Segurança e Eficácia da Terapia com Células-tronco Mesenquimais Derivadas do Tecido Adiposo para Cardiopatia Isquêmica: Revisão Sistemática
Resumo Fundamento A terapia celular utilizando células-tronco mesenquimais derivadas do tecido adiposo (ADSC, sigla em inglês) apresenta grande potencial como tratamento para doenças cardiovasculares. Objetivo Realizamos uma revisão sistemática para descrever a segurança e a eficácia das ADSC na car...
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Published in | Arquivos brasileiros de cardiologia Vol. 121; no. 9 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | Portuguese English |
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Sociedade Brasileira de Cardiologia - SBC
2024
Sociedade Brasileira de Cardiologia (SBC) |
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Abstract | Resumo Fundamento A terapia celular utilizando células-tronco mesenquimais derivadas do tecido adiposo (ADSC, sigla em inglês) apresenta grande potencial como tratamento para doenças cardiovasculares. Objetivo Realizamos uma revisão sistemática para descrever a segurança e a eficácia das ADSC na cardiopatia isquêmica. Métodos Pesquisamos na PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL e LILACS (desde o início até março de 2024) por estudos clínicos envolvendo ADSC em pacientes com cardiopatia isquêmica. Excluímos estudos envolvendo pacientes com outros tipos de doenças cardíacas, estudos utilizando células-tronco mesenquimais derivadas de outros tecidos, bem como estudos em andamento. Dois revisores independentes realizaram a triagem das citações recuperadas, extraíram dados relevantes e avaliaram o risco de viés nos ensaios incluídos, utilizando os critérios da Colaboração Cochrane modificados pela Universidade McMaster e o Índice Metodológico para Estudos Não-Randomizados (MINORS). Utilizamos uma síntese narrativa para apresentar os resultados. Resultados Dez estudos (compreendendo 29 publicações) preencheram nossos critérios de inclusão, incluindo 8 ensaios controlados randomizados e 2 ensaios não controlados. Não foram relatados eventos adversos graves associados à terapia com ADSC. Embora a maioria dos desfechos de eficácia não tenha alcançado significância estatística, houve relatos de melhora da área isquêmica, capacidade funcional, sintomas e contratilidade em pacientes tratados com ADSC. Conclusões Os resultados da nossa revisão sugerem que a terapia com ADSC é geralmente segura para pacientes com cardiopatia isquêmica. Contudo, são necessárias mais investigações para confirmar a sua eficácia, particularmente em ensaios clínicos de maior escala e em condições específicas onde as melhorias na microcirculação podem ter um impacto notável nos desfechos clínicos.
Abstract Background Cell therapy using adipose-derived mesenchymal stem cells (ADSCs) shows great potential as a treatment for cardiovascular diseases. Objective We conducted a systematic review to describe the safety and efficacy of ADSCs in ischemic heart disease. Methods We searched PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and LILACS (from inception to March 2024) for clinical studies involving ADSCs in patients with ischemic heart disease. We excluded studies involving patients with other types of heart disease, studies using mesenchymal stem cells derived from other tissues, as well as ongoing studies. Two independent reviewers screened the retrieved citations, extracted relevant data, and assessed the risk of bias in the included trials, using the Cochrane Collaboration criteria modified by McMaster University and Methodological Index for Non-Randomized Studies (MINORS). We used a narrative synthesis to present the results. Results Ten studies (comprising 29 publications) met our inclusion criteria, including 8 randomized controlled trials and 2 uncontrolled trials. No severe adverse events associated with ADSC therapy were reported. While most efficacy endpoints did not reach statistical significance, there were reports of improved ischemic area, functional capacity, symptoms, and contractility in patients treated with ADSCs. Conclusions The findings from our review suggest that ADSC therapy is generally safe for patients with ischemic heart disease. However, further investigation is warranted to confirm its efficacy, particularly with larger clinical trials and in specific conditions where improvements in microcirculation may have a notable impact on clinical outcomes. |
