Human mesenchymal stem cells for the management of systemic sclerosis. Systematic review.

INTRODUCTION: Sistemic Sclerosis (SSc) is a heterogeneous autoimmune disease with a high rate of progression and therapeutic failure, and treatment is a challenge, new therapeutic proposals being needed, being mesenchymal stem cells (MSCs) considered as alternative therapy for SSc for its immunomodulatory capacity. We evaluated the efficacy and safety of human MSC (hMSC) in patients with SSc through a systematic literature review (SLR). METHODS: SLR (PRISMA guideline) on MEDLINE/OVID, LILACS, EMBASE, and Cochrane/OVID bases (until July 2020, without limits). All types of clinical studies were considered: patients ≥18 years old with SSc and treatment with hMSC. EXCLUSION CRITERIA: animal models, autologous/allogenic hematopoietic stem cell transplants, narrative reviews, letters to the editor. MeSH and "Key word" terms were used. The level of evidence and the quality rating were rated [Joanna Briggs Institute (JBI) lists]. Registration in PROSPERO repository (ID CRD42020185245) The Synthesis Without Meta-analysis (SWiM) guideline was followed. RESULTS: We initially identified 508 articles, of which 11 were finally included (8 case series and 3 case reports). The 11 articles included 101 patients (85 female, age range 18-75 years). The level of evidence was mostly 4 (JBI); the quality of evidence was met (≥50% of JBI items). SWiM showed that vascular skin involvement (digital ulcers, necrosis, and gangrene) and associated pain were the predominant outcomes, while improvements were found in almost all cases. One patient died in the first month, and the frequency of complications was low. Expanded hMSCs were used in 24 patients and other cell sources in the remaining patients. CONCLUSION: There is too little reported data to reach definite conclusions about the use of hMSC in SSc. Further studies with better epidemiological designs are needed to evaluate the benefit of hMSCs in SSc patients.

El sistema de la proteína C activada en el cuadro séptico / The effects of activated protein c on the sepsis syndrome

Durante los últimos años y con el advenimiento del conocimiento y las técnicas de biología molecular, las concepciones fisiopatológicas del cuadro séptico han cambiado en forma dramática. Prueba de ello es la aprobación del empleo de formas recombinantes de la proteína C activada por parte de la Administración Federal de Alimentos y Medicamentos de Estados Unidos (FDA). Con la presente revisión se pretende hacer un análisis del estado general del conocimiento respecto al papel que la proteína C activada y su sistema de respuesta cumplen en el contexto del cuadro séptico...

The concepts on the pathophysiology of the clinical manifestations of sepsis have changed dramatically during recent years due to the development of knowledge and techniques in molecular biology. A proof of this is the approval by the US Food and Drug Administration (FDA) of the use of recombinant forms of activated protein C. This review attempts to analyze the overall state of knowledge regarding the role activated protein C and its response system play on the sepsis syndrome...