Is there a place for mesenchymal stromal cell-based therapies in the therapeutic armamentarium against COVID-19?

Abstract

The COVID-19 pandemic, caused by the rapid global spread of the novel coronavirus (SARS-CoV-2), has caused healthcare systems to collapse and led to hundreds of thousands of deaths. The clinical spectrum of COVID-19 is not only limited to local pneumonia but also represents multiple organ involvement, with potential for systemic complications. One year after the pandemic, pathophysiological knowledge has evolved, and many therapeutic advances have occurred, but mortality rates are still elevated in severe/critical COVID-19 cases. Mesenchymal stromal cells (MSCs) can exert immunomodulatory, antiviral, and pro-regenerative paracrine/endocrine actions and are therefore promising candidates for MSC-based therapies. In this review, we discuss the rationale for MSC-based therapies based on currently available preclinical and clinical evidence of safety, potential efficacy, and mechanisms of action. Finally, we present a critical analysis of the risks, limitations, challenges, and opportunities that place MSC-based products as a therapeutic strategy that may complement the current arsenal against COVID-19 and reduce the pandemic's unmet medical needs.

Keywords: Acute respiratory distress syndrome; COVID-19; Cell therapy; Mesenchymal stromal cells; SARS-CoV-2.

Fig. 1

Mechanisms of action of mesenchymal stromal cells

Fig. 2

Mesenchymal stromal cells (MSCs) and immune modulation in COVID-19. DC, dendritic cell; IFN-γ, interferon-γ; IL, interleukin; TGF-β, transforming growth factor-β; TNF, tumor necrosis factor; Treg, regulatory T cell