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Xu Z, Neuber S, Nazari-Shafti T, Liu Z, Dong F, Stamm C. Impact of procedural variability and study design quality on the efficacy of cell-based therapies for heart failure - a meta-analysis. PLoS One 2022; 17:e0261462. [PMID: 34986181 PMCID: PMC8730409 DOI: 10.1371/journal.pone.0261462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cell-based therapy has long been considered a promising strategy for the treatment of heart failure (HF). However, its effectiveness in the clinical setting is now doubted. Because previous meta-analyses provided conflicting results, we sought to review all available data focusing on cell type and trial design. METHODS AND FINDINGS The electronic databases PubMed, Cochrane library, ClinicalTrials.gov, and EudraCT were searched for randomized controlled trials (RCTs) utilizing cell therapy for HF patients from January 1, 2000 to December 31, 2020. Forty-three RCTs with 2855 participants were identified. The quality of the reported study design was assessed by evaluating the risk-of-bias (ROB). Primary outcomes were defined as mortality rate and left ventricular ejection fraction (LVEF) change from baseline. Secondary outcomes included both heart function data and clinical symptoms/events. Between-study heterogeneity was assessed using the I2 index. Subgroup analysis was performed based on HF type, cell source, cell origin, cell type, cell processing, type of surgical intervention, cell delivery routes, cell dose, and follow-up duration. Only 10 of the 43 studies had a low ROB for all method- and outcome parameters. A higher ROB was associated with a greater increase in LVEF. Overall, there was no impact on mortality for up to 12 months follow-up, and a clinically irrelevant average LVEF increase by LVEF (2.4%, 95% CI = 0.75-4.05, p = 0.004). Freshly isolated, primary cells tended to produce better outcomes than cultured cell products, but there was no clear impact of the cell source tissue, bone marrow cell phenotype or cell chricdose (raw or normalized for CD34+ cells). A meaningful increase in LVEF was only observed when cell therapy was combined with myocardial revascularization. CONCLUSIONS The published results suggest a small increase in LVEF following cell therapy for heart failure, but publication bias and methodologic shortcomings need to be taken into account. Given that cardiac cell therapy has now been pursued for 20 years without real progress, further efforts should not be made. STUDY REGISTRY NUMBER This meta-analysis is registered at the international prospective register of systematic reviews, number CRD42019118872.
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Affiliation(s)
- Zhiyi Xu
- Berlin Institute of Health Center for Regenerative Therapies, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Neuber
- Berlin Institute of Health Center for Regenerative Therapies, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Timo Nazari-Shafti
- Berlin Institute of Health Center for Regenerative Therapies, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Zihou Liu
- Berlin Institute of Health Center for Regenerative Therapies, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Fengquan Dong
- Department of Cardiology, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Christof Stamm
- Berlin Institute of Health Center for Regenerative Therapies, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
- Helmholtz Zentrum Geesthacht, Institut für Aktive Polymere, Teltow, Germany
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Zhang J, Zhao J, Mao Q, Xia H. A simple, efficient and economical method for isolating and culturing human umbilical cord blood‑derived mesenchymal stromal cells. Mol Med Rep 2019; 20:5257-5264. [PMID: 31661118 DOI: 10.3892/mmr.2019.10767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 09/23/2019] [Indexed: 11/05/2022] Open
Abstract
Mesenchymal stromal cells (MSCs) hold broad therapeutic potential in various diseases, however, it is difficult to produce sufficient numbers of MSCs for clinical application, therefore, improved culture systems are required. The present study aimed to develop a novel method for isolating and culturing human umbilical cord blood‑derived mesenchymal stromal cells (hUCB‑MSCs). A sequential culture method was developed that uses two types of culture media to optimize the isolation and culture of hUCB‑MSCs. First, DMEM supplemented with mesenchymal stem cell growth supplement was used to improve the colony formation and primary culture success rates of hUCB‑MSCs. Then, after removing the heterogeneous cell population, ordinary DMEM was used from the fourth passage. This method obtained hUCB‑MSCs with high culture efficiency and at a greatly reduced cost. The optimal culture conditions were determined and the hUCB‑MSCs were phenotypically characterized after passaging. Taken together, this simple, efficient and economical method can produce a large number of high‑quality hUCB‑MSCs in <1 month, therefore facilitating the future clinical applications of hUCB‑MSCs.
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Affiliation(s)
- Junhe Zhang
- Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi 710062, P.R. China
| | - Junli Zhao
- Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi 710062, P.R. China
| | - Qinwen Mao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Haibin Xia
- Laboratory of Gene Therapy, Department of Biochemistry, College of Life Sciences, Shaanxi Normal University, Xi'an, Shaanxi 710062, P.R. China
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Razban V, Khajeh S, Alaee S, Mostafavi-Pour Z, Soleimani M. Tube Formation Potential of BMSCs and USSCs in Response to HIF-1α Overexpression under Hypoxia. CYTOL GENET+ 2018. [DOI: 10.3103/s0095452718030064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nazari-Shafti TZ, Xu Z, Bader AM, Henke G, Klose K, Falk V, Stamm C. Mesenchymal Stromal Cells Cultured in Serum from Heart Failure Patients Are More Resistant to Simulated Chronic and Acute Stress. Stem Cells Int 2018; 2018:5832460. [PMID: 29760728 PMCID: PMC5901835 DOI: 10.1155/2018/5832460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022] Open
Abstract
Despite regulatory issues surrounding the use of animal-derived cell culture supplements, most clinical cardiac cell therapy trials using mesenchymal stromal cells (MSCs) still rely on fetal bovine serum (FBS) for cell expansion before transplantation. We sought to investigate the effect of human serum from heart failure patients (HFS) on cord blood MSCs (CB-MSCs) during short-term culture under regular conditions and during simulated acute and chronic stress. Cell survival, proliferation, metabolic activity, and apoptosis were quantified, and gene expression profiles of selected apoptosis and cell cycle regulators were determined. Compared to FBS, HFS and serum from healthy donors (CS) showed similar effects by substantially increasing cell survival during chronic and acute stress and by increasing cell yields 5 days after acute stress. Shortly after the termination of acute stress, both HFS and CS resulted in a marked decrease in apoptotic cells. Transcriptome analysis suggested a decrease in TNF-mediated induction of caspases and decreased activation of mitochondrial apoptosis. Our data confirm that human serum from both healthy donors and heart failure patients results in increased cell yields and increased resistance to cellular stress signals. Therefore, we consider autologous serum a valid alternative to FBS in cell-based therapies addressing severe heart disease.
