Stem cell therapy approaches for non-malignant diseases & non-haematological diseases in India: A systematic review

U et al23, 2019 Cystic maxillofacial bony defects Dental 15 . 6 Evaluate the role of BMA in regenerating new bone Autologous Bone marrow-derived Stem Cells 1) Bone defect volume reduction was statistically significant; 2) No tooth mobility; 3) Faster wound healing . Bhansali et al24, 2009 T2DM Diabetes 10 . 6 Efficacy of Autologous Bone Marrow–Derived Stem Cell Autologous Bone Marrow-derived Stem Cells 1) Insulin requirements reduced; 2) c-peptide stimulated 1) Self-limiting nausea; 2) Vomiting; 3) Hematoma Vanikar et al25, 2010 T1DM Diabetes 11 13 to 43 12 Efficacy and safety of combined Mixed Adipose tissue-derived insulin-secreting mesenchymal stem cells (IS-AD-MSC) and cultured bone marrow (CBM) 1) c-peptide assay- increased gradually; 2) Insulin requirement decreased; 3) HBA2c level - decreased; 4) GAD antibodies - decrease in some and others not . Dave et al26, 2015 T1DM Diabetes 10 8 to 45 31.71 Safety and efficacy Mixed Adipose tissue-derived MSC-differentiated insulin-secreting cells (ISC) with hematopoietic stem cells (HSC). 1) c-peptide level increased; 2) HbA1c improved; 3) Insulin requirement reduced; 4) GAD ab - positive No untoward effect Thakkar et al27, 2015 T1DM Diabetes 20 8 to 45 12 Compare & assess - safety & efficacy Mixed Adipose-derived MSC and Bone marrow-derived HSC 1) Insulin requirement reduced; 2) HBA1c reduced; 3) GAD antibody decreased; 4) Autologous SCT improved better than allogenic SCT for C-peptide No untoward effect, morbidity (pulmonary embolism, sepsis) or mortality Thakkar et al28, 2016 T1DM Diabetes 20 8 to 45 27+ Efficacy and safety of coinfusion Mixed Adipose tissue-derived insulin-secreting mesenchymal stem cells and bone marrow-derived hematopoietic stem cells 1) Mean GAD antibody - decreased 2) Mean insulin requirement decreased 3) absence of DKA episodes in all 4) c-peptide level - increased . Sood et al29, 2017 T2DM Diabetes 42 30 to 70 6 To find out optimal routes for deliveryof stem cells Autologous Bone Marrow-derived Mononuclear Cells 1) C-peptide assay - difference remained statistically non-significant across all groups; 2) Insulin sensitivity indices of HOMA IR and HOMA B did not show any significant differences; 3) Decrease in Insulin dosages except for peripheral intravenous route; 4) HbA1c - non-significant change . Bhansali et al30, 2017 T2DM Diabetes 40 30 to 60 12 Efficacy and safety of ABM-MSCs and ABM-MNCs transplantation Autologous Bone marrow-derived mesenchymal stem cells and mononuclear cells 1) Insulin requirement reduction; 2) HbA1c reduction; 3) Improvement in c-peptide response; 4) Insulin sensitivity also improved . Sangwan et al31, 2012 Unilateral limbal stem cell deficiency Eye . . . Novel simplified technique of limbal transplantation Autologous Limbal epithelial cells Epithelialised, avascular and stable corneal surface . Sharma et al32, 2013 Total limbal stem cell deficiency Eye 4 8 - 12 26 Clinical outcome with the phenotype of rejuvenated corneal epithelium Autologous Limbal epithelial cell (cultured) 1) Epithelial transparency increased; 2) Reduction or absence of corneal vascularization and conjunctivalization; 3) No sign of signs of recurrent LSCD; 4) ocular the surface remained stable and visual acuity improved . Titiyal et al33, 2015 Ocular burns Eye 20 . 6 Outcomes of live-related limbal allograft (Lr-CLAL) versus cadaveric keratolimbal allograft (KLAL) in limbal stem cell deficiency (LSCD) Allogenic Limbal stem cell (live and cadaveric) Lr-CLAL shows better results than KLAL regarding vision gain and ocular surface restoration. . Kaliki et al34, 2017 Ocular surface squamous neoplasia eye 8 . 