Mesenchymal stem cell treatment in a critically ill COVID-19 patient: a case report

Abstract

An outbreak of a new coronavirus causing severe respiratory disease (COVID-19) was first reported in China and rapidly spread worldwide. Clinical spectrum changes from asymptomatic infection to severe illness and even death, and no specific treatment is currently available. A range of antiviral, antimalarial and antibiotic agents are being used. We report a case of a COVID-19 patient that progressed to severe disease requiring intubation and intensive care. We performed mesenchymal stem cell (MSC) transplantation considering the signs showing persistent excessive immune response and deterioration despite all supportive and drug therapies. The two rounds of transplantation did not result in any severe complications and was well-tolerated. Clinical signs were improved. The use of MSC therapy may be considered for compassionate use in selected patients.

Mesenchymal stromal cells to fight SARS-CoV-2: Taking advantage of a pleiotropic therapy

“…Supporting the possible implementation of MSC treatment in COVID-19, since the beginning of the outbreak four clinical studies and four case reports investigating MSC’s therapeutic potential (and their derived products) to treat COVID-19 patients have been performed and already published their results [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. Moreover, several phase I or II clinical trials are currently ongoing ( www.clinicaltrials.gov ).…”

“…Additionally, MSC treatment was shown to promote patient’s recovery, even in critically ill elders with comorbidities [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. In these studies, moderate to critically ill COVID-19 patients were infused with MSC after they failed to improve, and symptoms worsened, under standard [ 5 , 7 ] or other treatment conditions [ 6 , 8 , [6] , [7] , [8] , [9] , [10] , [11] ]. So far, MSC transplantation seem to lead to clinical recovery of patients in relatively short time, showing amelioration of COVID-19 symptoms few days after MSC treatment.…”

“…So far, MSC transplantation seem to lead to clinical recovery of patients in relatively short time, showing amelioration of COVID-19 symptoms few days after MSC treatment. Indeed, MSC treatment alone or its combination with other therapies improved respiratory function and increased oxygenation [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Sánchez-Guijo and colleges demonstrated the effectiveness of MSC administration in 13 patients under invasive mechanical ventilation, as they improved the clinical status for 70 % of infected individuals and lead to the extubation of 53 % of them [ 11 ].…”

“…Importantly, these clinical studies underline MSC’s modulation of the immune response as a key mechanism to avoid a cytokine storm which may be a crucial step in the treatment of COVID-19. Indeed, MSC reestablished the levels of lymphocytes counts [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ], T and Natural killer cells [ 6 ] and increased migration of DC to the site of inflammation [ 5 ]. Moreover, treatment with MSC decreased the levels of C-reactive protein and of pro-inflammatory cytokines and chemokines, such as TNF-α and IL-6 [ 5 , 7 , 8 , 11 ].…”

“…Indeed, regardless of the organ, SARS-CoV-2 infection causes disseminated inflammatory reactions, so therapies that bear immunomodulatory effects are welcome to treat COVID-19. Corroborating this idea, several clinical trials using MSC or their derived products are now ongoing and eight clinical studies were already concluded and reported interesting results, as most COVID-19 patients recovered a few days after treatment [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ]. However, only one of these studies incorporated appropriate control groups and a considerable number of patients.…”