Mesenchymal Stromal Cell-Based Therapy: A Promising Approach for Severe COVID-19

Abstract

During the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many critically ill patients died of severe pneumonia, acute respiratory distress syndrome (ARDS), or multiple organ dysfunction syndrome. To date, no specific treatments have been proven to be effective for coronavirus disease 2019 (COVID-19). In the animal models and clinical applications, mesenchymal stromal/stem cells (MSCs) have been shown safety and efficacy for the treatment of respiratory virus infection through their abilities of differentiation and immunomodulation. Besides, possessing several advantages of MSC-derived extracellular vesicles (EVs) over MSCs, EV-based therapy also holds potential therapeutic effects in respiratory virus infection. In this review, we summarized the basic characteristics and mechanisms of COVID-19 and MSCs, outlined some preclinical and clinical studies of MSCs or MSC-EVs for respiratory virus infection such as influenza virus and SARS-CoV-2, shed light on the common problems that we should overcome to translate MSC therapy into clinical application, and discussed some safe issues related to the use of MSCs.

Keywords: clinical translation; coronavirus disease 2019; mesenchymal stromal cells.

Figure 1.

The spike protein of SARS-CoV-2 mediates the entry of the virus into target cells via the ACE2 receptor, which leads to cytokine storm. ARDS: acute respiratory distress syndrome; ACE2: angiotensin-converting enzyme 2; MODS: multiple organ dysfunction syndrome; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Figure 2.

Schematic showing the potential role of MSCs in the treatment of COVID-19. MSCs play a role by releasing anti-inflammatory factors, regulating immune response, restoring endothelial barrier integrity, and other effects during SARS-CoV-2 infection. COVID-19: coronavirus disease 2019; MSCs: mesenchymal stromal cells; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.