Meta-analysis Of The Safety And Efficacy Of Stem Cell Therapies For Ischemic Stroke In Preclinical And Clinical Studies

Background:Stroke is one of the leading causes of death and disability worldwide.Ischemia stroke affects more than 50 million people worldwide,with a yearly mortality rate approaching 10%.Moreover,most survivors experience long-term disability,reducing their quality of life and increasing the overall economic burden.To explore the best treatment for stroke has always been a topic of great concern to the medical community.Currently,intravenous tissue plasminogen activator(t-PA)is the primary reperfusion therapy for acute ischemic stroke(AIS).However,very few patients with ischemic stroke(<10%)meet the current eligibility criteria for intravenous t-PA.And with the current evidence,AIS due to occlusion of a large vessel in the anterior circulation can undergo catheter-based intervention with a stent retriever only if they meet relevant criteria.Due to the self-renewal and proliferative differentiation of stem cells,the repair of central nervous system injury including stroke has attracted much attention.At home and abroad,there is no definite conclusion on the delivery pathway,efficacy and safety of this therapy,either in basic experiments or clinical trials.This study was based on evidence-based medicine criteria and selected meta-analysis methods to reach a scientific and rigorous conclusion.Object:To investigate the efficacy and safety of stem cell transplantation in the treatment of ischemic stroke.Methods:We searched PubMed,Embase,Web of science,Cochrane,Ovid database,Cnki,Wip,WanFang et al.database related articles on stem cell therapy for ischemic stroke from inception through May 2018.Results:The composite weighted mean(95%CI)effect sizes for lesion volume,percentage of lesion volume,and mNSS were-46.59[-62.04,-11.15](P<0.001),-13.18[-25.62,-0.73](P=0.04),and-1.85[-2.17,-1.53](P<0.001),respectively.Our analysis revealed that all three outcomes were significantly more favorable in the stem cell group than in the control group.Barthel index(BI)values,modified Rankin Scale(mRS)scores,National Institutes of Health Stroke Scale(NIHSS)scores,and Fugl-Meyer Assessment(FMA)scores were regarded as outcome measures for human studies.Our results were as follows:NIHSS[MD=2.57,95%CI(-3.45,-1.68),P<0.001];BI[MD=7.93,95%Cl(3.11,12.75),P=0.001];mRS[MD-0.53,95%CI(-0.73,-0.28),P<0.001];FMA[MD=5.50,95%CI(2.05,8.95),P=0.002].These results suggest that stem cell transplantation was associated with significantly better outcomes than control treatment.Adverse reactions such as mild headache and fever resolved shortly following treatment.Stem cell transplantation can significantly improve neurological deficits and quality of life in patients with ischemic stroke,without severe adverse reactions.Our results also suggest that such treatment is most effective when provided earlier and via the intravenous route.Conclusion:Stem cell transplantation can promote the recovery of nerve function defect and motor function in patients with ischemic stroke without obvious adverse reactions.