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AbstractList | Resumo Fundamento A terapia celular utilizando células-tronco mesenquimais derivadas do tecido adiposo (ADSC, sigla em inglês) apresenta grande potencial como tratamento para doenças cardiovasculares. Objetivo Realizamos uma revisão sistemática para descrever a segurança e a eficácia das ADSC na cardiopatia isquêmica. Métodos Pesquisamos na PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL e LILACS (desde o início até março de 2024) por estudos clínicos envolvendo ADSC em pacientes com cardiopatia isquêmica. Excluímos estudos envolvendo pacientes com outros tipos de doenças cardíacas, estudos utilizando células-tronco mesenquimais derivadas de outros tecidos, bem como estudos em andamento. Dois revisores independentes realizaram a triagem das citações recuperadas, extraíram dados relevantes e avaliaram o risco de viés nos ensaios incluídos, utilizando os critérios da Colaboração Cochrane modificados pela Universidade McMaster e o Índice Metodológico para Estudos Não-Randomizados (MINORS). Utilizamos uma síntese narrativa para apresentar os resultados. Resultados Dez estudos (compreendendo 29 publicações) preencheram nossos critérios de inclusão, incluindo 8 ensaios controlados randomizados e 2 ensaios não controlados. Não foram relatados eventos adversos graves associados à terapia com ADSC. Embora a maioria dos desfechos de eficácia não tenha alcançado significância estatística, houve relatos de melhora da área isquêmica, capacidade funcional, sintomas e contratilidade em pacientes tratados com ADSC. Conclusões Os resultados da nossa revisão sugerem que a terapia com ADSC é geralmente segura para pacientes com cardiopatia isquêmica. Contudo, são necessárias mais investigações para confirmar a sua eficácia, particularmente em ensaios clínicos de maior escala e em condições específicas onde as melhorias na microcirculação podem ter um impacto notável nos desfechos clínicos. Resumo Fundamento A terapia celular utilizando células-tronco mesenquimais derivadas do tecido adiposo (ADSC, sigla em inglês) apresenta grande potencial como tratamento para doenças cardiovasculares. Objetivo Realizamos uma revisão sistemática para descrever a segurança e a eficácia das ADSC na cardiopatia isquêmica. Métodos Pesquisamos na PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL e LILACS (desde o início até março de 2024) por estudos clínicos envolvendo ADSC em pacientes com cardiopatia isquêmica. Excluímos estudos envolvendo pacientes com outros tipos de doenças cardíacas, estudos utilizando células-tronco mesenquimais derivadas de outros tecidos, bem como estudos em andamento. Dois revisores independentes realizaram a triagem das citações recuperadas, extraíram dados relevantes e avaliaram o risco de viés nos ensaios incluídos, utilizando os critérios da Colaboração Cochrane modificados pela Universidade McMaster e o Índice Metodológico para Estudos Não-Randomizados (MINORS). Utilizamos uma síntese narrativa para apresentar os resultados. Resultados Dez estudos (compreendendo 29 publicações) preencheram nossos critérios de inclusão, incluindo 8 ensaios controlados randomizados e 2 ensaios não controlados. Não foram relatados eventos adversos graves associados à terapia com ADSC. Embora a maioria dos desfechos de eficácia não tenha alcançado significância estatística, houve relatos de melhora da área isquêmica, capacidade funcional, sintomas e contratilidade em pacientes tratados com ADSC. Conclusões Os resultados da nossa revisão sugerem que a terapia com ADSC é geralmente segura para pacientes com cardiopatia isquêmica. Contudo, são necessárias mais investigações para confirmar a sua eficácia, particularmente em ensaios clínicos de maior escala e em condições específicas onde as melhorias na microcirculação podem ter um impacto notável nos desfechos clínicos. Abstract Background Cell therapy using adipose-derived mesenchymal stem cells (ADSCs) shows great potential