Title:Efficacy and Safety of Mesenchymal Stem Cell Therapy in Patients with
Acute Myocardial Infarction: A Systematic Review and Meta-analysis of
Randomized Controlled Trials
Volume: 17
Issue: 8
Author(s): Jiang Yu, Run-feng Zhang*, Yi-li Mao and Heng Zhang
Affiliation:
- Department of Cardiology, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang 621000,
Sichuan, China
Keywords:
Acute myocardial infarction (AMI), cell therapy, mesenchymal stem cells (MSCs), transplantation timing, cell doses, meta-analysis.
Abstract:
Background and Objectives: The adjuvant treatment of stem cell therapy for acute myocardial
infarction (AMI) has been studied in multiple clinical trials, but many questions remain to
be addressed, such as efficacy, safety, identification of the optimal cell type, tractable route of delivery,
transplant dosage, and transplant timing.
The current meta-analysis aimed to explore the issues of mesenchymal stem cells (MSCs) transplantation
in patients with AMI based on published randomized controlled trials (RCTs) and guide
the design of subsequent clinical trials of MSCs therapy for AMI.
Methods: The Cochrane Library, PubMed, EMBASE databases were searched for relevant clinical
trials from January 1, 2000, to January 23, 2021. Results from RCTs involving MSCs transplantation
for the treatment of AMI were identified. According to the Cochrane systematic review
method, the literature quality, including studies, was evaluated and valid data was extracted. Rev-
Man 5.3 and Stata 15.1 software were used for Meta-analysis.
Results: After literature search and detailed evaluation, 9 randomized controlled trials enrolling
460 patients were included in the quantitative analysis. Pooled analyses indicated that MSCs therapy
was associated with a significantly greater improvement in overall left ventricular ejection fraction
(LVEF), and the effect was maintained for up to 24 months. No significant difference in favor
of MSCs treatment in left ventricular (LV) volume and in the risk of rehospitalization as a result of
heart failure (HF) was noted, compared with the controls. For transplantation dose, the LVEF of patients
accepting a MSCs dose of 107-108 cells was significantly increased by 2.62% (95% CI 1.54
to 3.70; P < 0.00001; I2 =0%), but this increase was insignificant in the subgroup that accepted a
MSCs dose of < 107 cells (1.65% in LVEF, 95% CI, 0.03 to 3.27; P =0.05; I2 =75%) or >108 cells
(4.65% in LVEF, 95% CI, -4.55 to 13.48; P =0.32; I2 =95%), compared with the controls. For transplantation
timing, a significant improvement of LVEF of 3.18% was achieved in the group of patients
accepting a MSCs infusion within 2 to 14 days after percutaneous coronary intervention (PCI)
(95% CI, 2.89 to 3.47; P <0.00001; I2 = 0). There was no association between MSCs therapy
and major adverse events.
Conclusion: Results from our systematic review suggest that MSCs therapy for patients with AMI
appears to be safe and might induce a significant increase in LVEF with a limited impact on LV
volume and rehospitalization caused by HF. The effect was maintained for up to 24 months. MSCs
dose of 107-108 cells was more likely to achieve better clinical endpoints than <107 or >108 cells.
The optimal time window for cell transplantation might be within 2-14 days after PCI. This meta-analysis
was registered with PROSPERO, number CRD 42021241104.
