Preclinical stem cell therapy in fetuses with myelomeningocele: A systematic review and meta‐analysis

Prenatal Diagnosis, 2021 · DOI: 10.1002/pd.5887 · Published: January 1, 2021

Neurology Surgery Regenerative Medicine & Stem Cells

Simple Explanation

This study reviews the use of stem cells to treat myelomeningocele (MMC) in animal fetuses before birth. MMC is a birth defect where the spinal cord doesn't close fully. Researchers looked at studies where stem cells were given to animal fetuses with MMC to see if it was safe and if it helped improve the condition. The review found that stem cell treatment during pregnancy could be safe and helpful for MMC in animals, potentially covering the spinal defect and improving motor function.

Study Duration

Not specified

Participants

Animal fetuses with myelomeningocele

Evidence Level

Systematic Review and Meta-Analysis

Key Findings

1
Intra-amniotic injection of allogeneic amniotic fluid mesenchymal stem cells (AF-MSCs) in the fetal rat model did not compromise fetal survival.
2
Application of human placental mesenchymal stem cells (P-MSCs) to the spinal cord during fetal surgery in the ovine model did not compromise fetal survival.
3
Incorporation of human P-MSCs as a therapeutic adjunct to fetal surgery in the ovine MMC model significantly improved sheep locomotor rating scale after birth.

Research Summary

This systematic review and meta-analysis evaluated the safety and efficacy of stem cell transplantation in animal models of MMC, finding beneficial effects on animal survival, defect coverage, and spinal cord function. Safety data were reassuring, as intra-amniotic injection of allogeneic AF-MSCs in rats and application of P-MSCs during fetal surgery in lambs did not compromise fetal survival. A single intra-amniotic injection of AF-MSCs in fetal rats was associated with a higher rate of complete defect coverage, and P-MSCs improved motor function in newborn lambs when used as an adjunct to fetal surgery.

Practical Implications

Less Invasive Approaches

Intra-amniotic injection of stem cells can assist in defect coverage early in gestation.

Adjunct to Fetal Surgery

Stem cells can regenerate the 'already damaged' spinal cord, as even after fetal surgery, more than half of children with MMC were unable to walk without orthoses.

Clinical Translation

Further work is needed to determine the optimal source and dose of P-MSCs with appropriate toxicology studies before moving to a phase 1 clinical trial.

Study Limitations

1
Only included studies published in English language which may omit eligible studies reported in other languages.
2
Studies included in this review carry a high risk of bias due to lack of detail on randomization, allocation and treatment concealment.
3
Selective outcome reporting.

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