The Systematic Effect of Mesenchymal Stem Cell Therapy in Critical COVID-19 Patients: A Prospective Double Controlled Trial

The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 106 cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-β, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.

Mesenchymal stem cells treatment in COVID-19 patient with multi-organ involvement

The aim of this study is to evaluate the therapeutic effect of mesenchymal stem cells (MSCs) in a severe case of brain and multiple organ involvement in a patient with COVID-19. Here, a 51-year-old male patient with multi-organ involvement due to COVID-19 infection and developing cardiac arrest is presented. MSCs were transplanted to the patient four times systematically and once intrathecally. As a result, the application of MSCs has been found to have a healing effect on organs in this patient with severe COVID-19 infection. In addition, transplantation of MSCs both systematically and intrathecally is considered to be effective in the treatment of the central nervous system (Tab. 2, Fig. 2, Ref. 24). Keywords: mesenchymal stem cell, COVID-19, organ involvement.

Improving effects of mesenchymal stem cells on symptoms of chronic obstructive pulmonary disease

AIM

We aimed to identify the improving effects of umbilical cord tissue-derived (UCTD) MSCs on the symptoms of COPD in our phase 1.2 clinical study.

MATERIAL METHODS

Our study consisted of five patients with COPD. Respiratory function tests, SGRQ symptom, activity and impact scores and 6-minute walk test (6MWT) were examined before UCTD MSC treatment. All the patients were administered a total of 4 doses of UCTD MSCs by intravenous infusion at two-week intervals. All the tests were repeated three months after the treatment for evaluation of the response to MSCs treatment.

RESULTS

The mean age of five male patients was 56. The mean pretreatment FEV1/FVC ratios were 66.9 %. Pretreatment mean SGRQ symptom, activity and impact scores of the patients were 78.2, 83.8 and 58.02 respectively. The mean walking distance of the patients was 307 meters before MSCs treatment. The mean FEV1/FVC value of raised to 69.58 % after the treatment. The mean SGRQ symptom, activity and impact scores were noted as 39.8, 60.98 and 45.18 respectively. The mean walking distance of the patients raised to 362 meters after the treatment.

CONCLUSIONS

Our results showed that four doses of MSC treatment considerably alleviated the severity of symptoms of COPD (Tab. 2, Fig. 7, Ref. 25).

Neuronal regeneration in injured rat spinal cord after human dental pulp derived neural crest stem cell transplantation

OBJECTIVE

This study aimed to analyze the effect of human Dental Pulp-Neural Crest Stem Cells (hDP-NCSCs) delivery on lesion site after spinal cord injury (SCI), and to observe the functional recovery after transplantation.

METHODS

Neural Crest Stem Cells (NCSCs) were isolated from human Dental Pulp (hDP). The experimental rat population was divided into four groups (n = 6/24). Their behavioral motility was scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for Green Fluorescent Protein (GFP) labeled hDP-NCSCs by immunofluorescence (IF) staining.

RESULTS

In early post-injury (p.i) period, the ultrastructure of spinal cord tissue was preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be hDP-NCSCs. While the grey-and-white-matter around the ependymal region was composed of e.g. GFP cells, with astrocytic-like appearance. The scores showed significant motor recovery in hind limb functions in Group 4. However, no obvious change was observed in other groups.

CONCLUSION

Cells e.g., mesenchymal (Vimentin+) which express GFP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renewal and plasticity. Thus, transplantation of hDP-NCSCs might be an effective strategy to improve functional recovery following spinal cord trauma (Fig. 10, Ref. 32).

Differentiation Potential of Mouse Embryonic Stem Cells into Insulin Producing Cells in Pancreatic Islet Microenvironment

BACKGROUND

The differentiation capacity of embryonic stem cells (ESCs) has great promise for type-1 diabetes for cellular treatment. Therefore, different strategies have been reported so far for derivation of insulin producing cells (IPCs) from ESCs. Providing similar microenvironmental conditions as in vivo, functional differentiation of stem cells into desired cell types could be obtained in vitro. The aim of the present research was to utilize differentiation potential of ESCs to IPCs by co-culture with mouse pancreatic islets (mPIs) for the first time.

