Stem Cell Transplantation for Stroke: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

YUAN Yong ¹ , ZENG Xiaoxi ¹ ,  WU Taixiang ²

1. Department of Geriatrics, West China Hospital, Sichuan University,Chengdu 610041, China2.Chinese Evidence-Based Medicine centre Chinese Cochrane Centre, West China hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

WU Taixiang, Email: txwutx@hotmail.com

Keywords：

Stroke; Stem cell transplantation; Systematic review

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Objective　 To assess systematically the safety and ef fects of stem cell transplantation in stroke patients.
Methods　 CENTRAL (April 2007), MEDLINE (1966 to April 2007), EMBASE (1980 to April 2007), and other databases were searched for RCT of the use of stem cell transplantation for patients with stroke. We critically appraised the quality of included studies according to Juny 2001. We assessed the effects of stem cell therapy on mortal ity, functional outcomes, cognitive functions, image changes, quality of life, and adverse effects by doing meta-analysis with The Cochrane Collaboration’ s Review Manager. Dichotomous outcomes were reported as relative risk and continuous outcome measures as weighted mean differences, with 95% confidence intervals.
Results　 Three RCTs and one historical controlled trial were included involving a total of 69 participants. Only one trial　reported the effect on mortality, but because of the small number of death it was not possible to detect any significant differences between stem cell transplantation and routine treatment (RR 0.11, 95%CI 0.01 to 2.31, P = 0.16). Three studies indicated a statistically significant improvement of some functional outcomes in patients treated by stem cell transplantation. Improvements of cognitive function were reported in another trial. One trial showed that the stem cell transplantation significantly improved qual ity of life compared with the control group.
Conclusion　 The current evidence is insufficient to determine whether or not stem cell transplantation is a safe and effective therapy for stroke patients. High-quality, large-scale randomized trials are needed to assess the role of stem cell transplantation for stroke.

Citation： YUAN Yong,ZENG Xiaoxi,WU Taixiang. Stem Cell Transplantation for Stroke: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(10): 743-749. doi: Copy

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1. William A. Pulsinelli. Cerebrovascular Diseases-principles. In: Lee Goldman, J. Claude Bennett, eds. Cecil Textbook of Medicine. Philadelphia: Saunders, 2000: 2092.
2. American Heart Association. Heart disease and stroke statistics – 2006 update. www. Stroke Association. Org.
3. American Heart Association. Heart disease and stroke statistics – 2006 update. Circulation, 2006, 133: 85.
4. Will iam A, Pulsinelli. Cerebrovascular disease-principles. In: Goldman L, Bennett JC. Editor-in-Chief. Cecil Textbook of Medicine. Philadelphia: Saunders. 2000: 2523.
5. Bang OY, Lee JS, Lee PH, et al. Autologous mesenchymal stem cell transplantation in stroke patients. Ann Neurol, 2005, 57: 874.
6. Zivin JA, Choi DW. Stroke therapy. Science of American, 1991, 265: 56.
7. Kondziolka D, Wechsler L, Goldstein S, et al. Transplantation of cultured human neuronal cells for patients with stroke. Neurology, 2000, 55: 565.
8. Meltzer CC, Kondziolka D, Villemagne VL, et al. Serial[18F] fluorodeoxyglucose positron emission tomography after human neuronal implantation for stroke. Neurosurgery, 2001, 49: 586.
9. Nelson PT, Kondziolka D, Wechsler L, et al. Clonal human (hNT) neuron grafts for stroke therapy: neuropathology in a patient 27 months after implantation. Am J Sci, 2002, 160: 1201.
10. Savitz SI, Dinsmore J, Wu J, et al. Neurotransplantation of fetal porcine cells in patients with basal ganglia infarcts: a preliminary safety and feasibility study. Cerebrovasc Dis, 2005, 20: 101.
11. Wechsler L. Stem cell transplantation for stroke. Hong Kong Med J, 2001, 7: 9.
12. Bl iss T, Guzman R, Daadi M, et al. Cell transplantation therapy for stroke. Stroke, 2007, 38: 817.
13. Kornblurm HI. Introduction to neural stem cells. Stroke, 2007, 38: 810.
14. Wechsler L. Stem cell transplantation for stroke. Cleve Clin J Med, 2004, 71: 40.
15. Juni P, Altman DG, Egger M. Systematic reviews in health care: assessing the quality of randomized controlled trials. BMJ, 2001, 323: 42.
16. Kondziolka D, Steinberg GK, Wechsler L, et al. Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial. J Neurosurg, 2005, 103: 38.
17. Stilley C, Ryan CM, Kondziolka D, et al. Changes in cognitive function after neuronal cell transplantation for basal gangl ia stroke. Neurology, 2004, 63: 1320.
18. Rabinovich SS, Seledtsov VI, Banul NV, et al. Cell therapy of brain stroke. Bull Exp Biol Med, 2005, 139: 126.

Chinese Journal of Evidence-Based Medicine

Stem Cell Transplantation for Stroke: A Systematic Review

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