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Current Stem Cell Research & Therapy

Editor-in-Chief

ISSN (Print): 1574-888X
ISSN (Online): 2212-3946

Meta-Analysis

Transient Fever: The Sole Treatment-Related Adverse Event Associated with Mesenchymal Stromal Cells and Solid Clues from the Real World

Author(s): Yang Wang*, Qiuying Mou, Hanxiao Yi and Zilu Meng

Volume 19, Issue 9, 2024

Published on: 31 October, 2023

Page: [1263 - 1285] Pages: 23

DOI: 10.2174/011574888X179799231023060734

Price: $65

Abstract

Background: The number of trials investigating mesenchymal stromal cells (MSCs) soars within 3 years which urges a study analysing emerging MSC treatment-related adverse events.

Aim: To assess the safety of MSC therapy and provide solid evidence for clinical translation of MSC.

Methods: A meta-analysis of randomized clinical trials (RCTs) published up to April 20th, 2023 was performed. Odds ratio (OR) and 95% confidential intervals (CIs) were used to display pooled results.

Results: 152 randomized clinical trials (RCTs) that incorporated 9228 individuals treated with MSCs from autologous or allogenic adipose tissue, bone marrow, Wharton's Jelly, and placenta tissue were included in the analysis. We discovered appropriate 21 MSC treatment-related adverse events (TRAEs), of which fever [OR, 1.61, 95% CI: 1.22-2.11, p<0.01] was the sole event that was closely associated with MSC therapy. MSCs also trended to lower the incidence rate of tachycardia [OR, 0.83, 95% CI: 0.64-1.09, p=0.14] and fatigue [OR, 0.18, 95% CI: 0.61-1.07, p=0.18]. A separate analysis of studies with long-term follow-up (more than 1 year) demonstrated the close relationship between MSCs and fever [OR, 1.75, 95% CI: 1.26-2.24, p<0.01]. The rest TRAEs did not associate themselves with MSC therapy. Dose-response was also conducted for fever, linearity was discovered between MSCs from allogeneic tissue and Wharton's Jelly and fever.

Conclusion: To date, our results suggest that fever is the only AE closely associated with MSCs.

Keywords: MSC therapy, randomized clinical trials, safety, meta-analysis.