12 Compare the surgical outcomes with and without p-SLET Autologous Limbal epithelial cells None of them developed LSCD or tumor recurrence . Kaparthi et al35, 2008 Dilated cardiomyopathy Heart 5 20-65 . Safety and efficacy Autologous Bone marrow-derived mononuclear cells 1) Procedure was safe; 2) improved myocardial contractility and LV function . Guhathakurta et al36, 2009 Cellular Cardiomyoplasty Heart 40 . 6 Safety of protocol Mixed Bone marrow mononuclear cells and peripheral blood-derived endothelial precursor cells Marginal improvement in myocardial function . Prasad et al37, 2012 Stroke Heart 11 30 to 70 12 Feasibility, safety and clinical outcome Autologous Bone marrow-derived mononuclear cells 1) Study was feasible; 2) Safe - no evidence of tumour formation; 3) All scores - statistically significant . Bhasin et al38, 2013 Stroke Heart 40 18-65 6 Safety, feasibility and efficacy Autologous Bone marrow-derived mesenchymal stem cells and mononuclear cells Only the modified Barthel Index was statistically significant . Prasad et al39, 2014 Ischemic Stroke Heart 58 18 to 75 6 Efficacy and safety of autologous BMSCs Autologous Bone marrow-derived mononuclear cells No beneficial effect of treatment on stroke outcome . Chullikana et al40, 2015 Acute myocardial infarction Heart 20 . 24 Safety and efficacy of intravenous administration Allogenic Bone marrow-derived mesenchymal stem cell Not significant outcomes compared with placebo 1) 39 treatment-emergent adverse events; 2) SASEs - ventricular tachycardia, pericardial effusion and AMI Nair et al41, 2015 Acute myocardial infarction Heart 250 20-65 6 Efficacy of stem cells in the improvement of left ventricular function Autologous Bone marrow-derived mononuclear cells 1) Improvement was not significant; 2) Cell dose more than 5x10^8 shows positive impact 1) Chest pain, dyspnoea and other symptoms; 2) One died due to acute stent thrombosis with acute LV failure Patel et al42, 2015 Ischemic heart failure or non-ischemic heart failure Heart 60 . 12 Safety and feasibility Autologous Bone marrow-derived mononuclear cells Not powered to demonstrate statistical significance 1) Elevated troponin levels; 2) Catheterization site hematomas; 3) Bleeding at the marrow aspiration site; 4) Pain at the aspiration site; 5) Congestive heart failure exacerbation requiring hospital admission; 6) Ventricular arrhythmia; 7) Hematomas at the catheterization site and elevatedserum creatinine Bhatia et al43, 2018 Subacute Ischemic Stroke Heart . . 6 Evaluate the Safety and the efficacy of intra-arterial infusion Autologous Bone marrow-derived mononuclear cells 1) Good clinical outcomes; 2) modified Rankin Scale score also improved . Trivedi et al44, 2002 Pediatric renal transplant Kidney 44 . 18 To achieve zero-rejection status in pediatric renal allograft recipients, Allogenic Peripheral blood stem cell 1) 100% graft survival with sustained low serum creatinine value; 2) Absence of graft vs. host disease 1) Appearance of CMV Trivedi et al45, 2003 Renal Allograft Kidney 43 . 12 Tolerance in Living Related Renal Allografts Allogenic Bone Marrow-derived Stem Cells 2) Better graft function but not statistically significant 1) Single acute rejection; 2) Appearance of CMV disease; 3) Serum creatine not significant level; 4) No GVHD5) rise of donor-specifi cytotoxic allo-antibodies Trivedi et al46, 2007 Chronic kidney disease Kidney 357 . 