METHODS

We present an in-direct differentiation protocol which compared with a conventional differentiation protocol. Novel in-direct co-culture differentiation protocol in which mPIs induced differentiation of ESCs into IPCs was used. This technique was compared with the chemical differentiation protocol that involved supplementing the differentiation media with specific growth factors. We analyzed differentiated cells in both groups by immune labelling, gene expression and protein secretion.

RESULTS

IPCs were obtained with in-direct co-culture within 30 days. Differentiated ESCs were found to be positive for IPC specific markers, Pdx1, Insulin, C-peptide, Glut2 and MafA. The results of immunocytochemical and gene expression analysis showed higher differentiation efficiency in co-culture group than chemical differentiation group. These results were confirmed by the response assay to high glucose levels with ELISA for insulin.

DISCUSSION

Our findings illustrate the significant effect of co-culture in different stages of differentiation and maturation of ESCs in vitro. We have developed an efficient and easy way to differentiate ESCs into IPCs, which possess similar characters of mature insulin positive cells.

Immunomodulatory properties of pancreatic islet-derived stem cells co-cultured with T cells: Does it contribute to the pathogenesis of type 1 diabetes?

BACKGROUND

Previously, we isolated stem cells from rat pancreatic islets (rPI-SCs) with similar characteristics of bone-marrow derived-mesenchymal stem cells (MSCs). We aimed to investigate the immunomodulatory effects of them on stimulated T-cells.

METHODS

Following in vitro co-culturing directly and indirectly, the response of T-cells stimulated by concanavalin-A and immunosuppressive activity of rPI-SCs were evaluated by analysing in terms of cell viability, proliferation and apoptosis, cell cycle, differentiation of Treg, cytokines and some regulatory factors produced from T and SCs.

RESULTS

Our results have firstly demonstrated that rPI-SCs like MSCs could regulate stimulated T-cell responses by altering their cell-cycle and cytokine profile, inhibiting the cell proliferation, and inducing the apoptosis and differentiation of Treg. Direct and indirect in vitro co-cultures of rPI-SCs with stimulated T-cells showed immunosuppressive effects.

CONCLUSION

Therefore, we are introducing a novel type of stem cell with immunomodulatory properties. On the other hand, it is questionable why PI-SCs cannot protect the insulin producing cells from attacks of autoreactive T-cells in the developing of type1 diabetes. For this purpose, further molecular researches in vitro and in vivo are needed to clarify why PI-SCs may not suppress attacks of autoreactive-immune-cells towards PIs. PI-SCs from diseased people should be compared with pancreas of healthy ones at both genomic and proteomic levels.

Treatment of ischemic colonic anastomoses with systemic transplanted bone marrow derived mesenchymal stem cells

BACKGROUND

The aim of the study is to investigate the healing effect of the bone-marrow derived mesenchymal stem cells (BM-MSCs) on ischemic colon anastomosis in systemic application and to recovery the adverse effect of ischemia.

MATERIALS AND METHODS

Fourty male Wistar Albino rats weigthing 250-300 g were divided into four equal groups (n=10 Group 1: control; ischemic left colonic anastomoses (4th day); Group 2: control; ischemic left colonic anastomoses (7th day); Group 3: ischemic left colonic anastomoses + systemic transplanted BM-MSCs (4th day); Group 4: ischemic left colonic anastomoses + systemic transplanted BM-MSCs (7th day). BMSCs labelled with bromodeoxyuridine (BrdU) were transplanted into the vena cava. Group 1 and group 3 were killed four days after surgery. In group 2 and group 4 were sacrificed seven days after the surgical procedure. Histopathological features, hydroxyproline levels in the tissue, and anastomotic strength were investigated.

