Subcenter for Stem Cell Clinical Translation, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China.
School of Rehabilitation Medicine, Gannan Medical University, Ganzhou 341000, Jiangxi Province, China.
World J Gastroenterol. 2024 Aug 28;30(32):3766-3782. doi: 10.3748/wjg.v30.i32.3766.
The efficacy of mesenchymal stem cells (MSCs) in treating liver fibrosis has been demonstrated in several clinical studies. However, their low survival and liver implantation rates remain problematic. In recent years, a large number of studies in animal models of liver fibrosis have shown that MSCs combined with drugs can improve the efficacy of MSCs in the treatment of liver fibrosis alone and inhibit its progression to end-stage liver disease. This has inspired new ways of thinking about treating liver fibrosis.
To investigate the effectiveness and mechanisms of MSCs combined with drugs in treating liver fibrosis.
Data sources included four electronic databases and were constructed until January 2024. The subjects, interventions, comparators, outcomes, and study design principle were used to screen the literature, and the quality of the literature was evaluated to assess the risk of bias. Relevant randomised controlled trials were selected, and the final 13 studies were included in the final study.
A total of 13 studies were included after screening. Pooled analysis showed that MSCs combined with drug therapy significantly improved liver function, promoted the repair of damaged liver tissues, reduced the level of liver fibrosis-related indexes, and effectively ameliorated hepatic fibrosis by modulating the hepatic inflammatory microenvironment, promoting the homing of MSCs, and regulating the relevant signaling pathways, and the treatment efficacy was superior to MSCs alone. However, the combined treatment statistics showed no ame-lioration in serum albumin levels (standardized mean difference = 0.77, 95% confidence interval: -0.13 to 1.68, = 0.09).
In conclusion, MSCs combined with drugs for treating liver fibrosis effectively make up for the shortcomings of MSCs in their therapeutic effects. However, due to the different drugs, the treatment mechanism and effect also differ. Therefore, more randomized controlled trials are needed to compare the therapeutic efficacy of different drugs in combination with MSCs, aiming to select the "best companion" of MSCs in treating hepatic fibrosis.
间充质干细胞（MSCs）在治疗肝纤维化方面的疗效已在多项临床研究中得到证实。然而，其存活率低和肝内植入率仍然是个问题。近年来，大量肝纤维化动物模型研究表明，MSCs 联合药物可以提高 MSCs 单独治疗肝纤维化的疗效，并抑制其向终末期肝病进展。这为治疗肝纤维化提供了新的思路。
探讨 MSCs 联合药物治疗肝纤维化的疗效及机制。
检索四个电子数据库，构建至 2024 年 1 月。使用主题词、干预措施、对照措施、结局指标和研究设计方案进行文献筛选，并对文献质量进行评价以评估偏倚风险。选择相关的随机对照试验，最终纳入 13 项研究进行分析。
经筛选后共纳入 13 项研究。Meta 分析结果显示，MSCs 联合药物治疗能明显改善肝功能，促进受损肝组织修复，降低肝纤维化相关指标水平，通过调节肝内炎症微环境、促进 MSCs 归巢、调控相关信号通路等途径有效改善肝纤维化，疗效优于 MSCs 单独治疗。但联合治疗组的统计结果显示血清白蛋白水平无改善（标准化均数差=0.77，95%置信区间：-0.13 至 1.68，=0.09）。
综上所述，MSCs 联合药物治疗肝纤维化可有效弥补 MSCs 治疗效果的不足。但由于药物不同，其治疗机制和效果也存在差异。因此，需要更多的随机对照试验来比较不同药物联合 MSCs 的治疗效果，旨在为治疗肝纤维化选择 MSCs 的“最佳伴侣”。
