Department of Anaesthesia, Royal College of Surgeons in Ireland, Dublin, Ireland.
Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom.
Am J Respir Crit Care Med. 2024 Apr 1;209(7):789-797. doi: 10.1164/rccm.202311-2046CP.
There is considerable interest in the potential for cell-based therapies, particularly mesenchymal stromal cells (MSCs) and their products, as a therapy for acute respiratory distress syndrome (ARDS). MSCs exert effects via diverse mechanisms including reducing excessive inflammation by modulating neutrophil, macrophage and T-cell function, decreasing pulmonary permeability and lung edema, and promoting tissue repair. Clinical studies indicate that MSCs are safe and well tolerated, with promising therapeutic benefits in specific clinical settings, leading to regulatory approvals of MSCs for specific indications in some countries.This perspective reassesses the therapeutic potential of MSC-based therapies for ARDS given insights from recent cell therapy trials in both COVID-19 and in 'classic' ARDS, and discusses studies in graft-vs.-host disease, one of the few licensed indications for MSC therapies. We identify important unknowns in the current literature, address challenges to clinical translation, and propose an approach to facilitate assessment of the therapeutic promise of MSC-based therapies for ARDS.
细胞疗法，尤其是间充质基质细胞（MSCs）及其产物，作为急性呼吸窘迫综合征（ARDS）的一种治疗方法，引起了广泛关注。MSCs 通过多种机制发挥作用，包括通过调节中性粒细胞、巨噬细胞和 T 细胞功能来减少过度炎症，降低肺通透性和肺水肿，以及促进组织修复。临床研究表明，MSCs 安全且耐受性良好，在特定临床环境中具有有前景的治疗益处，导致一些国家对特定适应症的 MSC 治疗的监管批准。鉴于最近在 COVID-19 和“经典”ARDS 中的细胞治疗试验的见解，本文重新评估了基于 MSC 的疗法治疗 ARDS 的治疗潜力，并讨论了移植物抗宿主病的研究，这是 MSC 疗法为数不多的许可适应症之一。我们确定了当前文献中的重要未知因素，解决了临床转化的挑战，并提出了一种方法来促进评估基于 MSC 的疗法治疗 ARDS 的治疗潜力。
