Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Stem Cell Res Ther. 2022 May 16;13(1):203. doi: 10.1186/s13287-022-02883-3.
The effect of transplantation of bone-marrow mononuclear cells (BM-MNCs) and mesenchymal stem cells (MSCs) on ejection fraction (LVEF) has been studied in patients with acute myocardial infarction (AMI) in clinical trials. This raises the question that which type of cell may help improve LVEF better in AMI patients. No meta-analysis of clinical trials has yet addressed this question.
Electronic databases were searched thoroughly to find eligible trials on the effects of transplantation of BM-MNCs and MSCs in patients with AMI. The primary outcome was improvement in LVEF. Data were synthesized using random-effects meta-analysis. For maximizing the credibility of subgroup analysis, we used the instrument for assessing the Credibility of Effect Modification of Analyses (ICEMAN) for meta-analyses.
A total of 36 trials (26 on BM-MNCs and 10 on MSCs) with 2489 patients (1466 were transplanted [1241 with BM-MNCs and 225 with MSCs] and 1023 as controls) were included. Both types of cells showed significant improvements in ejection fraction in short-term follow-up (BM-MNCs: WMD = 2.13%, 95% CI = 1.23 to 3.04, p < 0.001; MSCs: WMD = 3.71%, 95% CI = 2.32 to 5.09, p < 0.001), and according to ICEMAN criteria, MSCs are more effective. For selected population of patients who received stem cell transplantation in early course after AMI (less than 11 days), this effect was even more pronounced (BM-MNC: WMD = 3.07%, 95% CI = 1.97 to 4.17, p < 0.001, I = 40.7%; MSCs: WMD = 5.65%, 95% CI = 3.47 to 7.84, p < 0.001, I = 84.6%).
Our results showed that transplantation of MSCs after AMI might increase LVEF more than BM-MNCs; also, based on ICEMAN, there was likely effect modification between subgroups although uncertainty still remained.
骨髓单个核细胞（BM-MNCs）和间充质干细胞（MSCs）移植对急性心肌梗死（AMI）患者射血分数（LVEF）的影响已在临床试验中进行了研究。这就提出了一个问题，即在 AMI 患者中，哪种类型的细胞可能更有助于改善 LVEF。目前尚无关于临床试验的荟萃分析来解决这个问题。
全面检索电子数据库，以查找关于 AMI 患者 BM-MNCs 和 MSCs 移植效果的临床试验。主要结局是 LVEF 的改善。使用随机效应荟萃分析综合数据。为了最大限度地提高亚组分析的可信度，我们使用分析效果修正可信度评估工具（ICEMAN）进行荟萃分析。
共纳入 36 项试验（26 项关于 BM-MNCs，10 项关于 MSCs），共 2489 例患者（1466 例接受移植[1241 例接受 BM-MNCs 移植，225 例接受 MSCs 移植]，1023 例作为对照组）。两种细胞在短期随访中均显著改善了射血分数（BM-MNCs：WMD=2.13%，95%CI=1.23 至 3.04，p<0.001；MSCs：WMD=3.71%，95%CI=2.32 至 5.09，p<0.001），根据 ICEMAN 标准，MSCs 的效果更显著。对于 AMI 后早期（<11 天）接受干细胞移植的特定患者人群，这种效果更为明显（BM-MNC：WMD=3.07%，95%CI=1.97 至 4.17，p<0.001，I=40.7%；MSCs：WMD=5.65%，95%CI=3.47 至 7.84，p<0.001，I=84.6%）。
我们的研究结果表明，AMI 后移植 MSCs 可能比 BM-MNCs 更能提高 LVEF；此外，根据 ICEMAN，尽管仍存在不确定性，但亚组之间可能存在效果修饰。
