Abstract
Because of the polysystemic nature of coronavirus disease 2019 (COVID-19), during the present pandemic, there have been serious concerns regarding pregnancy, vertical transmission, and intrapartum risk. The majority of pregnant patients with COVID-19 infection present with mild or asymptomatic course of the disease. Some cases were hospitalized, and few needed intensive care unit admission, or mechanical ventilation. There have also been scarce case reports where neonates required mechanical ventilation post COVID-19 pregnancies. Without approved therapies other than dexamethasone, advanced mesenchymal cell therapy is one immunomodulatory therapeutic approach that is currently explored and might hold great promise. We suggest that the circulating fetal stem cells might have an immune-protective effect to mothers and contribute to the often mild and even asymptomatic post-COVID-19 pregnancies. Thus, COVID-19 pregnancies come forth as a paradigm to be further and more comprehensively approached, to understand both the mechanism and action of circulating stem cells in immunoprotection and hypoxia in microcirculation.
Highlights
Maternal–fetal transmission of viral diseases may occur transvaginally or through the hematogenic, i.e., the transplacental transmission pathway
mesenchymal stem cells (MSCs)-derived EV therapies come with further clinical advantages as they pass across small blood capillaries due because of their small size; they have low chances of tumor formation as they are non-proliferative, and they are immune privileged as they are human leukocyte antigen (HLA)-I and HLA-II negative
Because of these immunomodulatory properties of MSCs, stem cell therapy clinical protocols against SARS-CoV2/COVID-19 have been registered, and six trials have been completed
Summary
Maternal–fetal transmission of viral diseases may occur transvaginally or through the hematogenic, i.e., the transplacental transmission pathway. The maternal immune system may tolerate fetal antigens suppressing cell-mediated immunity while retaining normal humoral immunity, changes known to occur locally at the maternal–fetal interface, which could affect systemic immune responses to infection (Jamieson et al, 2006) This may render pregnant women more vulnerable to viral infections, especially in cases where the infections may have an effect on the cardiorespiratory system during pregnancy and could enhance progression to respiratory failure (Dashraath et al, 2020). MSC-derived EV therapies come with further clinical advantages as they pass across small blood capillaries due because of their small size; they have low chances of tumor formation as they are non-proliferative, and they are immune privileged as they are HLA-I and HLA-II negative Because of these immunomodulatory properties of MSCs, stem cell therapy clinical protocols against SARS-CoV2/COVID-19 have been registered, and six trials have been completed (details are available at www.clinicaltrials.gov). Compared to adult BM-MSCs, UC-MSCs are superior in colonyforming capacity and differentiation potential; PL-MSCs have a lower colony-forming capacity but similar or less differentiation potential (Beeravolu et al, 2017)
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