Department of Cardiovascular Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Stem Cell Res Ther. 2024 Jul 6;15(1):202. doi: 10.1186/s13287-024-03829-7.
There is no clear evidence on the comparative effectiveness of bone-marrow mononuclear cell (BMMNC) vs. mesenchymal stromal cell (MSC) stem cell therapy in patients with chronic heart failure (HF).
Using a systematic approach, eligible randomized controlled trials (RCTs) of stem cell therapy (BMMNCs or MSCs) in patients with HF were retrieved to perform a meta-analysis on clinical outcomes (major adverse cardiovascular events (MACE), hospitalization for HF, and mortality) and echocardiographic indices (including left ventricular ejection fraction (LVEF)) were performed using the random-effects model. A risk ratio (RR) or mean difference (MD) with corresponding 95% confidence interval (CI) were pooled based on the type of the outcome and subgroup analysis was performed to evaluate the potential differences between the types of cells.
The analysis included a total of 36 RCTs (1549 HF patients receiving stem cells and 1252 patients in the control group). Transplantation of both types of cells in patients with HF resulted in a significant improvement in LVEF (BMMNCs: MD (95% CI) = 3.05 (1.11; 4.99) and MSCs: MD (95% CI) = 2.82 (1.19; 4.45), between-subgroup p = 0.86). Stem cell therapy did not lead to a significant change in the risk of MACE (MD (95% CI) = 0.83 (0.67; 1.06), BMMNCs: RR (95% CI) = 0.59 (0.31; 1.13) and MSCs: RR (95% CI) = 0.91 (0.70; 1.19), between-subgroup p = 0.12). There was a marginally decreased risk of all-cause death (MD (95% CI) = 0.82 (0.68; 0.99)) and rehospitalization (MD (95% CI) = 0.77 (0.61; 0.98)) with no difference among the cell types (p > 0.05).
Both types of stem cells are effective in improving LVEF in patients with heart failure without any noticeable difference between the cells. Transplantation of the stem cells could not decrease the risk of major adverse cardiovascular events compared with controls. Future trials should primarily focus on the impact of stem cell transplantation on clinical outcomes of HF patients to verify or refute the findings of this study.
骨髓单个核细胞（BMMNC）与间充质基质细胞（MSC）干细胞疗法在慢性心力衰竭（HF）患者中的比较疗效尚缺乏明确证据。
采用系统方法，检索了 HF 患者干细胞治疗（BMMNC 或 MSC）的合格随机对照试验（RCT），采用随机效应模型对临床结局（主要不良心血管事件（MACE）、HF 住院和死亡率）和超声心动图指标（包括左心室射血分数（LVEF））进行荟萃分析。根据结局类型和亚组分析，采用风险比（RR）或均数差（MD）及其相应的 95%置信区间（CI）进行汇总。
该分析共纳入 36 项 RCT（1549 例 HF 患者接受干细胞治疗，对照组 1252 例）。HF 患者两种类型细胞的移植均显著改善 LVEF（BMMNC：MD（95%CI）=3.05（1.11；4.99）和 MSC：MD（95%CI）=2.82（1.19；4.45），亚组间 p=0.86）。干细胞治疗并未显著改变 MACE 的风险（MD（95%CI）=0.83（0.67；1.06），BMMNC：RR（95%CI）=0.59（0.31；1.13）和 MSC：RR（95%CI）=0.91（0.70；1.19），亚组间 p=0.12）。全因死亡风险（MD（95%CI）=0.82（0.68；0.99））和再住院风险（MD（95%CI）=0.77（0.61；0.98））均略有降低，细胞类型间无差异（p＞0.05）。
两种类型的干细胞均能有效改善心力衰竭患者的 LVEF，且细胞间无显著差异。与对照组相比，干细胞移植不能降低主要不良心血管事件的风险。未来的试验应主要关注干细胞移植对 HF 患者临床结局的影响，以验证或反驳本研究的结果。