Graphical Abstract
[1]
Brody M, Agronin M, Herskowitz BJ, et al. Results and insights from a phase I clinical trial of Lomecel‐B for Alzheimer’s disease. Alzheimers Dement 2023; 19(1): 261-73.
[http://dx.doi.org/10.1002/alz.12651] [PMID: 35357079]
[2]
Centeno C, Fausel Z, Stemper I, Azuike U, Dodson E. A randomized controlled trial of the treatment of rotator cuff tears with bone marrow concentrate and platelet products compared to exercise therapy: A midterm analysis. Stem Cells Int 2020; 2020: 1-10.
[http://dx.doi.org/10.1155/2020/5962354] [PMID: 32399045]
[3]
Fathi-Kazerooni M, Fattah-Ghazi S, Darzi M, et al. Safety and efficacy study of allogeneic human menstrual blood stromal cells secretome to treat severe COVID-19 patients: Clinical trial phase I & II. Stem Cell Res Ther 2022; 13(1): 96.
[http://dx.doi.org/10.1186/s13287-022-02771-w] [PMID: 35255966]
[4]
Albu S, Kumru H, Coll R, et al. Clinical effects of intrathecal administration of expanded Wharton jelly mesenchymal stromal cells in patients with chronic complete spinal cord injury: A randomized controlled study. Cytotherapy 2021; 23(2): 146-56.
[http://dx.doi.org/10.1016/j.jcyt.2020.08.008] [PMID: 32981857]
[5]
Ramkisoensing AA, Pijnappels DA, Askar SFA, et al. Human embryonic and fetal mesenchymal stem cells differentiate toward three different cardiac lineages in contrast to their adult counterparts. PLoS One 2011; 6(9): e24164.
[http://dx.doi.org/10.1371/journal.pone.0024164] [PMID: 21931658]
[6]
Ward MR, Abadeh A, Connelly KA. Concise Review: Rational Use of Mesenchymal Stem Cells in the Treatment of Ischemic Heart Disease. Stem Cells Transl Med 2018; 7(7): 543-50.
[http://dx.doi.org/10.1002/sctm.17-0210] [PMID: 29665255]
[7]
Mashayekhi M, Mirzadeh E, Chekini Z, et al. Evaluation of safety, feasibility and efficacy of intra-ovarian transplantation of autologous adipose derived mesenchymal stromal cells in idiopathic premature ovarian failure patients: non-randomized clinical trial, phase I, first in human. J Ovarian Res 2021; 14(1): 5.
[http://dx.doi.org/10.1186/s13048-020-00743-3] [PMID: 33407794]
[8]
Sharifzadeh N, Ghasemi A, Tavakol Afshari J, et al. Intrathecal autologous bone marrow stem cell therapy in children with autism: A randomized controlled trial. Asia-Pac Psychiatry 2021; 13(2): e12445.
[http://dx.doi.org/10.1111/appy.12445] [PMID: 33150703]
[9]
Zu Y, Zhou J, Fu Y, et al. Feasibility of reduced-dose posttransplant cyclophosphamide and cotransplantation of peripheral blood stem cells and umbilical cord-derived mesenchymal stem cells for SAA. Sci Rep 2021; 11(1): 253.
[http://dx.doi.org/10.1038/s41598-020-80531-7] [PMID: 33420287]
[10]
Lublin FD, Bowen JD, Huddlestone J, et al. Human placenta-derived cells (PDA-001) for the treatment of adults with multiple sclerosis: A randomized, placebo-controlled, multiple-dose study. Mult Scler Relat Disord 2014; 3(6): 696-704.
[http://dx.doi.org/10.1016/j.msard.2014.08.002] [PMID: 25891548]
[11]
Tsiapalis D, O’Driscoll L. Mesenchymal stem cell derived extracellular vesicles for tissue engineering and regenerative medicine applications. Cells 2020; 9(4): 991.
[http://dx.doi.org/10.3390/cells9040991] [PMID: 32316248]
[12]
Roth M, Spaniol K, Kordes C, et al. The influence of oxygen on the proliferative capacity and differentiation potential of lacrimal gland–derived mesenchymal stem cells. Invest Ophthalmol Vis Sci 2015; 56(8): 4741-52.
[http://dx.doi.org/10.1167/iovs.14-15475] [PMID: 26207311]
[13]
Xu X, Jiang W, Chen L, et al. Evaluation of the safety and efficacy of using human menstrual blood‐derived mesenchymal stromal cells in treating severe and critically ill COVID‐19 patients: An exploratory clinical trial. Clin Transl Med 2021; 11(2): e297.
[http://dx.doi.org/10.1002/ctm2.297] [PMID: 33634996]
[14]
