Safwan M, Bourgleh MS, Aldoush M, Haider KH. Tissue-source effect on mesenchymal stem cells as living biodrugs for heart failure: Systematic review and meta-analysis. World J Cardiol 2024; 16(8): 469-483 [PMID: 39221190 DOI: 10.4330/wjc.v16.i8.469]
Corresponding Author of This Article
Khawaja Husnain Haider, PhD, Professor, Department of Basic Sciences, Sulaiman Al Rajhi University, PO Box 777, Al Bukairiyah 51941, Saudi Arabia. kh.haider@sr.edu.sa
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Moaz Safwan, Mariam Safwan Bourgleh, Mohamed Aldoush, Khawaja Husnain Haider, Department of Basic Sciences, Sulaiman Al Rajhi University, Al Bukairiyah 51941, Saudi Arabia
Author contributions: Haider KH designed and produced the study and its methodology; Safwan M and Bourgleh MS performed database research and screened the extracted records against eligibility criteria; Bourgleh MS, Aldoush M, and Safwan M performed the data extraction and plotting; Safwan M and Aldoush M reviewed and validated the extracted data; Safwan M and Bourgleh MS performed the quality assessment of the included trials; Bourgleh MS and Safwan M conducted the statistical analysis; Safwan M and Haider KH drafted the first manuscript; All the authors contributed to the final manuscript, reviewed the final manuscript and have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Khawaja Husnain Haider, PhD, Professor, Department of Basic Sciences, Sulaiman Al Rajhi University, PO Box 777, Al Bukairiyah 51941, Saudi Arabia. kh.haider@sr.edu.sa
Received: May 6, 2024 Revised: June 24, 2024 Accepted: July 23, 2024 Published online: August 26, 2024 Processing time: 112 Days and 3.2 Hours
Abstract
BACKGROUND
Mesenchymal stem cells (MSCs), as living biodrugs, have entered advanced phases of clinical assessment for cardiac function restoration in patients with myocardial infarction and heart failure. While MSCs are available from diverse tissue sources, bone-marrow-derived MSCs (BM-MSCs) remain the most well-studied cell type, besides umbilical-cord-derived MSCs (UC-MSCs). The latter offers advantages, including noninvasive availability without ethical considerations.
AIM
To compare the safety and efficacy of BM-MSCs and UC-MSCs in terms of left ventricular ejection fraction (LVEF), 6-min walking distance (6MWD), and major adverse cardiac events (MACEs).
METHODS
Five databases were systematically searched to identify randomized controlled trials (RCTs). Thirteen RCTs (693 patients) were included using predefined eligibility criteria. Weighted mean differences and odds ratio (OR) for the changes in the estimated treatment effects.
RESULTS
UC-MSCs significantly improved LVEF vs controls by 5.08% [95% confidence interval (CI): 2.20%-7.95%] at 6 mo and 2.78% (95%CI: 0.86%-4.70%) at 12 mo. However, no significant effect was observed for BM-MSCs vs controls. No significant changes were observed in the 6MWD with either of the two cell types. Also, no differences were observed for MACEs, except rehospitalization rates, which were lower only with BM-MSCs (odds ratio 0.48, 95%CI: 0.24-0.97) vs controls.
CONCLUSION
UC-MSCs significantly improved LVEF compared with BM-MSCs. Their advantageous characteristics position them as a promising alternative to MSC-based therapy.
Core Tip: Mesenchymal stem cells (MSCs) are fast emerging as living biodrugs to repair and replace dysfunctional myocardium. While MSCs are available from diverse adult and fetal tissues, bone-marrow-derived MSCs (BM-MSCs; adult tissue source) and umbilical-cord-derived MSCs (UC-MSCs; fetal tissue source) remain the most well-studied types during recent clinical trials. The primary aim of this systematic review and meta-analysis was to evaluate the comparative safety and effectiveness of BM-MSC- and UC-MSC-based therapy in heart failure patients, analyzing left ventricular ejection fraction and 6-min walking distance as the primary functional and clinical outcomes.
