Abstract
Multiple sclerosis (MS) is considered to be a central nervous system (CNS) chronic inflammatory demyelinating disease, affecting more than 2 million individuals worldwide. In this meta-analysis, we aimed to assess the safety and efficacy of autologous mesenchymal stem cells (aMSCs) in treating MS patients. The PubMed, Embase, Cochrane, Web of Science, and Clinical Trial databases were searched in September 2019. The analysis was conducted for three endpoints: transplant-related mortality (TRM), rate of disease progression, and no evidence of disease activity (NEDA) status. RevMan and the metaprop command of the meta package in R was used in assessing the efficacy and safety of aMSCs. Subgroup analyses were performed for exploration of heterogeneity regarding outcomes. Nine studies comprising 133 patients were included in the meta-analysis. The pooled estimate of TRM was 0% (95% confidence interval (CI) 0%–0.3%). The rate of progression was 16% at 6 months (95% CI 10%–27%) and 35% at 1 year (95% CI 27%–46%). Lower 6-month and 1-year progression rates were significantly associated with intrathecal injection (p = 0.02; p = 0.003). The pooled proportion of NEDA patients at 6 months was 72% (95% CI 58%–89%) and at 1 year was 62% (95% CI 42%–81%). Cell transplantation with aMSCs in MS patients is safe, with the largest benefit profile obtained in patients with aMSCs intrathecal injection.
Highlights
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease in the central nervous system (CNS), leading to demyelination, neurodegeneration, and gliosis [1]
A total of 82 duplicated studies were excluded, and the titles and abstracts of the remaining articles were screened by two reviewers
We performed subgroup analysis on the percentage of patients with no evidence of disease activity (NEDA) at 6 months and 1 year, and the results showed that there were no significant differences between the age, Expanded Disability Status Scale (EDSS), MS duration, and transplantation method of the different groups
Summary
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease in the central nervous system (CNS), leading to demyelination, neurodegeneration, and gliosis [1]. Most effective diseasemodifying therapies (DMTs) improve cognitive and physical disability in MS patients, there has been limited efficacy in these treatments and they are often related with side effects [1, 3]. MSCs have been used therapeutically in over 700 clinical trials which include heart diseases, stroke, and autoimmune diseases (multiple sclerosis, graft-versus-host disease, systemic lupus erythematosus, and so on) [5, 6]. In addition to their multipotential abilities, MSCs have displayed immunoregulatory and neuroprotective properties [3, 4, 7]. Related studies on MSCs using the experimental autoimmune encephalomyelitis (EAE), an animal model for MS, have shown that increased numbers of regulatory T cells (Tregs), decreased demyelination, and inflammation [6]. The meta-analysis of autologous hematopoietic stem cell transplantation (aHSCT) has been evaluated in treating MS patients [9]
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