The effectiveness and safety of mesenchymal stromal/stem cell therapy for acute respiratory distress syndrome: an umbrella review.
- 1Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
- 2Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China.
- 3Department of Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China. [email protected].
Abstract
Background
Acute respiratory distress syndrome (ARDS) is closely related to public health because of its consistently high rates of mortality and morbidity. Mesenchymal stem/stromal cells (MSCs) treatment has become a promising therapeutic approach due to the regenerative and immunomodulatory qualities of it. Based on an umbrella review methodology, we seek to thoroughly integrate the available data on the effectiveness and safety of MSCs treatment for ARDS from various angles.Methods
This study was conducted following PRISMA 2020 standards. PubMed, Embase, Web of Science, and Cochrane Library databases were searched thoroughly between 1995 and October 2025 in order to find umbrella reviews that addressed the use of MSC treatment for ARDS. Review Manager and Stata MP software were used to carry out a meta-analysis of outcome measures. The methodological quality of the included research was assessed using the AMSTAR-2 scale, while the risk of bias in systematic reviews was assessed using the ROBIS tool. The certainty of the evidence was assessed using the GRADE procedure.Results
A total of 15 systematic reviews were included, of which 10 were related to randomized clinical trials (RCTs) and 5 were related to controlled preclinical studies. MSCs therapy may lower the death rate of ARDS patients (risk ratio [RR] = 0.79, 95% confidence interval [CI] 0.66-0.96) with moderate certainty of evidence, according to findings from systematic evaluations of clinical studies. With low certainty of evidence, adverse events did not significantly differ between the groups receiving MSCs therapy and those receiving conventional treatment (RR = 0.98, 95% CI 0.85-1.12). In controlled preclinical studies, ARDS animal models treated with MSCs had lower mortality rates and lower lung injury score (RR = 0.50, 95% CI 0.40-0.62; standardized mean difference [SMD] = - 3.19, 95% CI - 4.33 to - 2.05), which was accompanied by low credibility and significant heterogeneity.Conclusions
Our umbrella review shows the potential benefit of MSCS treatment in reducing mortality among ARDS patients, particularly in studies of UC-MSCs, and the possibility of reducing the degree of lung injury in ARDS animal models. The safety of MSCs has been validated in clinical trials, although the certainty of evidence is low. Our umbrella review clarifies the importance of standardized treatment protocols and clinical trials for confirming the efficacy of MSCs treatment and facilitating its clinical translation. However, the current evidence was limited by the substantial heterogeneity with very low certainty and requires confirmation in adequately powered, standardized, multicenter RCTs to promote translational application to human patients. Trial registration Systematic Review Registration: PROSPERO registration CRD420251267987 and CRD420251268056.
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BibTeX
@article{li2026effectiveness,
title = {{The effectiveness and safety of mesenchymal stromal/stem cell therapy for acute respiratory distress syndrome: an umbrella review.}},
author = {Wenchi Li and Feifei Wang and Yiqing Lin and Jinwei Shang and Shuyue Sheng and Feng Zhu},
journal = {Stem cell research \& therapy},
year = {2026},
month = jul,
doi = {10.1186/s13287-026-05212-0},
url = {https://europepmc.org/article/MED/42972454},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - The effectiveness and safety of mesenchymal stromal/stem cell therapy for acute respiratory distress syndrome: an umbrella review.
AU - Wenchi Li
AU - Feifei Wang
AU - Yiqing Lin
AU - Jinwei Shang
AU - Shuyue Sheng
AU - Feng Zhu
PY - 2026
DA - 2026/07/31
JO - Stem cell research & therapy
DO - 10.1186/s13287-026-05212-0
UR - https://europepmc.org/article/MED/42972454
AB - Background Acute respiratory distress syndrome (ARDS) is closely related to public health because of its consistently high rates of mortality and morbidity. Mesenchymal stem/stromal cells (MSCs) treatment has become a promising therapeutic approach due to the regenerative and immunomodulatory qualities of it. Based on an umbrella review methodology, we seek to thoroughly integrate the available data on the effectiveness and safety of MSCs treatment for ARDS from various angles.Methods This study was conducted following PRISMA 2020 standards. PubMed, Embase, Web of Science, and Cochrane Library databases were searched thoroughly between 1995 and October 2025 in order to find umbrella reviews that addressed the use of MSC treatment for ARDS. Review Manager and Stata MP software were used to carry out a meta-analysis of outcome measures. The methodological quality of the included research was assessed using the AMSTAR-2 scale, while the risk of bias in systematic reviews was assessed using the ROBIS tool. The certainty of the evidence was assessed using the GRADE procedure.Results A total of 15 systematic reviews were included, of which 10 were related to randomized clinical trials (RCTs) and 5 were related to controlled preclinical studies. MSCs therapy may lower the death rate of ARDS patients (risk ratio [RR] = 0.79, 95% confidence interval [CI] 0.66-0.96) with moderate certainty of evidence, according to findings from systematic evaluations of clinical studies. With low certainty of evidence, adverse events did not significantly differ between the groups receiving MSCs therapy and those receiving conventional treatment (RR = 0.98, 95% CI 0.85-1.12). In controlled preclinical studies, ARDS animal models treated with MSCs had lower mortality rates and lower lung injury score (RR = 0.50, 95% CI 0.40-0.62; standardized mean difference [SMD] = - 3.19, 95% CI - 4.33 to - 2.05), which was accompanied by low credibility and significant heterogeneity.Conclusions Our umbrella review shows the potential benefit of MSCS treatment in reducing mortality among ARDS patients, particularly in studies of UC-MSCs, and the possibility of reducing the degree of lung injury in ARDS animal models. The safety of MSCs has been validated in clinical trials, although the certainty of evidence is low. Our umbrella review clarifies the importance of standardized treatment protocols and clinical trials for confirming the efficacy of MSCs treatment and facilitating its clinical translation. However, the current evidence was limited by the substantial heterogeneity with very low certainty and requires confirmation in adequately powered, standardized, multicenter RCTs to promote translational application to human patients. Trial registration Systematic Review Registration: PROSPERO registration CRD420251267987 and CRD420251268056.
SN - 1757-6512
ER -