- A small clinical trial suggests stem cells from umbilical cords can reduce the mortality rate of COVID-19 patients on ventilators.
- The cells may help calm the cytokine storm implicated in acute respiratory distress syndrome.
- The treatment appears particularly effective among patients with underlying health conditions such as obesity, kidney disease, and diabetes.
In the early months of the pandemic in 2020, the mortality rate of patients with pneumonia due to COVID-19 in the intensive care unit (ICU) of Persahabatan Central Hospital in Jakarta, Indonesia, reached 87%.
“[T]his situation necessitated that clinicians fashion a breakthrough therapy to increase the survival of patients in the ICU,” write Professor Ismail Hadisoebroto Dilogo, M.D., Ph.D., and his colleagues in the journal Stem Cells Translational Medicine.
In their paper, Prof. Dilogo and his team, specialists in stem cell therapy at Cipto Mangunkusumo Central Hospital in Jakarta, describe a clinical trial of the treatment they devised.
Between May 1 and October 10, 2020, the trial randomly assigned 40 patients with COVID-19 to receive either injections of umbilical cord stem cells in saline solution or injections of saline alone.
All the patients had severe pneumonia and were on ventilators in the ICU at four hospitals in Jakarta.
Out of the 20 patients who received injections of stem cells, 10 survived, while only 4 out of 20 patients survived in the control group.
The researchers report that among patients with underlying health conditions, those who received the treatment were 4.5 times as likely to survive compared with controls.
There were no adverse events that the scientists could attribute to the treatment.
Cytokine storm
The leading cause of death in COVID-19 is acute respiratory distress syndrome, which may be due to an overreaction of the immune system or “cytokine storm” — although this remains controversial.
The type of stem cell that researchers used in the new trial, called a mesenchymal stromal cell or MSC, has shown promise for treating lung diseases such as asthma and chronic obstructive pulmonary disease.
MSCs appear to improve these conditions by toning down the immune system’s inflammatory responses.
The cells are found in several tissues in the body, including bone marrow and adipose tissue, but also
The latter is a more freely available, readily accessible source. In addition, the recipient’s immune system is
In their paper, Prof. Dilogo and his co-authors conclude that MSCs may increase survival rates among critically ill patients by switching their immune systems to an anti-inflammatory mode.
They report that circulating levels of a pro-inflammatory cytokine called interleukin 6 were significantly reduced in patients who received infusions of MSCs compared with control patients.
Interestingly, the antibody-drug tocilizumab — which blocks IL-6 receptors — is one of the few treatments found to
Naive stem cells
In contrast to the few other studies of MSCs in COVID-19, published in
The earlier studies from China, which were on a smaller scale, used cells that had undergone a complex procedure to strip them of ACE-2 receptors.
These are the receptors that SARS-CoV-2, the virus that causes COVID-19, uses to break into its host cells in the human body.
However, the new trial suggests that this precaution is unnecessary to reap the potential benefits of the treatment, which greatly simplifies the procedure.
The researchers believe their approach could lead to an effective therapy for COVID-19 patients in intensive care who do not respond to conventional treatment.
“Reflecting on our study result, we will continue to explore the usage of MSC in COVID-19 cases,” said Bernadus Riyan, M.D., Prof. Dilogo’s assistant.
He told Medical News Today that Prof. Dilogo and his team hope to make MSCs from umbilical cords more widely available to save the lives of more critically ill patients in Indonesia.
Limitations of the study
The authors acknowledge their study had several limitations.
For example, researchers need to conduct more clinical trials involving larger numbers of patients to confirm the results.
In addition, the authors report that they did not apply strict criteria to determine how long patients in each experimental group received treatment in the ICU. This hidden variable may have biased the results.
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