as a treatment for cardiovascular diseases. Objective We conducted a systematic review to describe the safety and efficacy of ADSCs in ischemic heart disease. Methods We searched PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and LILACS (from inception to March 2024) for clinical studies involving ADSCs in patients with ischemic heart disease. We excluded studies involving patients with other types of heart disease, studies using mesenchymal stem cells derived from other tissues, as well as ongoing studies. Two independent reviewers screened the retrieved citations, extracted relevant data, and assessed the risk of bias in the included trials, using the Cochrane Collaboration criteria modified by McMaster University and Methodological Index for Non-Randomized Studies (MINORS). We used a narrative synthesis to present the results. Results Ten studies (comprising 29 publications) met our inclusion criteria, including 8 randomized controlled trials and 2 uncontrolled trials. No severe adverse events associated with ADSC therapy were reported. While most efficacy endpoints did not reach statistical significance, there were reports of improved ischemic area, functional capacity, symptoms, and contractility in patients treated with ADSCs. Conclusions The findings from our review suggest that ADSC therapy is generally safe for patients with ischemic heart disease. However, further investigation is warranted to confirm its efficacy, particularly with larger clinical trials and in specific conditions where improvements in microcirculation may have a notable impact on clinical outcomes. |
Author | Suzumura, Erica Aranha Pinesi, Henrique Trombini Sady, Erica Regina Ribeiro Giugni, Fernando Rabioglio Laranjeira, Lígia Nasi Habrum, Fabio Cetinic Krieger, José Eduardo Giugni, Melina de Oliveira Valdo Gowdak, Luis Henrique Wolff |
AuthorAffiliation | Hospital do Coração Baylor University Medical Center at Dallas The University of Texas Southwestern Medical Center Universidade de São Paulo |
AuthorAffiliation_xml | – name: Universidade de São Paulo – name: The University of Texas Southwestern Medical Center – name: Hospital do Coração – name: Baylor University Medical Center at Dallas |
Author_xml | – sequence: 1 givenname: Fernando Rabioglio orcidid: 0000-0001-9268-286X surname: Giugni fullname: Giugni, Fernando Rabioglio organization: The University of Texas Southwestern Medical Center, EUA; Universidade de São Paulo, Brasil – sequence: 2 givenname: Melina de Oliveira Valdo surname: Giugni fullname: Giugni, Melina de Oliveira Valdo organization: Universidade de São Paulo, Brasil; Baylor University Medical Center at Dallas, EUA – sequence: 3 givenname: Henrique Trombini surname: Pinesi fullname: Pinesi, Henrique Trombini organization: Universidade de São Paulo, Brasil – sequence: 4 givenname: Fabio Cetinic surname: Habrum fullname: Habrum, Fabio Cetinic organization: Universidade de São Paulo, Brasil – sequence: 5 givenname: Lígia Nasi surname: Laranjeira fullname: Laranjeira, Lígia Nasi organization: Hospital do Coração, Brasil – sequence: 6 givenname: Erica Regina Ribeiro orcidid: 0000-0003-2390-1605 surname: Sady fullname: Sady, Erica Regina Ribeiro organization: Hospital do Coração, Brasil – sequence: 7 givenname: Erica Aranha surname: Suzumura fullname: Suzumura, Erica Aranha organization: Universidade de São Paulo, Brasil – sequence: 8 givenname: Luis Henrique Wolff surname: Gowdak fullname: Gowdak, Luis Henrique Wolff organization: Universidade de São Paulo, Brasil – sequence: 9 givenname: José Eduardo surname: Krieger fullname: Krieger, José Eduardo organization: Universidade de São Paulo, Brasil; Hospital do Coração, Brasil |
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Keywords | Medicina Regenerativa Terapia Baseada em Transplante de Células e Tecidos Isquemia Miocárdica Células-Tronco Mesenquimais Regenerative Medicine Cell- and Tissue-Based Therapy Myocardial Ischemia Mesenchymal Stem Cells |
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Title | Segurança e Eficácia da Terapia com Células-tronco Mesenquimais Derivadas do Tecido Adiposo para Cardiopatia Isquêmica: Revisão Sistemática |
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