Hsueh Po-Ren, Ho Sung-Jung, Hsieh Po-Chuen, Liu I-Min, Jean Shio-Shin
Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
Stem Cells Int. 2023 Aug 18;2023:7179592. doi: 10.1155/2023/7179592. eCollection 2023.
Acute respiratory distress syndrome (ARDS) is a critical complication in severe COVID-19 patients. The intravenous infusion (IVF) of umbilical cord- (UC-) mesenchymal stem cells (MSCs), validated to substantially reduce the release of several inflammatory cytokines , was also shown to exhibit benefits in improving hypoxemia among severe COVID-19 patients. A single dose of IVF-UC-MSCs therapy for severe COVID-19 patients was shown to alleviate the initial ARDS severity, but have 50%-67% case-fatality rates. In Taiwan, few adult patients with severe COVID-19-induced ARDS receiving compassionate adjuvant treatment consisting of either a single dose (1-10 × 10 cells/kg body weight (kg BW)) or three doses (5 × 10 cells/kg BW in each dose) of IVF-UC-MSCs had good outcomes. However, the optimal dosage and rounds of IVF-UC-MSCs administration for the treatment of severe COVID-19 patients with ARDS are undetermined.
We reviewed the 2020-2022 PubMed literature database concerning the clinical efficacy of IVF-UC-MSCs among severe COVID-19 patients.
The data of COVID-19 case series in the PubMed literature revealed a notable heterogeneity in the therapeutic dosage (a single dose: 1-10 × 10 cells/kg BW; and three doses: 50-200 × 10 cells/kg BW in each dose) and the post-ARDS days of IVF-UC-MSCs administration (a single dose: 1-12; and multiple doses: 5-14) for the treatment of severe COVID-19-associated ARDS. The survival rates among these severe COVID-19 patients ranged from 50% to 76%. However, an overall rate of 93.1% of significant improvement in hypoxemia was observed for the COVID-19 survivors receiving IVF-UC-MSCs at the initial ARDS stage.
According to our analysis, the ideal treatment dosage of IVF-UC-MSCs for severe COVID-19-induced ARDS is likely 5 × 10 cells/kg BW for three cycles within 5 days of ARDS onset in severe COVID-19 patients.
急性呼吸窘迫综合征（ARDS）是重症新型冠状病毒肺炎（COVID-19）患者的一种严重并发症。经证实，静脉输注脐带（UC）间充质干细胞（MSCs）可大幅减少多种炎性细胞因子的释放，且在改善重症COVID-19患者低氧血症方面也显示出益处。单剂量静脉输注UC-MSCs治疗重症COVID-19患者可减轻初始ARDS严重程度，但病死率为50%-67%。在台湾，很少有重症COVID-19所致ARDS的成年患者接受由单剂量（1-10×10个细胞/千克体重（kg BW））或三剂量（每剂量5×10个细胞/kg BW）静脉输注UC-MSCs组成的同情性辅助治疗后有良好结局。然而，用于治疗重症COVID-19合并ARDS患者的静脉输注UC-MSCs的最佳剂量和疗程尚未确定。
我们检索了2020年至2022年PubMed文献数据库中关于静脉输注UC-MSCs在重症COVID-19患者中的临床疗效的文献。
PubMed文献中COVID-19病例系列的数据显示，在治疗重症COVID-19相关ARDS时，静脉输注UC-MSCs的治疗剂量（单剂量：1-10×10个细胞/kg BW；三剂量：每剂量50-200×10个细胞/kg BW）和ARDS后静脉输注UC-MSCs的天数（单剂量：1-12天；多剂量：5-14天）存在显著异质性。这些重症COVID-19患者的生存率在50%至76%之间。然而，在初始ARDS阶段接受静脉输注UC-MSCs的COVID-19幸存者中，观察到低氧血症显著改善的总体发生率为93.1%。
根据我们的分析，对于重症COVID-19所致ARDS，静脉输注UC-MSCs的理想治疗剂量可能是在重症COVID-19患者ARDS发作后5天内分三个周期给予5×10个细胞/kg BW。
