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Mesenchymal stromal cell extracellular vesicles as therapy for acute and chronic respiratory diseases: A meta-analysis.
Tieu, Alvin; Hu, Kevin; Gnyra, Catherine; Montroy, Joshua; Fergusson, Dean A; Allan, David S; Stewart, Duncan J; Thébaud, Bernard; Lalu, Manoj M.
  • Tieu A; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Hu K; Clinical Epidemiology Program, BLUEPRINT Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Gnyra C; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Montroy J; Clinical Epidemiology Program, BLUEPRINT Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Fergusson DA; Clinical Epidemiology Program, BLUEPRINT Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Allan DS; Clinical Epidemiology Program, BLUEPRINT Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Stewart DJ; Clinical Epidemiology Program, BLUEPRINT Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
  • Thébaud B; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
  • Lalu MM; Clinical Epidemiology Program, BLUEPRINT Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Extracell Vesicles ; 10(12): e12141, 2021 10.
Article in English | MEDLINE | ID: covidwho-1451869
ABSTRACT
Preclinical studies suggest mesenchymal stromal cell extracellular vesicles (MSC-EVs) reduce inflammation and improve organ function in lung diseases; however, an objective analysis of all available data is needed prior to translation. Using rigorous meta-research methods, we determined the effectiveness of MSC-EVs for preclinical respiratory diseases and identified experimental conditions that may further refine this therapy. A systematic search of MEDLINE/Embase identified 1167 records. After screening, 52 articles were included for data extraction and evaluated for risk of bias and quality of reporting in study design. A random effects meta-analysis was conducted for acute lung injury (ALI; N = 23), bronchopulmonary dysplasia (BPD; N = 8) and pulmonary arterial hypertension (PAH; N = 7). Subgroup analyses identified EV methods/characteristics that may be associated with improved efficacy. Data is presented as standardized mean differences (SMD) or risk ratios (RR) with 95% confidence intervals (CI). For ALI, MSC-EVs markedly reduced lung injury (SMD -4.33, CI -5.73 to -2.92), vascular permeability (SMD -2.43, CI -3.05 to -1.82), and mortality (RR 0.39, CI 0.22 to 0.68). Small EVs were more consistently effective than large EVs whereas no differences were observed between tissue sources, immunocompatibility or isolation techniques. For BPD, alveolarization was improved by MSC-EVs (SMD -1.45, CI -2.08 to -0.82) with small EVs more consistently beneficial then small/large EVs. In PAH, right ventricular systolic pressure (SMD -4.16, CI -5.68 to -2.64) and hypertrophy (SMD -2.80, CI -3.68 to -1.91) were significantly attenuated by EVs. In BPD and PAH, EVs isolated by ultracentrifugation demonstrated therapeutic benefit whereas tangential flow filtration (N = 2) displayed minimal efficacy. Lastly, risk of bias and quality of reporting for experimental design were consistently unclear across all studies. Our findings demonstrate clear potential of MSC-EVs to be developed as therapy for acute and chronic lung diseases. However, greater transparency in research design and direct comparisons of isolation technique and EV subtypes are needed to generate robust evidence to guide clinical translation. Protocol Registration PROSPERO CRD42020145334.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration Disorders / Mesenchymal Stem Cell Transplantation / Mesenchymal Stem Cells / Extracellular Vesicles Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Animals / Humans Language: English Journal: J Extracell Vesicles Year: 2021 Document Type: Article Affiliation country: Jev2.12141

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration Disorders / Mesenchymal Stem Cell Transplantation / Mesenchymal Stem Cells / Extracellular Vesicles Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Animals / Humans Language: English Journal: J Extracell Vesicles Year: 2021 Document Type: Article Affiliation country: Jev2.12141