Friedenstein AJ, Chailakhyan RK, Latsinik NV, Panasyuk AF, Keiliss-Borok IV. Stromal cells responsible for transferring the microenvironment of the hemopoietic tissues. Cloning in vitro and retransplantation in vivo. Transplantation 1974; 17(4): 331-40.
[http://dx.doi.org/10.1097/00007890-197404000-00001] [PMID: 4150881]
[15]
Rebelatto CLK, Senegaglia AC, Franck CL, et al. Safety and long-term improvement of mesenchymal stromal cell infusion in critically COVID-19 patients: A randomized clinical trial. Stem Cell Res Ther 2022; 13(1): 122.
[http://dx.doi.org/10.1186/s13287-022-02796-1] [PMID: 35313959]
[16]
Zhang Y, Zhang J, Yi H, et al. A novel MSC-based immune induction strategy for ABO-incompatible liver transplantation: A phase I/II randomized, open-label, controlled trial. Stem Cell Res Ther 2021; 12(1): 244.
[http://dx.doi.org/10.1186/s13287-021-02246-4] [PMID: 33863383]
[17]
Amirdelfan K, Bae H, McJunkin T, et al. Allogeneic mesenchymal precursor cells treatment for chronic low back pain associated with degenerative disc disease: A prospective randomized, placebo-controlled 36-month study of safety and efficacy. Spine J 2021; 21(2): 212-30.
[http://dx.doi.org/10.1016/j.spinee.2020.10.004] [PMID: 33045417]
[18]
Squassoni SD, Sekiya EJ, Fiss E, et al. Autologous infusion of bone marrow and mesenchymal stromal cells in patients with chronic obstructive pulmonary disease: Phase I randomized clinical trial. Int J Chron Obstruct Pulmon Dis 2021; 16: 3561-74.
[http://dx.doi.org/10.2147/COPD.S332613] [PMID: 35002228]
[19]
Schacher FC, Martins Pezzi da Silva A, Silla LMR, Álvares-da-Silva MR. Bone marrow mesenchymal stem cells in acute-on-chronic liver failure grades 2 and 3: A Phase I-II randomized clinical trial. Can J Gastroenterol Hepatol 2021; 2021: 1-9.
[http://dx.doi.org/10.1155/2021/3662776] [PMID: 34395335]
[20]
Shahror RA, Wu CC, Chiang YH, Chen KY. Genetically modified mesenchymal stem cells: The next generation of stem cell-based therapy for TBI. Int J Mol Sci 2020; 21(11): 4051.
[http://dx.doi.org/10.3390/ijms21114051] [PMID: 32516998]
[21]
Lalu MM, McIntyre L, Pugliese C, et al. Safety of cell therapy with mesenchymal stromal cells (SafeCell): A systematic review and meta-analysis of clinical trials. PLoS One 2012; 7(10): e47559.
[http://dx.doi.org/10.1371/journal.pone.0047559] [PMID: 23133515]
[22]
Wang Y, Yi H, Song Y. The safety of MSC therapy over the past 15 years: A meta-analysis. Stem Cell Res Ther 2021; 12(1): 545.
[http://dx.doi.org/10.1186/s13287-021-02609-x] [PMID: 34663461]
[23]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372(71): n71.
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[24]
Xu C, Doi SAR. The robust error meta-regression method for dose–response meta-analysis. Int J Evid-Based Healthc 2018; 16(3): 138-44.
[http://dx.doi.org/10.1097/XEB.0000000000000132] [PMID: 29251651]
[25]
Šponer P, Kučera T, Brtková J, et al. Comparative study on the application of mesenchymal stromal cells combined with tricalcium phosphate scaffold into femoral bone defects. Cell Transplant 2018; 27(10): 1459-68.
[http://dx.doi.org/10.1177/0963689718794918] [PMID: 30203687]
[26]
Shadmanfar S, Labibzadeh N, Emadedin M, et al. Intra-articular knee implantation of autologous bone marrow–derived mesenchymal stromal cells in rheumatoid arthritis patients with knee involvement: Results of a randomized, triple-blind, placebo-controlled phase 1/2 clinical trial. Cytotherapy 2018; 20(4): 499-506.
[http://dx.doi.org/10.1016/j.jcyt.2017.12.009] [PMID: 29428486]
[27]
Zhang R, Yu J, Zhang N, et al. Bone marrow mesenchymal stem cells transfer in patients with ST-segment elevation myocardial infarction: Single-blind, multicenter, randomized controlled trial. Stem Cell Res Ther 2021; 12(1): 33.
[http://dx.doi.org/10.1186/s13287-020-02096-6] [PMID: 33413636]
[28]
