Transplantation of mesenchymal stem cells for spinal cord injury: a systematic review and network meta-analysis

Abstract

Spinal cord injury (SCI) is a severe traumatic disease of the central nervous system, with a global prevalence of 236–4187 per million people. This meta-analysis aimed to evaluate the safety and efficacy of mesenchymal stem cells (MSCs) in treating patients with SCI as well as the optimal source and transplantation method of MSCs. PubMed, OVID, Cochrane, Web of Science, and China Biomedical Database were searched up until April 01, 2021. The study was conducted for five endpoints: American Spinal Injury Association (ASIA) motor and sensory score, ASIA grade improvement, Barthel Index (BI), and adverse reactions. Standard meta-analysis and network meta-analysis were performed using Stata 14.0. Eighteen studies with a total of 949 patients, were included in the meta-analysis. Standard meta-analysis showed that MSCs significantly improved ASIA motor score (P < 0.001), sensory score (P < 0.001), ASIA grade (P < 0.001), and BI (P < 0.001) compared to rehabilitation. In addition, in the network meta-analysis, autologous MSCs significantly improved the ASIA motor [MD = 8.01, 95% CI (4.27, 11.76)], sensory score [MD = 17.98, 95% CI (10.04, 25.91)], and BI [MD = 7.69, 95% CI (2.10, 13.29)] compared to rehabilitation. Similarly, compared to rehabilitation, intrathecal injection (IT) of MSCs significantly improved the ASIA motor [MD = 7.97, 95% CI (4.40, 11.53)] and sensory score [MD = 19.60, 95% CI (9.74, 29.46)]. Compared to rehabilitation, however, only the IL of MSCs was associated with more adverse reactions [OR = 17.82, 95% CI (2.48, 128.22)]. According to the results of SUCRA, both autologous MSCs and IT transplantation approaches most improved the neurological function in SCI patients. Cell transplantation using MSCs is effective in patients with SCI and IT of autologous MSCs may be more beneficial.

Rat Bone Mesenchymal Stem Cell-Derived Exosomes Loaded with miR-494 Promoting Neurofilament Regeneration and Behavioral Function Recovery after Spinal Cord Injury

“…Stem cell transplantation has been investigated in tissue regeneration for years; however, it still has some limitations [ 33 , 34 ]. Over the past few years, exosomes, a novel type of intercellular communication device, have been employed as a good biological carrier for local or systemic small RNA delivery for treating stroke or spinal cord injury and other central nervous system diseases.…”

Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment

“…These results were translatable to the chronic phase of the injury in mice [ 259 , 270 ]. Single MSC application was demonstrated to be safe but had little therapeutic outcome in a phase three clinical trial [ 271 ], which was supported by former and recent systematic reviews summarising clinical and preclinical evidence [ 19 , 272 , 273 ]. There are currently several trials in progress and their completion will deliver the required data on the efficacy of MSC therapies after TSCI [ 84 , 274 ].…”

Neuroinflammation and Scarring After Spinal Cord Injury: Therapeutic Roles of MSCs on Inflammation and Glial Scar

“…Over the past decade, an increasing body of evidences has documented that mesenchymal stem cells (MSCs) engraftment can be served as an effective therapeutic strategy for SCI ( 16 , 17 ). Early on, it was expected that these multipotent cells were likely to promote functional recovery via their multidirectional differentiation potential, which may enable them to replace injured neural tissue ( 18 ).…”