Mesenchymal stem cells and exosome therapy for COVID-19: current status and future perspective

Abstract

Acute respiratory distress syndrome (ARDS) is the main cause for the COVID-19 infection-related morbidity and mortality. Recent clinical evidences suggest increased level of cytokines and chemokines targeting lung tissue as a prominent etiological factor. The immunomodulatory effect of mesenchymal stem cells (MSCs) as the alternative therapy for the treatment of inflammatory and autoimmune diseases is well known. Several studies have also revealed that similar therapeutic impacts of parent MSCs are also exhibited by MSCs-derived extracellular vesicles (EVs) including exosomes. In this review, we explored the therapeutic potential of both MSCs and exosomes in mitigating the COVID-19 induced cytokine storm as well as promoting the regeneration of alveolar tissue, attributed to the intrinsic cytokines and growth factor present in the secretome. The preliminary studies have demonstrated the safety and efficacy of MSCs and exosomes in mitigating symptoms associated with COVID-19. Thus, they can be used on compassionate basis, owing to their ability to endogenously repair and decrease the inflammatory reactions involved in the morbidity and mortality of COVID-19. However, more preclinical and clinical studies are warranted to understand their mechanism of action and further establish their safety and efficacy.

Overview of current adipose-derived stem cell (ADSCs) processing involved in therapeutic advancements: flow chart and regulation updates before and after COVID-19

“…However, interesting and encouraging approaches have been realized through MSCs therapy intravenously or intrathecally administered to COVID-19 patients [ 17 , 21 , 23 , 25 , 27 , 28 , 148 , 155 – 157 ]. Effectiveness and efficacy of MSCs in disease-associated inflammation and in immune diseases were well documented [ 158 ].…”

“…Thirteen severe cases of COVID-19 patients under invasive mechanical ventilation have received doses of allogenic ADSCs and presented improved clinical and biological outcomes [ 29 ]. Used at autologous and allogenic state, these cells have gained interest [ 13 , 14 , 19 , 23 , 27 , 169 ] provided that MSCs and derivatives are performed in GMP conditions and regulated by the FDA or EMA.…”

Nanomedicine for COVID-19: the role of nanotechnology in the treatment and diagnosis of COVID-19

“…Nanoscale drug delivery vehicle that reduces dosage requirement and toxicity while enhancing target specificity 4. Immunomodulation, which may reverse the cytokine storm-the main etiology of severe clinical symptoms of COVID-19 [263] So the advantages of nanomedicine in treating COVID-19 generalized can be named as follows:…”

Rapid evolution of our understanding of the pathogenesis of COVID-19: Implications for therapy

“…Marik et al [66] Vitamin C Multiple scientific benefits Unproven Cheng [67] Mesenchymal stromal/stem cell therapy Counter inflammation and apoptosis Unproven Cao, [4] Gupta et al [68] Nutritional components including glutathione peroxidase, lipoic acid, ferulic acid, sulforaphane, N-acetylcysteine, glycine, citrulline and high-dose folate…”