Mesenchymal stem cell transplantation improves the prognosis of ischemic stroke:a Meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND: Mesenchymal stem cell (MSC) transplantation has been gradually developed to improve the prognosis of cerebral infarction and its sequelae in clinical trials, which has been identified as effective and safe. A small sample size, however, results in the lack of evidence-based medical evidence.OBJECTIVE: To systematically review the efficacy of MSC transplantation on the prognosis of cerebral infarction. METHODS: In order to collect randomized controlled trials (RCTs) of MSC transplantation for the prognosis of cerebral infarction, we searched Cochrane Library, PubMed, Ovid, CBM, CNKI, WanFang, and VIP Data from its inception to November 2016. Articles addressing MSCs transplantation alone or with conventional drug treatment and/or rehabilitation training versus conventional drug treatment alone or with rehabilitation training were included. Two authors independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias. Thereafter, qualitative description and Meta-analysis were performed. RESLUTS AND CONCLUSION: Ten RCTs involving 626 cerebral infarction patients were included in the Meta-analysis. The results showed that the MSCs group was superior to the control group with statistical significance in the daily life ability(Barthel index)[MD=20.06, 95%CI(9.95,30.18),P=0.000 1],motor function(Fugl-Meyer scale)[MD=14.60,95% CI(12.96,16.25),P<0.000 01],personal disability (functional independent measure)[MD=15.16,95%CI(9.06,21.26),P<0.000 01]and neurological deficit score(National Institute of Health stroke scale)[MD=-2.59,95% CI(-3.14,-2.05),P<0.000 01].Low fever and mild headache were reported by four included studies,and waist pain was only by one study, but these symptoms went away by themselves or after symptomatic treatment. Subgroup analysis suggested that MSCs from the bone marrow were superior to those from the umbilical cord and cord blood, but showed a greater heterogeneity. It is suggested that the MSC transplantation ameliorate the prognosis in patients with cerebral infarction, significantly improve the activities of daily living, motor function, personal disability and neurological function, with no presence of serious adverse effects. However, high-quality studies with large sample size are required for further investigation on the clinical application of MSC transplantation.