RESULTS

There was no mortality all of the groups.The mean bursting pressures of ischemic colonic anastomoses in group 3 were higher than in control group 1 (4th day). We found significantly higher hydroxyproline values in group 3 and were significantly higher in group 4 than in control groups. We investigated the early period of wound healing (4th day and 7th day). When comparing between group 1 and group 3, we found higher levels for all of the histological parameters except inflammation in group 3. On day 7, when comparing between group 2 and group 4, we found higher levels for parameters of necrosis, collagen deposition.

CONCLUSIONS

BM-MSCs therapy significantly accelerated all of the healing parameters for ischemic colonic anastomosis except for inflammation on fourth day. On the seventh day, BM-MSCs augmented the levels of the hydroxyproline. Histological parameters, necrosis and collagen deposition were also found to be important for healing of ischemic colonic anastomoses. However, they did not accelerate the others histological parameters especially angiogenesis.

Effects of mesenchymal stem cells in critical size bone defect

BACKGROUND AND OBJECTIVES

The aim of this study was to compare culture-expanded, bone marrow-derived mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) loaded to biphasic calcium phosphate (BCP) bone ceramic in the repair of rat calvarial bone.

MATERIALS AND METHODS

Critical-size (7 mm dia.) calvarial defects were prepared in the frontal-parietal bones of 90 adult female Sprague-Dawley rats. Rats were randomly divided into 5 groups, according to defect filling, as follows: Group I (n = 21), BCP; Group II (n = 21), BCP+PRP; Group III (n = 21), BCP+MSC; Group IV (n = 21), BCP+PRP+MSC; Group V (n = 6) (control), no treatment. Animals were sacrificed at 2, 8 and 12 weeks postsurgery and bone regeneration was evaluated both histologically and immunohistochemically.

RESULTS

Statistically significant differences were observed in bone osteoblastic activity in calvarial defects among the groups (p < 0.05). PRP and MSC used in combination with BCP as a defect filling resulted in greater osteoblastic bone formation activity when compared to the use of BCP alone.

CONCLUSIONS

The combination of mesenchymal stem cells, platelet rich plasma and synthetic bone substitute was found to be more effective in inducing new bone formation (osteogenesis) than the use of platelet rich plasma combined with synthetic bone substitute and the use of synthetic bone substitute alone.

Pancreatic islet derived stem cells can express co-stimulatory molecules of antigen-presenting cells

BACKGROUND

Antigen-presenting cells (APCs) are crucial intermediates in the generation of both innate and specific immune responses. It has long been understood that some APCs are resident in islets in situ as well as after isolation. Our aim was to investigate the presence of molecules involved in antigen presentation in rat pancreatic islet-derived stem cells (PI-SCs).

METHODS

We used immunocytochemistry and reverse transcription polymerization chain reaction to study immunophenotypic characteristics; pluripotent-related gene expressions; transcripts coding for antigen-presenting surface proteins CD40, CD80, CD86; and major histocompatibility complex class II in addition to genes with known antiapoptotic functions including mitogen-activated protein kinase-activated protein kinase 2 (MAPKAPK2), tumor necrosis factor alpha-induced protein 3 (TNFAIP3) interacting protein 1 (TNIP1) and BCL3 of the PI-SCs.

RESULTS

Rat PI-SCs were negative for CD45 as demonstrated by flow cytometry and for CD31, CD34, and CD71 as demonstrated by immunocytochemistry. Therefore, there was no evidence of hematopoietic precursors in the cultures. OCT4, SOX2, and REX1 were expressed by rat PI-SCs. We determined the expression of genes for antigen-presenting surface proteins CD40 and CD80, and genes with known antiapoptotic functions including MAPKAPK2, TNIP1 and BCL3, besides the surface protein, CD80, by flow cytometry.

CONCLUSION

Expression of these genes by rat PI-SCs implied that they could be involved in the regulation of immunity in islets, highlighting the influence of protective role-playing antiapoptotic mechanisms on pancreatic islet cells. This study offers the potential to understand the molecular mechanisms of a devastating disease, type-1 diabetes mellitus.