36 Induce tolerance against MHC barriers Allogenic Bone marrow (BM)-derived and peripheral blood stem cell (PBSC) 1) Significantly better allograft function with low serum creatinine value 1) Acute rejection episode; 2) Acute vascular plus tubulointerstitial rejection; 3) Systemic infections; 4) Patients died Vanikar et al47, 2014 end-stage renal disease Kidney 95 . 7 Safety, efficacy and benefits Mixed Adipose-derived mesenchymal stem cells (AD-MSC) + hematopoietic stem cells (HSC) 1) No side effects; 2) Survival rate is high; 3) safe and effectivestrategy for minimization of immunosuppression . Khan et al48, 2010 Cirrhosis Liver 25 . . Safety and efficacy of human fetal liver-derived stem cell Allogenic Human fetal liver-derived stem cell 1) Decrease MELD score; 2) Improve clinical and biochemical parameters; 3) No episodes related to hepatic encephalopathy recurred No other clinical complications were observed after follow up Sharma et al49, 2015 Liver cirrhosis Liver 55 18-70 3 Effect of peripheral CD+ cells Autologous Peripheral blood CD34+ cell 1) Procedure was safe; 2) Statistically significant - improve live function; 3) helps to delay liver transplantation . Kumar et al50, 2009 Spinal cord injury Neuro 297 . . Safety and primary efficacy Autologous Bone marrow derived mononuclear cell 1) One-third patients show perceptible improvements; 2) No correlation between level of injury and improvements; 3) Number of CD34+ cells injected has direct correlation to outcomes In some - fever, Headache, Tingling sensation, Neuropathic sensory symptoms Pal et al51, 2009 Spinal cord injury Neuro 30 . 3 Growth kinetics of BM MSC, safety and functional improvement Autologous Bone marrow-derived mesenchymal stem cell 1) Protocol is safe; 2) uncontrolled nature of the trial does notpermit demonstration of the effectiveness . Venkataramana et al52, 2010 Parkinson’s Disease Neuro 7 . 36 Safety and feasibility of BM-MSCs Autologous Bone marrow-derived mesenchymal stem cell 1) Improvements in the UPDRS scale; 2) H&Y and S&E score also improved; 3) PD medication reduced . Srivastava et al53, 2011 Cerebral palsy Neuro 30 5-25 12 To evaluate the feasibility, safety, therapeutic potential Autologous Bone marrow-derived mononuclear cells 1) Twopatient - fever; 2) Protocol - Safe; 3) mBI score - significantly improved; 4) MRC, Ashworth scale - significantly improved . Bhanot et al54, 2011 Spinal cord injury Neuro 13 18-51 12 Safety and efficacy of Autologous Bone marrow-derived mesenchymal stem cells Only few patients shows improvement 1) 50% patients reported - a transient increase in spasticity; 2) In some - Fever, vomiting, general body ache, tingling/burning girdle sensation Sharma et al55, 2012 Muscular dystrophy, spinal cord injury, cerebral palsy, and miscellaneous Neuro 71 . 15 Outcomes of autologous stem cell therapy Autologous Bone marrow derived mononuclear cell Shows improvements and also improves quality of life No adverse event Venkataramana et al56, 2012 Parkinson’s Disease Neuro 12 37–69 12 Safety, feasibility, and efficacy of allogenic Allogenic Bone marrow-derived mesenchymal stem cells Subjective improvement observedreported clarity in speech, reduction in tremors, rigidity, and freezing attacks . Aggarwal et al5,7, 2012 Posttraumatic Facial Nerve Paralysis Neuro 8 18-60 6 Safety profile and role Autologous Bone marrow-derived mononuclear cells 1) Significant improvement in ENoG amplitude; 2) statistically significant both for eyeclosure and for deviation of angle of mouth . Sharma et al58, 2013 Autism Neuro 32 3-33 26 Safety, efficacy, and clinical effects Autologous Bone marrow-derived mononuclear cells 1) Statistically significant in CGI-I score