Safety and efficacy of autologous bone marrow mesenchymal stem cells for dilated cardiomyopathy：a Meta-analysis / 中国组织工程研究

ABSTRACT

BACKGROUND:Autologous bone marrow mesenchymal stem cels (BMSCs) transplantation has been used for clinical treatment of dilated cardiomyopathy. But the efficacy and safety of autologous BMSCs transplantation remains controversial. OBJECTIVE: To systematicaly assess the efficacy and safety of autologous BMSCs transplantation for treatment of dilated cardiomyopathy by using meta-analysis approach. METHODS:PubMed, Cochrane Library (Issue 2, 2016), Embase, CNKI, CBM, VIP, WanFang were systemicaly searched for relevant randomized controled trials (RCTs) about autologous BMSCs transplantation and conventional drugs for the treatment of dilated cardiomyopathy. After information extracting and quality assessing, Meta-analysis of left ventricular ejection fraction, left ventricular end-diastolic diameter, 6-minute walking distance, percentage of myocardial perfusion defect, mortality, incidence of malignant arrhythmia events and heart transplantation rate during treatment and folow-up was performed using R3.1.0 software. RESULTS AND CONCLUSION:A total of 7 RCTs involving 341 patients were included. Meta-analysis results showed that for efficacy, compared with the conventional drugs, BMSCs can increase the left ventricular ejection fraction [1 month post-treatment mean difference (MD)=3.02, 95% confidence interval (CI) (1.55, 4.49); 3 months post-treatmentMD=4.38, 95%CI(3.55, 5.52); 6 months post-treatmentMD=6.47, 95%CI(4.78, 8.15);≥ 12 months post-treatmentMD=8.23, 95%CI(5.15, 9.19)]; decrease the left ventricular end-diastolic diameter after 3 months [3 months post-treatmentMD=-0.65, 95%CI(-0.72,-0.59); 6 months post-treatmentMD=-0.12, 95%CI(-0.21,-0.03);≥ 12 months post-treatmentMD=-0.19, 95%CI(-0.24,-0.13)]; increase 6-minute walking distance after 6 months [6 months post-treatmentMD=87.70, 95%CI(51.55, 123.85);≥ 12 months post-treatmentMD=143.83, 95%CI(122.73, 164.93)]; and decrease percentage of myocardial perfusion defect at 3 months [MD=-3.56, 95%CI(-5.57,-1.55)]. For safety, BMSCs can decrease the mortality [risk ratio=0.46, 95%CI(0.24, 0.89)], but there is no significant difference in the incidence of malignant arrhythmia events and heart transplantation rate between two treatment groups. To conclude, these results indicate that BMSCs transplantation for dilated cardiomyopathy is one of effective and safe treatments.