate certainty) and 12 months (12.48, 7.09-18.12, moderate certainty), and the IANR-SCIFRS at 6 (3.96, 0.62-6.97, moderate certainty) and 12 months (5.54, 2.45-8.42, moderate certainty). OECs improved the FIM score at 6 months (9.35, 1.71-17.00, moderate certainty). No intervention improved the motor score significantly at 12 months. The certainty of other interventions was low or very low. Overall, the number of adverse events associated with transplanted cells was low.
Patients with SCI who receive transplantation of macrophages, MSCs, NSCs, or OECs may have improved disease prognosis. MSCs are the primary recommendations. Further exploration of the mechanism of cell transplantation in the treatment of SCI, transplantation time window, transplantation methods, and monitoring of the number of transplanted cells and cell survival is needed.
https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD 42021282043.
比较不同来源的移植细胞治疗脊髓损伤（SCI）的安全性和有效性。
系统评价和贝叶斯网络Meta分析。
Medline、Embase和Cochrane对照试验中央注册库。
纳入与SCI患者细胞移植相关的随机对照试验、病例对照研究和病例系列，至少包括以下一项结局指标：美国脊髓损伤协会（ASIA）损伤量表（AIS分级）、ASIA运动评分、ASIA感觉评分、功能独立性测量评分（FIM）、国际神经修复学会脊髓损伤功能评定量表（IANR-SCIFRS）或不良事件。在6个月和12个月时分析随访数据。
44项符合条件的试验，涉及1266例患者，研究了6种治疗方法：嗅鞘细胞（OECs）、神经干细胞/神经祖细胞（NSCs）、间充质干细胞（MSCs）、雪旺细胞、巨噬细胞以及细胞组合（MSCs加雪旺细胞）。巨噬细胞在12个月时改善了AIS分级（均值0.42，95%可信区间：0-0.91，低确定性）和12个月时的FIM评分（42.83，36.33-49.18，极低确定性）。MSCs在6个月时改善了AIS分级（0.42，0.15-0.73，中等确定性）、6个月时的运动评分（4.43，0.91-7.78，中等确定性）、6个月（10.01，5.81-13.88，中等确定性）和12个月（11.48，6.31-16.64，中等确定性）时的轻触觉评分、6个月（14.54，9.76-19.46，中等确定性）和12个月（12.48，7.09-18.12，中等确定性）时的针刺觉评分，以及6个月（3.96，0.62-6.97，中等确定性）和12个月（5.54，2.45-8.42，中等确定性）时的IANR-SCIFRS。OECs在6个月时改善了FIM评分（9.35，1.71-17.00，中等确定性）。没有干预措施在12个月时显著改善运动评分。其他干预措施的确定性为低或极低。总体而言，与移植细胞相关的不良事件数量较少。
接受巨噬细胞、MSCs、NSCs或OECs移植的SCI患者可能改善疾病预后。MSCs是主要推荐。需要进一步探索细胞移植治疗SCI的机制、移植时间窗、移植方法以及对移植细胞数量和细胞存活的监测。
https://www.crd.york.ac.uk/PROSPERO/#recordDetails，标识符：CRD 42021282043。