and total ISAA score; 2) Not significant in FIM score and Wee-FIM scores; 3) CGI-II scale - global improvement 1) Seizures after therapy controlled using antiepileptic drugs; 2) In some - headache, nausea, vomiting backache, pain at the site of injection, aspiration; 3) Increase in hyperactivity at minimal and persistent level but not interfere with the global clinical improvement Sharma et al59, 2013 Muscular dystrophy Neuro 150 2.11-8 Mean 12 Safety and Efficacy Autologous Bone marrow-derived mononuclear cells Neurological improvements in trunk muscle strength, limb strength No adverse events Sharma et al60, 2015 Cerebral palsy Neuro 40 17 months-22 yr 6 to evaluate the efficacy Autologous Bone marrow-derived mononuclear cells 95% of patients showed improvements 1) The beneficial effect of MNC (stem cell instillation) onhip survival. Spinal headache, nausea, vomiting, pain at the site of injection, suffered diarrhoea Rajput et al61, 2015 Muscular Dystrophy, Duchenne Neuro 11 . 36 Role in the cellular therapy Allogenic Human umbilical cord mesenchymal stem cells 1) Provide muscle stability; 2) Provide muscle strength in the distal and proximal lower limb; 3) Stability in muscle function of other body parts . Sharma et al,62, 2015 Traumatic Brain Injury Neuro 14 12-65 6 To promote angiogenesis, axonal remodelling, neurogenesis and synaptogenesis Autologous Bone marrow-derived mononuclear cells 1) Improvements - speech, trunk, upper limb activity, muscle tone, voluntary control, ambulation, gait pattern, posture, balance, psychological status, cognition, memory, Adls; 2) improved functional outcome and enhanced quality of life Side effect noted - seizure Chhabra et al63, 2016 Spinal cord injury, acute Neuro 21 . 12 The safety and feasibility Autologous Bone marrow-derived stem cells 1) No significant adverse effects; 2) No significant improvements; 3) procedure is safe and feasible; 4) No efficacy demonstrated . Sharma et al64, 2018 Intellectual disability Neuro 58 4-45 . Safety, efficacy and clinical effects of autologous bone marrow mononuclear cell Autologous Bone marrow-derived mononuclear cells 1) Symptomatic improvements in the intervention the group showed after transplantation compared with rehabilitation 1) No adverse events were recorded; 2) In some - Fever, headache, vomiting Sen et al65, 2012 Femoral Head Osteonecrosis Skeletomuscular 40 . . Evaluates the early results of BMNC instillation into the femur head Autologous Bone marrow-derived mononuclear cells 1) Statistically, significant differences in HHS and its domains (pain, function, deformity, and motion); 2) the beneficial effect of MNC on hip survival. . Gupta et al66,2013 critical limb ischemia Skeletomuscular 20 . 24 Safety and efficacy Allogenic Bone marrow derived mesenchymal stem cell 1) Improvements - rest pain scores in both the arms SAE - death but not related to stem cells Gupta et al67, 2016 osteoarthritis Skeletomuscular 60 . 12 Safety and efficacy Allogenic Bone marrow mesenchymal stromal cells 1) Trend towards improvement in subjective parameters; 2) Not statistically significant with placebo Knee pain and swelling Gupta et al68, 2017 Critical limb ischemia (CLI) due to Buerger’s disease Skeletomuscular 36 38-42 24 Efficacy and safety of i.m. injection of allogenic BMMSC Allogenic Bone marrow-derived mesenchymal stem cells Benefit in both the primary endpoints (rest pain relief and ulcer healing) and most secondary endpoints (improvement in total walking distance, ankle brachial pressure index, and quality of life). 