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Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1014-1021. doi: 10.19723/j.issn.1671-167X.2018.06.013

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Efficacy of mesenchymal stem cells on systemic lupus erythematosus:a meta-analysis

Shuang LIU1,Yu-long GUO2,Jing-yi YANG3,Wei WANG1,Jian XU1,△()   

  1. 1. Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
    2. Department of Cardiology, Yunnan Provincial Fuwai Cardiovascular Disease Hospital, Kunming 650000, China
    3. Yunnan Shunxi Regeneration Medical Engineering Co., Ltd, Kunming 650000, China
  • Received:2018-07-10 Online:2018-12-18 Published:2018-12-18
  • Contact: Jian XU E-mail:casxujian@163.com
  • Supported by:
    Supported by the National Natural Science Foundation of China(81160379);Supported by the National Natural Science Foundation of China(81460256);Supported by the National Natural Science Foundation of China(81560233);Supported by the National Natural Science Foundation of China(81501406);Supported by the National Natural Science Foundation of China(81760296);Yunnan Applied Basic Research Projects-Union Foundation(2017FE467);Yunnan Applied Basic Research Projects-Union Foundation(2017FE467(-138));the Funding of Yunnan Provincial Health Science and Technology Plan(2014NS171);the Funding of Yunnan Provincial Health Science and Technology Plan(2016NS026);the Funding of Yunnan Provincial Health Science and Technology Plan(2016NS052);the Funding of Yunnan Provincial Health Science and Technology Plan(2017NS051);the Funding of Yunnan Provincial Health Science and Technology Plan(2018NS0133);the Funding of Yunnan Provincial Health Science and Technology Plan(2018NS0134);Yunnan Provincial Fund for High Level Reserve Talents in Health Science(H-2017068);Yunnan Provincial Fund for Preparatory Young Leaders in Academic and Technology(2015HB071);Yunnan Provincial Fund for Preparatory Young Leaders in Academic and Technology (2015HB071), the Hundred-Talent Program of Kunming Medical University(60117190457);Innovative Research Team of Kunming Medical University(CXTD201613)

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Abstract:

Objective: Systemic lupus erythematosus (SLE) is an autoimmune disease with multi-organ involvement and several typical autoantibodies. Mesenchymal stem cells (MSC) are multipotent stem cells with low immunogenicity that can differentiate into various kinds of cells, such as bone, cartilage, fat and skin tissue. MSC have immunomodulatory and reparative properties through interactions with immune cells. MSC have been used in the treatment of refractory SLE and lupus nephritis patients for more than ten years. Most clinical studies were self-controlled studies and only a few were randomized controlled trials. The objective of this study was to use meta-analysis method to evaluate the efficacy and safety of MSC treatment in SLE patients. Methods:The PubMed, Cochrane Library, Wanfang and VIP databases were searched for published randomized controlled trials and self-controlled studies before June 1, 2018. The search terms included the Chinese and English versions of mesenchymal stem cells, Mesenchymal Stromal Cells [Mesh], systemic lupus erythematosus, lupus, Lupus Erythematosus, Systemic [Mesh]. Two authors independently screened the literatures, assessed the quality of the studies and collected data according to the inclusion and exclusion criteria. The endpoints were the SLE disease activity index, 24 h urine protein and complement C3. Meta-analysis was performed with the Revman 5.3 software according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard. Results:Eight studies involving 213 patients were included and three of the studies were randomized controlled trials with 66 patients involved. The MSC group showed that the SLE disease activity index decreased significantly [standard mean difference (SMD)=-1.76, 95% confidence interval (CI):-2.00 to -1.51, P<0.001), the 24 h urine protein decreased significantly (SMD=-1.74, 95%CI:-2.46 to -1.03, P<0.001), as well as the complement C3 increased significantly (SMD=1.28, 95%CI: 0.93 to 1.62, P<0.001). Four studies reported adverse events including fever, diarrhea and headache during the infusion. Conclusion:Current evidences showed that MSC could improve the disease activity, proteinuria and hypocomplementemia in SLE patients. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of MSC treatment in SLE patients.

Key words: Mesenchymal stem cell, Systemic lupus erythematosus, Lupus nephritis, Meta-analysis

CLC Number: 

  • R593.24

Figure 1

Flow of study selection"

Table 1

Table A summary of the included eight studies"

Table 2

Quality assessment of randomized controlled trials"

Table 3

Quality assessment of self-control studies"

Study Representativeness of the exposed cohort Selection
of the non-
exposed cohort		 Ascertainment of
exposure		 Demonstration that the outcome of
interest was
not present
at baseline		 Comparability of cohorts on the basis of design or analysis Assessment of the out-
come		 Was follow-up enough
for outcomes
to occur?		 Adequacy of
follow-up of
cohorts
Gu, et al, 2014[15] Yes NA Yes Yes NA Yes Yes Yes
Zhu, et al, 2016[17] Yes NA Yes Yes NA Yes No Yes
Li, et al, 2016[13] Yes NA Yes Yes NA Yes Yes Yes
Qiu, et al, 2016[18] Yes NA Yes Yes NA Yes Yes Yes
Bai, et al, 2017[12] Yes NA Yes Yes NA Yes Yes Yes

Figure 2

Summary of meta-analysis for SLEDAI outcomesRCT, randomized controlled trial;SD, standard deviation;CI, confidence interval;SLEDAI, systemic lupus erythematosus disease activity index."

Figure 3

Summary of meta-analysis for urine protein outcomesAbbreviations as in Figure 2."

Figure 4

Summary of meta-analysis for complement outcomesAbbreviations as in Figure 2."

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