Abstract
BackgroundTrials investigating the role of mesenchymal stem cells (MSCs) in increasing ejection fraction (LVEF) after acute myocardial infarction (AMI) have raised some controversies. This study was conducted to find whether transplantation of MSCs after AMI can help improve myocardial performance indices or clinical outcomes.MethodsRandomized trials which evaluated transplantation of MSCs after AMI were enrolled. The primary outcome was LVEF change. We also assessed the role of cell origin, cell number, transplantation time interval after AMI, and route of cell delivery on the primary outcome.ResultsThirteen trials including 956 patients (468 and 488 in the intervention and control arms) were enrolled. After excluding the biased data, LVEF was significantly increased compared to the baseline among those who received MSC (WMD = 3.78%, 95% CI: 2.14 to 5.42, p < 0.001, I2 = 90.2%) with more pronounced effect if the transplantation occurred within the first week after AMI (MD = 5.74%, 95%CI: 4.297 to 7.183; I2 = 79.2% p < 0.001). The efficacy of trans-endocardial injection was similar to that of intracoronary infusion (4% [95%CI: 2.741 to 5.259, p < 0.001] vs. 3.565% [95%CI: 1.912 to 5.218, p < 0.001], respectively). MSC doses of lower and higher than 107 cells did not improve LVEF differently (5.24% [95%CI: 2.06 to 8.82, p = 0.001] vs. 3.19% [95%CI: 0.17 to 6.12, p = 0.04], respectively).ConclusionTransplantation of MSCs after AMI significantly increases LVEF, showing a higher efficacy if done in the first week. Further clinical studies should be conducted to investigate long-term clinical outcomes such as heart failure and cardiovascular mortality.
Highlights
Trials investigating the role of mesenchymal stem cells (MSCs) in increasing ejection fraction (LVEF) after acute myocardial infarction (AMI) have raised some controversies
Performing a meta-analysis seemed essential to reveal the real effect of these cells, so this study aimed to investigate the effect of MSC on the cardiac function after AMI and factors affecting it by conducting a meta-analysis
The mesenchymal stem cells were injected through intracoronary route in ten studies, intramyocardial route in two studies, and intravenous in one study
Summary
Trials investigating the role of mesenchymal stem cells (MSCs) in increasing ejection fraction (LVEF) after acute myocardial infarction (AMI) have raised some controversies. One approach to restore the damaged myocardium after MI has pointed at stem cell-based therapies [6]. Attar et al Stem Cell Research & Therapy (2021) 12:600 to reconstruct the damaged myocardium. Many studies on animals and humans have been performed to assess different cell types and their ability to repair cardiac and vascular damage in the settings of MI, cardiomyopathy, etc. Most of the studies on cell therapy in AMI are done by BM-MNCs. Based on a meta-analysis by Fisher and colleagues, treatment with BM-MNC would increase LVEF after AMI by 2.72% [9]. Studies on the mesenchymal stem cells (MSC)s are more encouraging. In the TAC-HFT trial, it was shown that MSC was about twice as much effective as the bone marrow-derived mononuclear cells (BM-MNCs) [10]
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