Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, School of Medicine, Hormozgan University of Medical Sciences, Bandarabbas, Iran.
Mult Scler Relat Disord. 2024 Jul;87:105681. doi: 10.1016/j.msard.2024.105681. Epub 2024 May 11.
BACKGROUND: Current therapeutic strategies for multiple sclerosis (MS) aim to suppress the immune response and reduce relapse rates. As alternative treatments, mesenchymal stem cells (MSCs) are being explored. MSCs show promise in repairing nerve tissue and reducing autoimmune responses in people with MS (pwMS). OBJECTIVE: This review delves into the literature on the efficacy and safety of MSC therapy for pwMS. METHODS: A comprehensive search strategy was employed to identify relevant articles from five databases until January 2024. The inclusion criteria encompassed interventional studies. Efficacy and safety data concerning MSC therapy in relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS) groups were extracted and analyzed. RESULTS: A comprehensive analysis encompassing 30 studies revealed that individuals who underwent intrathecal (IT) protocol-based transplantation of MSCs experienced a noteworthy improvement in their expanded disability status scale (EDSS) compared to the placebo group. Weighted mean difference (WMD) was -0.28; 95 % CI -0.53 to -0.03, I = 0 %, p-value = 0.028); however, the intravenous (IV) group did not show significant changes in EDSS scores. The annualized relapse rate (ARR) did not significantly decrease among pwMS (WMD = -0.34; 95 % CI -1.05 to 0.38, I = 98 %, p-value = 0.357). Favorable results were observed in magnetic resonance imaging (MRI), with only 19.11 % of pwMS showing contrast-enhanced lesions (CEL) in the short term and no long-term MRI activity. The most common complications in both short-term and long-term follow-ups were infection, back pain, and gastrointestinal symptoms. CONCLUSIONS: The study highlights the safety potential of MSC therapy for pwMS. While MRI-based neural regeneration shows significant treatment potential, the effectiveness of MSC therapy remains uncertain due to study limitations and ineffective outcome measures. Further research is needed to establish efficacy and optimize evaluation methods for MSC therapy on pwMS.
背景：目前，多发性硬化症（MS）的治疗策略旨在抑制免疫反应并降低复发率。间充质干细胞（MSCs）作为替代疗法正在被探索。MSCs 在修复神经组织和减轻 MS 患者（pwMS）的自身免疫反应方面显示出潜力。
目的：本综述深入探讨了 MSCs 治疗 pwMS 的疗效和安全性的文献。
方法：采用全面的检索策略，从五个数据库中检索截至 2024 年 1 月的相关文章。纳入标准包括干预性研究。提取并分析了 MSCs 治疗复发缓解型 MS（RRMS）、继发进展型 MS（SPMS）和原发进展型 MS（PPMS）患者的疗效和安全性数据。
结果：对 30 项研究进行综合分析表明，与安慰剂组相比，接受鞘内（IT）方案移植 MSC 的个体在扩展残疾状况量表（EDSS）方面有显著改善。加权均数差（WMD）为-0.28；95%置信区间（CI）-0.53 至-0.03，I=0%，p 值=0.028）；然而，静脉内（IV）组的 EDSS 评分没有显著变化。pwMS 的年复发率（ARR）没有显著降低（WMD=-0.34；95%CI-1.05 至 0.38，I=98%，p 值=0.357）。磁共振成像（MRI）显示出有利的结果，只有 19.11%的 pwMS 在短期内出现对比增强病变（CEL），且无长期 MRI 活动。在短期和长期随访中最常见的并发症是感染、背痛和胃肠道症状。
结论：该研究强调了 MSC 治疗 pwMS 的安全性潜力。虽然基于 MRI 的神经再生显示出显著的治疗潜力，但由于研究限制和无效的结局测量，MSC 治疗的有效性仍不确定。需要进一步研究以确定 MSC 治疗 pwMS 的疗效并优化评估方法。
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