Current evidence on mesenchymal stem cell therapy for traumatic spinal cord injury: systematic review and meta-analysis |
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| Authors: | Sathish Muthu Madhan Jeyaraman Arun Gulati Arunabh Arora |
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| Institution: | 1. Government Hospital, Velayuthampalayam, Karur, Tamil Nadu, India;2. Orthopaedic Research Group, Coimbatore, Tamil Nadu, India;3. Indian Stem Cells Study Group, Lucknow, India;4. Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, India;5. Department of Orthopaedics, Kalpana Chawla Government Medical College & Hospital, Karnal, India;1. Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA;2. University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA;3. Department of Biological Sciences, College of Science, University of Notre Dame, Notre Dame, Indiana, USA;4. Department of Anatomy and Neuroscience, Centre for Stem Cell Systems, University of Melbourne, Parkville, Australia;5. Division of Pulmonary and Critical Care Medicine and Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA;6. Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA;7. Department of Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA;8. Biomedical Ethics Research Program and Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA;1. Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St, MC 6342, Redwood City, CA 94063, USA;2. Department of Orthopaedic Surgery, University of California Los Angeles, 1250 16th St, Santa Monica, CA 90404, USA;3. Department of Orthopaedics and Physical Rehabilitation, University of Massachusetts Medical School, 119 Belmont St, Worcester, MA 01605, USA;4. Stemedica, 5375 Mira Sorrento Place, Suite 100, San Diego, CA 92121, USA |
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| Abstract: | Background aimsThe authors aim to analyze the evidence in the literature regarding the efficacy and safety of mesenchymal stem cell (MSC) therapy in human subjects with traumatic spinal cord injury (SCI) and identify its potential role in the management of SCI.MethodsThe authors conducted independent and duplicate searches of electronic databases, including PubMed, Embase and the Cochrane Library, until May 2020 for studies analyzing the efficacy and safety of stem cell therapy for SCI. American Spine Injury Association (ASIA) impairment scale (AIS) grade improvement, ASIA sensorimotor score, activities of daily living score, residual urine volume, bladder function improvement, somatosensory evoked potential (SSEP) improvement and adverse reactions were the outcomes analyzed. Analysis was performed in R platform using OpenMetaAnalyst] software.ResultsNineteen studies involving 670 patients were included for analysis. On analysis, the intervention group showed statistically significant improvement in AIS grade (P < 0.001), ASIA sensory score (P < 0.017), light touch (P < 0.001), pinprick (P = 0.046), bladder function (P = 0.012), residual urine volume (P = 0.023) and SSEP (P = 0.002). However, no significant difference was noted in motor score (P = 0.193) or activities of daily living score (P = 0.161). Although the intervention group had a significant increase in complications (P < 0.001), no serious or permanent adverse events were reported. On subgroup analysis, low concentration of MSCs (<5 × 107 cells) and initial AIS grade A presentation showed significantly better outcomes than their counterparts.ConclusionsThe authors’ analysis establishes the efficacy and safety of MSC transplantation in terms of improvement in AIS grade, ASIA sensory score, bladder function and electrophysiological parameters like SSEP compared with controls, without major adverse events. However, further research is needed to standardize dose, timing, route and source of MSCs used for transplantation. |
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