Qin H, Zhu X, Zhang B, Zhou L, Wang W. Clinical evaluation of human umbilical cord mesenchymal stem cell transplantation after angioplasty for diabetic foot. Exp Clin Endocrinol Diabetes 2016; 124(8): 497-503.
[http://dx.doi.org/10.1055/s-0042-103684] [PMID: 27219884]
[29]
Karamouzian S, Nematollahi-Mahani SN, Nakhaee N, Eskandary H. Clinical safety and primary efficacy of bone marrow mesenchymal cell transplantation in subacute spinal cord injured patients. Clin Neurol Neurosurg 2012; 114(7): 935-9.
[http://dx.doi.org/10.1016/j.clineuro.2012.02.003] [PMID: 22464434]
[30]
Khalifeh Soltani S, Forogh B, Ahmadbeigi N, et al. Safety and efficacy of allogenic placental mesenchymal stem cells for treating knee osteoarthritis: A pilot study. Cytotherapy 2019; 21(1): 54-63.
[http://dx.doi.org/10.1016/j.jcyt.2018.11.003] [PMID: 30522806]
[31]
Lee WS, Kim HJ, Kim KI, Kim GB, Jin W. Intra-articular injection of autologous adipose tissue-derived mesenchymal stem cells for the treatment of knee osteoarthritis: A Phase IIb, randomized, placebo-controlled clinical trial. Stem Cells Transl Med 2019; 8(6): 504-11.
[http://dx.doi.org/10.1002/sctm.18-0122] [PMID: 30835956]
[32]
Petrou P, Kassis I, Yaghmour NE, Ginzberg A, Karussis D. A phase II clinical trial with repeated intrathecal injections of autologous mesenchymal stem cells in patients with amyotrophic lateral sclerosis. Front BiosciLandm 2021; 26(10): 693-706.
[http://dx.doi.org/10.52586/4980] [PMID: 34719198]
[33]
de la Portilla F, Guerrero JL, Maestre MV, et al. Treatment of faecal incontinence with autologous expanded mesenchymal stem cells: Results of a pilot study. Colorectal Dis 2021; 23(3): 698-709.
[http://dx.doi.org/10.1111/codi.15382] [PMID: 32986295]
[34]
Vanikar AV, Trivedi HL. Stem cell transplantation in living donor renal transplantation for minimization of immunosuppression. Transplantation 2012; 94(8): 845-50.
[http://dx.doi.org/10.1097/TP.0b013e3182664000] [PMID: 22992765]
[35]
Li J, Su P, Li J, Chen G, Xiong Y. Efficacy and safety of stem cell combination therapy for osteonecrosis of the femoral head: A systematic review and meta-analysis. J Healthc Eng 2021; 2021: 1-8.
[http://dx.doi.org/10.1155/2021/9313201] [PMID: 34608416]
[36]
Fu H, Chen Q. Mesenchymal stem cell therapy for heart failure: A meta-analysis. Herz 2020; 45(6): 557-63.
[http://dx.doi.org/10.1007/s00059-018-4762-7] [PMID: 30341444]
[37]
Attar A, Bahmanzadegan Jahromi F, Kavousi S, Monabati A, Kazemi A. Mesenchymal stem cell transplantation after acute myocardial infarction: A meta-analysis of clinical trials. Stem Cell Res Ther 2021; 12(1): 600.
[http://dx.doi.org/10.1186/s13287-021-02667-1] [PMID: 34876213]
[38]
Li DY, Li RF, Sun DX, Pu DD, Zhang YH. Mesenchymal stem cell therapy in pulmonary fibrosis: A meta-analysis of preclinical studies. Stem Cell Res Ther 2021; 12(1): 461.
[http://dx.doi.org/10.1186/s13287-021-02496-2] [PMID: 34407861]
[39]
Wang R, Yao Q, Chen W, et al. Stem cell therapy for Crohn’s disease: Systematic review and meta-analysis of preclinical and clinical studies. Stem Cell Res Ther 2021; 12(1): 463.
[http://dx.doi.org/10.1186/s13287-021-02533-0] [PMID: 34407875]
[40]
Lanzoni G, Linetsky E, Correa D, et al. Umbilical cord mesenchymal stem cells for COVID-19 acute respiratory distress syndrome: A double-blind, phase 1/2a, randomized controlled trial. Stem Cells Transl Med 2021; 10(5): 660-73.
[http://dx.doi.org/10.1002/sctm.20-0472] [PMID: 33400390]
[41]
Gibbons CH, Zhu J, Zhang X, Habboubi N, Hariri R, Veves A. Phase 2a randomized controlled study investigating the safety and efficacy of PDA ‐002 in diabetic peripheral neuropathy. J Peripher Nerv Syst 2021; 26(3): 276-89.
[http://dx.doi.org/10.1111/jns.12457] [PMID: 34169613]
[42]
Chen W, Liu W, Bai Y, et al. Transplantation of mesenchymal stem cells for spinal cord injury: A systematic review and network meta-analysis. J Transl Med 2021; 19(1): 178.
