Mesenchymal Stem Cells
Last Updated: October 9, 2020
Mesenchymal stem cells are investigational products that have been studied extensively for broad clinical applications in regenerative medicine1 and for their immunomodulatory properties.2 It is hypothesized that mesenchymal stem cells could reduce the acute lung injury and inhibit the cell-mediated inflammatory response induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- The COVID-19 Treatment Guidelines Panel recommends against the use of mesenchymal stem cells for the treatment of COVID-19, except in a clinical trial (AII).
Rationale for Recommendation
No mesenchymal stem cells are approved by the Food and Drug Administration (FDA) for the treatment of COVID-19. There are insufficient data to assess the role of mesenchymal stem cells for the treatment of COVID-19.
The FDA has recently issued several warnings about patients being potentially vulnerable to stem cell treatments that are illegal and potentially harmful.3 Several cord blood-derived products are currently licensed by the FDA for indications such as the treatment of cancer (e.g., stem cell transplant) or rare genetic diseases, and as scaffolding for cartilage defects and wound beds. None of these products are approved for the treatment of COVID-19 or any other viral disease.4 In the United States, mesenchymal stem cells should not be used for the treatment of COVID-19 outside of an FDA-approved clinical trial, expanded access programs, or an Emergency Investigational New Drug application (AII).
Rationale for Use in COVID-19
Mesenchymal stem cells are multipotent adult stem cells that are present in most human tissues, including the umbilical cord. Mesenchymal stem cells can self-renew by dividing and can differentiate into multiple types of tissues, including osteoblasts, chondroblasts, adipocytes, hepatocytes, and others, which has led to a robust clinical research agenda in regenerative medicine. It is hypothesized that mesenchymal stem cells could reduce the acute lung injury and inhibit the cell-mediated inflammatory response induced by SARS-CoV-2. Furthermore, mesenchymal stem cells lack the angiotensin-converting enzyme 2 receptor that SARS-CoV-2 uses for viral entry into cells; therefore, mesenchymal stem cells are resistant to infection.5,6
Data supporting the use of mesenchymal stem cells in patients with viral infections, including SARS-CoV-2 infection, are limited to case reports and small, open-label studies.
Clinical Data for COVID-19
- A pilot study of intravenous mesenchymal stem cell transplantation in China enrolled 10 patients with confirmed COVID-19 categorized according to the National Health Commission of China criteria as critical, severe, or common type. Seven patients (one with critical illness, four with severe illness, and two with common-type illness) received mesenchymal stem cells; three patients with severe illness received placebo. All seven patients who received mesenchymal stem cells recovered. Among the three severely ill control patients, one died, one developed acute respiratory distress syndrome (ARDS), and one remained stable with severe disease.7
- A small clinical trial evaluated human umbilical cord mesenchymal stem cell (hUC-MSC) infusion in patients with severe COVID-19 who had not responded to standard of care therapies after 7 to 10 days of treatment. The standard of care therapies included supplemental oxygen, umifenovir/oseltamivir, antibiotics if indicated, and glucocorticosteroids. The study was intended as a randomized controlled trial; however, due to the lack of sufficient hUC-MSCs, it was not possible to randomize the participants as originally planned. Among the 41 patients eligible to participate in the study, 12 received hUC-MSC infusion and 29 received standard of care therapies only. The study arms were well balanced with regard to demographic characteristics, laboratory test results, and disease severity. All 12 participants who received hUC-MSC infusion recovered without requiring mechanical ventilation and were discharged to home, whereas four patients who received only standard of care therapies progressed to critical illness requiring mechanical ventilation, and three of these patients died. These results are not statistically significant and interpretation of the study is limited by its lack of randomization and small sample size.8
Clinical Data for Other Viral Infections
- In an open-label study of mesenchymal stem cells for the treatment of H7N9 influenza in China, 17 patients received mesenchymal stem cell treatment plus standard of care, and 44 patients received standard of care only. In the mesenchymal stem cell group, three patients (17.6%) died; in the control group, 24 patients (54.5%) died. The 5-year follow-up was limited to five patients in the mesenchymal stem cell group. No safety concerns were identified.9
See ClinicalTrials.gov for a list of clinical trials evaluating mesenchymal stem cells for the treatment of COVID-19, COVID-19-related ARDS, and COVID-19-associated multiorgan system inflammatory syndrome in children (MIS-C).
Risks associated with mesenchymal stem cell transfusion appear to be uncommon. The potential risks include failure of the cells to work as expected, potential for mesenchymal stem cells to multiply or change into inappropriate cell types, product contamination, growth of tumors, infections, thrombus formation, and administration site reactions.10
Considerations in Pregnancy
There are insufficient data to assess the risk of mesenchymal stem cell use during pregnancy.
Considerations in Children
There are insufficient data on the efficacy and safety of mesenchymal stem cell use in children.
- Samsonraj RM, Raghunath M, Nurcombe V, Hui JH, van Wijnen AJ, Cool SM. Concise review: multifaceted characterization of human mesenchymal stem cells for use in regenerative medicine. Stem Cells Transl Med. 2017;6(12):2173-2185. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29076267.
- Li N, Hua J. Interactions between mesenchymal stem cells and the immune system. Cell Mol Life Sci. 2017;74(13):2345-2360. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28214990.
- Food and Drug Administration. FDA warns about stem cell therapies. 2019. Available at: https://www.fda.gov/consumers/consumer-updates/fda-warns-about-stem-cell-therapies. Accessed June 26, 2020.
- Food and Drug Administration. Approved cellular and gene therapy products. 2019. Available at: https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/approved-cellular-and-gene-therapy-products. Accessed June 26, 2020.
- Lukomska B, Stanaszek L, Zuba-Surma E, Legosz P, Sarzynska S, Drela K. Challenges and controversies in human mesenchymal stem cell therapy. Stem Cells Int. 2019. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31093291.
- Shetty AK. Mesenchymal stem cell infusion shows promise for combating coronavirus (COVID-19)-induced pneumonia. Aging Dis. 2020;11(2):462-464. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32257554.
- Leng Z, Zhu R, Hou W, et al. Transplantation of ACE2(-) mesenchymal stem cells improves the outcome of patients with COVID-19 pneumonia. Aging Dis. 2020;11(2):216-228. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32257537.
- Shu L, Niu C, Li R, et al. Treatment of severe COVID-19 with human umbilical cord mesenchymal stem cells. Stem Cell Res Ther. 2020;11(1):361. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32811531.
- Chen J, Hu C, Chen L, et al. Clinical study of mesenchymal stem cell treating acute respiratory distress syndrome induced by epidemic Influenza A (H7N9) infection, a hint for COVID-19 treatment. Engineering (Beijing). 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32292627.
- Centers for Disease Control and Prevention. Stem cell and exosome products. 2019. Available at: https://www.cdc.gov/hai/outbreaks/stem-cell-products.html. Accessed June 26, 2020.