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Affiliation(s)
- Timo Z. Nazari-Shafti
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Zhiyi Xu
- Berlin Center for Regenerative Therapies (BCRT), Berlin, Germany
| | | | - Georg Henke
- Berlin Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Kristin Klose
- Berlin Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Christof Stamm
- Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Center for Regenerative Therapies (BCRT), Berlin, Germany
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Amati E, Sella S, Perbellini O, Alghisi A, Bernardi M, Chieregato K, Lievore C, Peserico D, Rigno M, Zilio A, Ruggeri M, Rodeghiero F, Astori G. Generation of mesenchymal stromal cells from cord blood: evaluation of in vitro quality parameters prior to clinical use. Stem Cell Res Ther 2017; 8:14. [PMID: 28115021 PMCID: PMC5260040 DOI: 10.1186/s13287-016-0465-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 12/13/2016] [Accepted: 12/21/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Increasing evidence suggests the safety and efficacy of mesenchymal stromal cells (MSC) as advanced therapy medicinal products because of their immunomodulatory properties and supportive role in hematopoiesis. Although bone marrow remains the most common source for obtaining off-the-shelf MSC, cord blood (CB) represents an alternative source, which can be collected noninvasively and without major ethical concerns. However, the low estimated frequency and inconsistency of successful isolation represent open challenges for the use of CB-derived MSC in clinical trials. This study explores whether CB may represent a suitable source of MSC for clinical use and analyzes several in vitro parameters useful to better define the quality of CB-derived MSC prior to clinical application. METHODS CB units (n = 50) selected according to quality criteria (CB volume ≥ 20 ml, time from collection ≤ 24 h) were cultured using a standardized procedure for CB-MSC generation. MSC were analyzed for their growth potential and secondary colony-forming capacity. Immunophenotype and multilineage differentiation potential of culture-expanded CB-MSC were assessed to verify MSC identity. The immunomodulatory activity at resting conditions and after inflammatory priming (IFN-γ-1b and TNF-α for 48 hours) was explored to assess the in vitro potency of CB-MSC prior to clinical application. Molecular karyotyping was used to assess the genetic stability after prolonged MSC expansion. RESULTS We were able to isolate MSC colonies from 44% of the processed units. Our results do not support a role of CB volume in determining the outcome of the cultures, in terms of both isolation and proliferative capacity of CB-MSC. Particularly, we have confirmed the existence of two different CB-MSC populations named short- and long-living (SL- and LL-) CBMSC, clearly diverging in their growth capacity and secondary colony-forming efficiency. Only LL-CBMSC were able to expand consistently and to survive for longer periods in vitro, while preserving genetic stability. Therefore, they may represent interesting candidates for therapeutic applications. We have also observed that LL-CBMSC were not equally immunosuppressive, particularly after inflammatory priming and despite upregulating priming-inducible markers. CONCLUSIONS This work supports the use of CB as a potential MSC source for clinical applications, remaining more readily available compared to conventional sources. We have provided evidence that not all LL-CBMSC are equally immunosuppressive in an inflammatory environment, suggesting the need to include the assessment of potency among the release criteria for each CB-MSC batch intended for clinical use, at least for the treatment of immune disorders as GvHD.
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Affiliation(s)
- Eliana Amati
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy
| | - Sabrina Sella
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy
| | - Omar Perbellini
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy
| | | | - Martina Bernardi
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy.,Hematology Project Foundation, Vicenza, Italy
| | - Katia Chieregato
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy.,Hematology Project Foundation, Vicenza, Italy
| | - Chiara Lievore
- Transfusion Medicine, S. Bortolo Hospital, Vicenza, Italy
| | - Denise Peserico
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy
| | - Manuela Rigno
- Transfusion Medicine, S. Bortolo Hospital, Vicenza, Italy
| | - Anna Zilio
- Genetics and Molecular Biology, Transfusion Medicine, S. Bortolo Hospital, Vicenza, Italy
| | - Marco Ruggeri
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy
| | | | - Giuseppe Astori
- Advanced Cellular Therapy Laboratory - Hematology Unit, S. Bortolo Hospital - ULSS 6, Contra' San Francesco 41, 36100, Vicenza, Italy.
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Werle SB, Chagastelles P, Pranke P, Casagrande L. The effects of hypoxia on in vitro culture of dental-derived stem cells. Arch Oral Biol 2016; 68:13-20. [DOI: 10.1016/j.archoralbio.2016.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 12/19/2022]
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