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. 2016 Dec 9;7(1):186.
doi: 10.1186/s13287-016-0441-x.

A systematic review of randomised controlled trials examining the therapeutic effects of adult bone marrow-derived stem cells for non-ischaemic dilated cardiomyopathy

Yi Lu  1 , Yiqin Wang  1 , Menglu Lin  1 , Jiale Zhou  1 , Zi Wang  1 , Meng Jiang  2 , Ben He  3
Affiliations

A systematic review of randomised controlled trials examining the therapeutic effects of adult bone marrow-derived stem cells for non-ischaemic dilated cardiomyopathy

Yi Lu et al. Stem Cell Res Ther. .

Abstract

Background: Certain early-phase clinical trials have suggested that bone marrow-derived stem cell transplantation might improve left ventricular function in patients with non-ischaemic dilated cardiomyopathy (NIDCM), whereas others trials have revealed no benefit from this approach. We sought to evaluate the therapeutic effects of bone marrow-derived stem cell therapy on NIDCM.

Methods: We searched the PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases (through February 2016) for randomised controlled clinical trials that reported on bone marrow-derived stem cell transplantation for patients with NIDCM with a follow-up period ≥12 months. The co-primary endpoints were changes in mortality rate and left ventricular ejection fraction (LVEF); the secondary endpoints were changes in the 6-minute-walk test (6MWT) and left ventricular chamber size. Seven trials involving bone marrow-derived stem cell therapy that included 482 patients satisfied the inclusion and exclusion criteria.

Results: Subjects who received bone marrow-derived stem cell therapy exhibited a significant reduction in mortality rate (19.7% in the cell group vs. 27.1% in the control group; 95% confidence interval (CI) -0.16 to -0.00, I 2 = 52%, p = 0.04). Bone marrow-derived stem cell therapy tended to produce LVEF improvement within 6 months (1.83% increase; 95% CI -0.27 to 3.94, I 2 = 74%, p = 0.09) and significantly improved LVEF after mid-term (6-12 months) follow-up (3.53% increase; 95% CI 0.76 to 6.29, I 2 = 88%, p = 0.01). However, this therapy produced no significant benefit in the 6MWT (p = 0.18). Finally, the transplantation of increased numbers of stem cells resulted in no observable additional benefit with respect to LVEF.

Conclusions: Bone marrow-derived stem cell therapy might have improved prognoses and appeared to provide moderate benefits in cardiac systolic function at mid-term follow-up. However, this therapy produced no observed improvement in exercise tolerance.

Keywords: Bone marrow-derived stem cell therapy; Cardiac systolic function; Follow-up; Mortality rate; Non-ischaemic dilated cardiomyopathy.

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Figures

Fig. 1
Fig. 1
Review process. This scheme diagrams the reviewing process. RCT randomised control trial
Fig. 2
Fig. 2
Mortality of stem cell therapy. Forest plot of the weighted mean differences revealed a reduced mortality rate after cell therapy compared with the control treatment. CI confidence interval
Fig. 3
Fig. 3
The effect of stem cell therapy on left ventricular structure and function. a Forest plot of the effect of stem cell therapy on left ventricular ejection fraction. b, c Forest plots of the effect of stem cell therapy on left ventricular end-systolic volume (b) and left ventricular end-diastolic chamber size (c). CI confidence interval, IV inverse variance, SD standard deviation
Fig. 4
Fig. 4
The effect of stem cell therapy on the 6-minute-walk test. Forest plots revealed no beneficial impact of stem cell therapy on the 6-minute-walk test compared with control. CI confidence interval, IV inverse variance, SD standard deviation
See this image and copyright information in PMC

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