1) Two deaths were reported; 2) administered allogeneic cells did not adversely alter the immunological and lymphocytic profile Mulekar69, 2003 Vitiligo Skin 122 12-70 12 To evaluate the usefulness of epidermal cell transplantation Autologous Melanocyte-keratinocyte 1) Excellent repigmentation; 2) Recurrence also observed . Tegta et al70, 2006 Vitiligo Skin 20 . 3 Efficacy of Autologous melanocyte Autologous Melanocyte 210-250 cells/mm2 required for satisfactory repigmentation . Dash et al71, 2009 Nonhealing Ulcers Skin 24 . 3 Assess the efficacy and feasibility Autologous Bone marrow-derived mesenchymal stem cells and mononuclear cells Significant improvement in pain-free walking distance and reduction in ulcer size . Mohanty et al72, 2011 Vitiligo Skin 14 . . To evaluate the efficacy of a novel surgical method Autologous Melanocyte Greatly achieved repigmentation . Sahni et al73, 2011 Vitiligo Skin 25 . . Compare results of autologous melanocyte trnasplanation with saline and serum Autologous Melanocyte 1) Own serum shows better results than saline; 2) Statistically significant DLQI score 1) Mild adverse events; 2) Halo phenomenon and infection at site of injection;3) Hyperpigmentation; 4) scarring at the donor site Budania et al74, 2012 Vitiligo Skin 41 . 4 Comparison of techniques Autologous Melanocyte 1) Excellent re-pigmentation observed; 2) NCES better than SBEG . Singh et al75, 2013 Vitiligo Skin 30 . 4 Compare NCES and NCORSHFS Autologous Melanocyte 1) Excellent repigmentation; 2) reduction in DLQI score; 3) Both Safe and effective; 4) NCES is superior to NCORSHFS None any adverse events reported Vinay et al76, 2015 Vitiligo Skin 30 . 6 Clinical characteristics and treatment variables Autologous Melanocytes and hair follicle stem cells 1) Achieving optimum repigmentation; 2) a strong correlation between repigmentation at 24 week and number of melanocytes and HFSC transplanted; 3) absence of dermal inflammation . Donaparthi & Chopra,77, 2016 Vitiligo Skin 11 . 6 Comparative efficacy Autologous Melanocyte epidermal 1) >90% repigmentation; 2) safe and effective method; 3) Smaller patches repigmented better than larger ones . Kumar et al78, 2018 Vitiligo Skin 25 . 6 Clinical Efficacy, Viability and cell compositions of suspension Autologous Melanocyte-keratinocyte 1) More than 50% repigmentation; 2) More than 80% cell viability Recipient site infection Thakur et al79, 2018 Vitiligo Skin 40 . 6 Efficacy of transplantation of NCES and NDCS vs NCES Autologous Melanocyte-keratinocyte 1) Combination of NCES and NDCS resulted in excellent response than NCES alone 1) Mild hyperpigmentation or hypopigmentation; 2) Post surgery perilesional halo developed Sahoo et al80, 2019 localized facial volume loss Skin 10 15-24 6 Safety and efficacy Autologous Dermal mesenchymal stem cells 1) Improvement in dermal atrophy and lipoatrophy 1) Erythema, edema and mild to moderate pain at the site of injection Gupta et al81, 2019 Vitiligo Skin 32 13-31 6 Compare the two techniques Autologous Melanocyte-keratinocyte 1) 49% repigmentation achieved; 2) No statistically significant between two techniques Reported 1) Hyperpigmentation; 2) Scarring; 3) achromatic fissures; 4) reactivation of disease Mrigpuri et al82, 2019 Vitiligo Skin 30 . 4 Efficacy of NCES Autologous Melanocyte-keratinocyte 1) Good repigmentation . Gunaabalaji et al83, 2020 Vitiligo Skin 20 . . Comparison of efficacy Autologous Melanocyte hair follicle cell suspension and noncultured epidermal cell and 1) ECS was better than HFCS in repigmentation of leukotrichia and vitiligo, although the difference was not statistically significant .

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