Stem Cell Therapy for Dilated Cardiomyopathy
Diaz-Navarro R, UrrútiaG, Cleland JGF, Poloni D, Villagran F, Acosta-Dighero R, Bangdiwala SI, Rada G, MadridE. Stem cell therapy in dilated cardiomyopathy. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013433. doi: 10.1002 /14651858.CD013433.pub2. Accessed July 28, 2021.
Commentary
This study was conducted to evaluate the efficacy and safety of SCT in adults with non-ischemic DCM.
The main results included 13 RCTs with 762 participants (452 cell therapies and 310 controls) and only one study with a low risk of bias across all domains.
It should be noted that the publication had a number of shortcomings that prevented us from accurately assessing the risk of bias in many areas. Due to the nature of the intervention, the main source of potential bias was the lack of blinding of participants (performance bias).
It is unclear whether SCT reduces mortality from all causes in DCM patients compared to no intervention/placebo. (Mean follow-up 12 months)
It is unclear whether SCT increases the risk of procedural complications related to cell injection in DCM patients, and it is also unclear whether it improves HRQoL and functional capacity (6 minutes walk).
However, they do say that SCT may result in a small functional class improvement.
When SCT is compared to cell mobilization with granulocyte colony-stimulating factor (G-CSF), it is unclear whether SCT reduces mortality from all causes. It will be unknown whether it increases the risk of procedural complications associated with cell infusion and may not improve HRQoL. However, it does appear to have the potential to improve functional capacity. (Six-minute walk test)
The results across these studies, based on physiological measures of cardiac function, had some beneficial effects suggesting a potential benefit of SCT in people with non-ischemic DCM.
However, it is unclear whether this intermediate effect will translate into clinical benefit for these patients.
The authors conclude that
It is unclear whether SCT in patients with DCM reduces the risk of all-cause mortality and procedural complications and improves HRQoL and performance status (exercise capacity); SCT may improve functional class (NYHA) compared with usual care (no cells).
It is also unclear whether it also reduces the risk of death when compared to G-CSF, but several studies within this comparison have observed a favorable effect that should be interpreted with caution.
That is, SCT may not improve HRQoL, but it may improve performance status (exercise capacity) to some extent.
