Efficacy and Mode of Action of Mesenchymal Stem Cells in Non-Ischemic Dilated Cardiomyopathy: A Systematic Review.
Cecilie HoeegSabina FrljakAbbas Ali QayyumBojan VrtovecJens KastrupAnnette EkblondBjarke FollinPublished in: Biomedicines (2020)
Non-ischemic dilated cardiomyopathy (NIDCM) constitutes one of the most common causes to non-ischemic heart failure. Despite treatment, the disease often progresses, causing severe morbidity and mortality, making novel treatment strategies necessary. Due to the regenerative actions of mesenchymal stem cells (MSCs), they have been proposed as a treatment for NIDCM. This systematic review aims to evaluate efficacy and mode of action (MoA) of MSC-based therapies in NIDCM. A systematic literature search was conducted in Medline (Pubmed) and Embase. A total of 27 studies were included (3 clinical trials and 24 preclinical studies). MSCs from different tissues and routes of delivery were reported, with bone marrow-derived MSCs and direct intramyocardial injections being the most frequent. All included clinical trials and 22 preclinical trials reported an improvement in cardiac function following MSC treatment. Furthermore, preclinical studies demonstrated alterations in tissue structure, gene, and protein expression patterns, primarily related to fibrosis and angiogenesis. Consequently, MSC treatment can improve cardiac function in NIDCM patients. The MoA underlying this effect involves anti-fibrosis, angiogenesis, immunomodulation, and anti-apoptosis, though these processes seem to be interdependent. These encouraging results calls for larger confirmatory clinical studies, as well as preclinical studies utilizing unbiased investigation of the potential MoA.
Keyphrases
- mesenchymal stem cells
- systematic review
- clinical trial
- heart failure
- umbilical cord
- cell therapy
- gene expression
- bone marrow
- randomized controlled trial
- early onset
- atrial fibrillation
- oxidative stress
- cell proliferation
- cell death
- meta analyses
- combination therapy
- prognostic factors
- brain injury
- ischemia reperfusion injury
- blood brain barrier
- cell cycle arrest
- climate change
- open label
- cerebral ischemia
- liver fibrosis
- vascular endothelial growth factor
- ultrasound guided
- platelet rich plasma
- genome wide analysis