[http://dx.doi.org/10.1186/s12967-021-02843-0] [PMID: 33910588]
[43]
Balck F, Zschieschang A, Zimmermann A, Ordemann R. A randomized controlled trial of problem-solving training (PST) for hematopoietic stem cell transplant (HSCT) patients: Effects on anxiety, depression, distress, coping and pain. J Psychosoc Oncol 2019; 37(5): 541-56.
[http://dx.doi.org/10.1080/07347332.2019.1624673] [PMID: 31304890]
[44]
Ning H, Yang F, Jiang M, et al. The correlation between cotransplantation of mesenchymal stem cells and higher recurrence rate in hematologic malignancy patients: Outcome of a pilot clinical study. Leukemia 2008; 22(3): 593-9.
[http://dx.doi.org/10.1038/sj.leu.2405090] [PMID: 18185520]
[45]
Yi H, Wang Y, Yang Z, Xie Z. Efficacy assessment of mesenchymal stem cell transplantation for burn wounds in animals: A systematic review. Stem Cell Res Ther 2020; 11(1): 372.
[http://dx.doi.org/10.1186/s13287-020-01879-1] [PMID: 32859266]
[46]
Wang Y, Lai X, Wu D, Liu B, Wang N, Rong L. Umbilical mesenchymal stem cell-derived exosomes facilitate spinal cord functional recovery through the miR-199a-3p/145-5p-mediated NGF/TrkA signaling pathway in rats. Stem Cell Res Ther 2021; 12(1): 117.
[http://dx.doi.org/10.1186/s13287-021-02148-5] [PMID: 33579361]
[47]
Zhang T, Ma S, Lv J, et al. The emerging role of exosomes in Alzheimer’s disease. Ageing Res Rev 2021; 68: 101321.
[http://dx.doi.org/10.1016/j.arr.2021.101321] [PMID: 33727157]
[48]
Sansone P, Savini C, Kurelac I, et al. Packaging and transfer of mitochondrial DNA via exosomes regulate escape from dormancy in hormonal therapy-resistant breast cancer. Proc Natl Acad Sci 2017; 114(43): E9066-75.
[http://dx.doi.org/10.1073/pnas.1704862114] [PMID: 29073103]
[49]
Sun JM, Case LE, McLaughlin C, et al. Motor function and safety after allogeneic cord blood and cord tissue‐derived mesenchymal stromal cells in cerebral palsy: An open‐label, randomized trial. Dev Med Child Neurol 2022; 64(12): 1477-86.
[http://dx.doi.org/10.1111/dmcn.15325] [PMID: 35811372]
[50]
Hernigou P, Dubory A, Homma Y, et al. Cell therapy versus simultaneous contralateral decompression in symptomatic corticosteroid osteonecrosis: A thirty year follow-up prospective randomized study of one hundred and twenty five adult patients. Int Orthop 2018; 42(7): 1639-49.
[http://dx.doi.org/10.1007/s00264-018-3941-8] [PMID: 29744647]
[51]
Lan Y, Liu F, Chang L, et al. Combination of umbilical cord mesenchymal stem cells and standard immunosuppressive regimen for pediatric patients with severe aplastic anemia. BMC Pediatr 2021; 21(1): 102.
[http://dx.doi.org/10.1186/s12887-021-02562-x] [PMID: 33639900]
[52]
Moon KC, Suh HS, Kim KB, et al. Potential of allogeneic adipose-derived stem cell–hydrogel complex for treating diabetic foot ulcers. Diabetes 2019; 68(4): 837-46.
[http://dx.doi.org/10.2337/db18-0699] [PMID: 30679183]
[53]
Shi L, Yuan X, Yao W, et al. Human mesenchymal stem cells treatment for severe COVID-19: 1-year follow-up results of a randomized, double-blind, placebo-controlled trial. EBioMedicine 2022; 75: 103789.
[http://dx.doi.org/10.1016/j.ebiom.2021.103789] [PMID: 34963099]
[54]
Wei Y, Chen X, Zhang H, et al. Efficacy and safety of bone marrow-derived mesenchymal stem cells for chronic antibody-mediated rejection after kidney transplantation- a single-arm, two-dosing-regimen, Phase I/II Study. Front Immunol 2021; 12: 662441.
[http://dx.doi.org/10.3389/fimmu.2021.662441] [PMID: 34248942]
[55]
Kim HJ, Cho KR, Jang H, et al. Intracerebroventricular injection of human umbilical cord blood mesenchymal stem cells in patients with Alzheimer’s disease dementia: A phase I clinical trial. Alzheimers Res Ther 2021; 13(1): 154.
[http://dx.doi.org/10.1186/s13195-021-00897-2] [PMID: 34521461]

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