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IMMUNOMODULATORY AND ANTI-FIBROTIC EFFECTS FOLLOWING THE INFUSION OF UMBILICAL CORD MESENCHYMAL STROMAL CELLS IN A CRITICALLY ILL PATIENT WITH COVID-19 PRESENTING LUNG FIBROSIS: A CASE REPORT
Síndrome do Desconforto Respiratório
Células estromais mesenquimais
Terapia celular
Imunomodulação
Fibrose
ARDS
Mesenchymal stromal cells
Cell therapy
Immunomodulation
Fibrosis
Autor
Silva, Kátia Nunes da
Pinheiro, Priscila Carvalho Guedes
Gobatto, André Luiz Nunes
Passos, Rogério da Hora
Paredes, Bruno Diaz
França, Luciana Souza de Aragão
Nonaka, Carolina Kymie Vasques
Duarte, Beatriz Barreto
Pereira, Mariana Araújo
Tibúrcio, Rafael
Cruz, Fernanda Ferreira
Martins, Gabriele Louise Soares
Andrade, Bruno Bezerril de
Faria Neto, Hugo Caire de Castro
Rocco, Patricia Rieken Macêdo
Souza, Bruno Solano de Freitas
Pinheiro, Priscila Carvalho Guedes
Gobatto, André Luiz Nunes
Passos, Rogério da Hora
Paredes, Bruno Diaz
França, Luciana Souza de Aragão
Nonaka, Carolina Kymie Vasques
Duarte, Beatriz Barreto
Pereira, Mariana Araújo
Tibúrcio, Rafael
Cruz, Fernanda Ferreira
Martins, Gabriele Louise Soares
Andrade, Bruno Bezerril de
Faria Neto, Hugo Caire de Castro
Rocco, Patricia Rieken Macêdo
Souza, Bruno Solano de Freitas
Afiliación
"Múltipla ver em Notas"
Resumen en ingles
Background: The patients with coronavirus disease 2019 (COVID-19) associated with
severe acute respiratory distress syndrome (ARDS) may require prolonged mechanical
ventilation which often results in lung fibrosis, thus worsening the prognosis and
increasing fatality rates. A mesenchymal stromal cell (MSC) therapy may decrease lung
inflammation and accelerate recovery in COVID-19. In this context, some studies have
reported the effects ofMSC therapy for patients not requiring invasive ventilation or during
the first hours of tracheal intubation. However, this is the first case report presenting the
reduction of not only lung inflammation but also lung fibrosis in a critically ill long-term
mechanically ventilated patient with COVID-19.
Case Presentation: This is a case report of a 30-year-old male patient with COVID-19
under invasive mechanical ventilation for 14 days in the intensive care unit (ICU),
who presented progressive clinical deterioration associated with lung fibrosis. The
symptoms onset was 35 days before MSC therapy. The patient was treated with
allogenic human umbilical-cord derived MSCs [5 × 107 (2 doses 2 days interval)]. No
serious adverse events were observed during and after MSC administration. After MSC therapy, PaO2/FiO2 ratio increased, the need for vasoactive drugs reduced, chest CT
scan imaging, which initially showed signs of bilateral and peripheral ground-glass, as
well as consolidation and fibrosis, improved, and the systemic mediators associated with
inflammation decreased. Modulation of the different cell populations in peripheral blood
was also observed, such as a reduction in inflammatory monocytes and an increase in
the frequency of patrolling monocytes, CD4+ lymphocytes, and type 2 classical dendritic
cells (cDC2). The patient was discharged 13 days after the cell therapy.
Conclusions: Mesenchymal stromal cell therapy may be a promising option in critically
ill patients with COVID-19 presenting both severe lung inflammation and fibrosis. Further
clinical trials could better assess the efficacy of MSC therapy in critically ill patients with
COVID-19 with lung fibrosis associated with long-term mechanical ventilation.
Palabras clave en portugues
COVID-19Síndrome do Desconforto Respiratório
Células estromais mesenquimais
Terapia celular
Imunomodulação
Fibrose
Palabras clave en ingles
COVID-19ARDS
Mesenchymal stromal cells
Cell therapy
Immunomodulation
Fibrosis
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