Mesenchymal and mononuclear stem cell therapy for acute ischemic stroke - A systematic review

Background: Studies have shown that stem cells have promising effect in ischemic stroke management. As an alternative therapy, the effectiveness and safety of mesenchymal (MSC) and mononuclear (MNC) stem cells in acute stroke are still unclear. This review evaluated the efficacy and safety of the use of MSC and MNC in acute ischemic stroke in terms of clinical and structural improvement. Methods: This is a systematic review which is conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. Our review focused on RCT, with acute ischemic stroke population using MSC or MNC, and evaluated the clinical and structural improvements, and safety outcome after administration of the stem-cells. Results: Eight studies were included, consisted of 155 patients in intervention and 408 in control group. In the MNC group, there was significant improvement of NIHSS within one month and achieved mRS ≤ 1 by six months. Slightly different from MNC, studies using MSC showed mRS improvement occurred after 3 months and NIHSS-motor improvement achieved after 2 years of infusion. One month after cell infusion, MRI showed structural improvement, with infarct expansion ratio of 0.9 ± 0.2 (p < 0.05). There was no differences in adverse events between intervention and control group in all studies. Conclusions: This review show that MSC and MNC stem-cells are effective and safe to use as alternative treatment in acute ischemic stroke if other definitive measures could not be done or not available.