Protection of rat pancreatic islet function and viability by coculture with rat bone marrow-derived mesenchymal stem cells

The maintenance of viable and functional islets is critical in successful pancreatic islet transplantation from cadaveric sources. During the isolation procedure, islets are exposed to a number of insults including ischemia, oxidative stress and cytokine injury that cause a reduction in the recovered viable islet mass. A novel approach was designed in which streptozotocin (STZ)-damaged rat pancreatic islets (rPIs) were indirectly cocultured with rat bone marrow-derived mesenchymal stem cells (rBM-MSCs) to maintain survival of the cultured rPIs. The results indicated that islets cocultured with rBM-MSCs secreted an increased level of insulin after 14 days, whereas non-cocultured islets gradually deteriorated and cell death occurred. The cocultivation of rBM-MSCs with islets and STZ-damaged islets showed the expression of IL6 and transforming growth factor-β1 in the culture medium, besides the expression of the antiapoptotic genes (Mapkapk2, Tnip1 and Bcl3), implying the cytoprotective, anti-inflammatory and antiapoptotic effects of rBM-SCs through paracrine actions.

Effect of thyroidectomy on the histology of rat sublingual gland

This study was carried out to investigate the effect of thyroidectomy on the histology of rat sublingual gland. Twenty-eight male Wistar albino rats, aged 4 weeks and weighing between 45-55 g, were used. The rats were divided into two experimental groups (control and thyroidectomy), each containing 14 animals. Total thyroidectomy of rats was performed under ether anesthesia in thyroidectomy group. The rats in the control group were sham operated without having the thyroidectomy. Seven rats randomly selected from both groups were fixed using the perfusion fixation technique 2 and 6 weeks after thyroidectomy, and their sublingual glands were harvested for histological investigation. No histological difference was observed between the two groups 2 weeks after thyroidectomy. However, 6 weeks after thyroidectomy considerable cytoplasmic vacuolization of the epithelial cells of the mucous tubules was seen in the thyroidectomy group compared to the controls. Enlargement of mucous tubules was also observed, and the lumina in most of the tubules was quite dilated. In the stroma surrounding the parenchymal tissues, increased lipid tissue mass was observed. In addition, increased connective tissue mass and mononuclear cell infiltrations were evident. Furthermore, the number of mast cells was significantly higher in the thyroidectomy group than in the controls 6 weeks after thyroidectomy. It was concluded that the thyroid gland and hormones might have an influence on the histology of the sublingual gland.

Ischemia, whether from ligation or torsion, causes ultrastructural changes on the contralateral testis

OBJECTIVE

Unilateral testicular torsion results with a decrease in contralateral testicular blood flow caused by a reflexive sympathetic response. The aim of this study was to investigate whether twisting of the spermatic cord, or testicular ischemia without twisting, activates this reflex mechanism and causes ultrastructural changes in the contralateral side.

MATERIALS AND METHODS

Thirty adult male albino Wistar rats were randomly allocated into three groups of sham, torsion, and ligation. Right testes were twisted 720 degrees counterclockwise in the torsion group. Right spermatic cords were ligated permanently with a silk suture including the vas deferens in the ligation group. After 24 h of testicular ischemia, contralateral left testes were removed for electron microscopic evaluation.

RESULTS

Contralateral testes showed similar ultrastructural changes in the torsion and ligation groups. The fibrous tunica propria enveloping the seminiferous tubule was thickened due to increased collagen fibers. The basal lamina was continuous but thickened and showed several foldings. The gap between basal lamina and the germ cells was increased because of collagen fibers. Leydig cells showed mitochondrial degeneration with the loss of its cristae. Leydig cells lost their contact with its neighborhood cells in some areas, and these gaps were filled with collagen fibers. Germ cells showed dilated cisternae of smooth endoplasmic reticulum, cytoplasmic electron-dense bodies and clear regions.

CONCLUSIONS

Similar electron microscopic findings observed in the torsion and ligation groups indicate that testicular ischemia rather than twisting of the spermatic cord is responsible for the ultrastructural changes in the contralateral side.