BackgroundSepsis is a major cause of death in hospitalised patients. Dysregulated immune response is the driving pathophysiologic phenomenon underlying tissue damage and organ failure. Due to immune-modulatory properties of mesenchymal stromal cells (MSCs) several trials experimented their efficacy in sepsis. In-vitro and preclinical studies are quite promising however, clinical trials showed inconsistent results.Methods and resultsWe gathered available evidence in a meta-analysis to figure out if clinical advantage of cellular therapy in sepsis. Eleven trials were included with total of 360 patients, 191 received MSCs and 169 as control. The overall mortality was 0.248 with 95% CI 0.191–0.316. Relative to control, mortality Odds ratio (OR) was 0.54, 95% CI 0.294–1.006 and P = 0.05. Frequent MSCs infusions showed better survival, OR = 0.3, 95% CI 0.1–0.87 and P = 0.03. While survival in the cohort that received infrequent MSCs infusions was comparable with the control, OR = 0.7, 95% CI 0.35–1.41 and P = 0.3. Also, survival benefit was associated with the 1 × 106 cell/kg dose, OR = 0.31, 95% CI 0.14–0.68 and P = 0.004. While the cohort that received higher doses had OR 1.22, 95% CI 0.54–2.75 and P = 0.6. Length of hospitalisation in the MSCs cohort was significantly shorter. The standardized difference in means (d) was − 0.443, 95% CI − 0.743 to − 0.144, P = 0.004. Also, MSCs therapy was associated with significantly shorter ICU stay, d = − 0.349 with 95% CI of − 0.647 to − 0.051 and P = 0.022. Furthermore, MSCs therapy was associated with significant reduction of the proinflammatory cytokines IL-6 and IL-8 but non-significant increase of the anti-inflammatory cytokine IL-10.ConclusionCellular therapy with MSCs is a promising therapeutic modality in sepsis. Positive effects are mainly associated with frequent infusions and the dose of 1 × 106 cell/kg. Larger scale studies are needed to address the pending questions about the optimal indications and cell manipulation conditions.
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