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Journal of Ultrasound in Medicine :... Aug 2014The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the... (Review)
Review
The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the association of sonographic estimates of AFV with dye-determined AFV, and correlate AFV with antepartum, intrapartum, and perinatal outcomes in twin pregnancies. Studies were included if they were adequately powered and investigated antepartum, intrapartum, and/or perinatal adverse outcome parameters in twin gestations. Studies with comparable populations and exclusion criteria were merged into forest plots. Data comparing the accuracy of AFV assessment, correlation of AFV with gestational age, and adverse outcomes were tabulated. Five of the 6 studies investigating AFV by the amniotic fluid index as a function of gestational age reported data fitting a quadratic equation, with fluid volumes peaking at mid gestation and then declining. This trend was less pronounced when AFV was assessed by the single deepest pocket (2 of 4 studies reporting a quadratic fit). Polyhydramnios was associated with prematurity in 2 of 4 studies (1 amniotic fluid index and 1 single deepest pocket), and oligohydramnios was associated with prematurity in 1 single deepest pocket study. Stillbirth was the only intrapartum outcome reported in more than 1 study. Perinatal outcomes associated with polyhydramnios included neonatal death (P < .05 in 1 of 2 studies), low Apgar scores (1 of 2 studies), neonatal intensive care unit admission (1 of 2 studies), and low birth weight (2 of 3 studies).
Topics: Amniotic Fluid; Female; Humans; Oligohydramnios; Polyhydramnios; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Reproducibility of Results; Twins; Ultrasonography, Prenatal
PubMed: 25063400
DOI: 10.7863/ultra.33.8.1353 -
Revista Brasileira de Enfermagem 2021Analyze available evidence related to SARS-CoV-2 infection and vertical transmission. (Review)
Review
OBJECTIVE
Analyze available evidence related to SARS-CoV-2 infection and vertical transmission.
METHODS
Scoping review, according to the Joanna Briggs Institute and PRISMA-ScR. Searches were conducted in five electronic databases to find publications about coronavirus infection and vertical transmission. Data were extracted, analyzed and synthesized by three independent researchers using a descriptive approach.
RESULTS
The search resulted in 76 publications. After selective steps, 15 articles - retrospective descriptive or case studies - were analyzed, all in English. In order to track the infection, specimens were collected from neonates through nasal swabs and C-reactive protein from breast milk, cord blood, amniotic fluid, placenta and vaginal secretion was analyzed. A small percentage of neonates tested positive for COVID-19, but these cases were not attributed to vertical transmission.
CONCLUSION
Vertical transmission could not be demonstrated. Research protocol registered with the Open Science Framework (https://osf.io/fawmv).
Topics: C-Reactive Protein; COVID-19; DNA, Viral; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pandemics; Pregnancy; Pregnancy Complications, Infectious; Real-Time Polymerase Chain Reaction; SARS-CoV-2
PubMed: 34037165
DOI: 10.1590/0034-7167-2020-0849 -
Journal of Clinical Medicine Nov 2022The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the... (Review)
Review
The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the evidence about the safety and efficacy of these products. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the RoB 2.0 for randomized controlled trials (RCTs) and the modified Coleman Methodology Score (mCMS) for all studies. A total of 20 clinical studies (735 patients) was identified, 12 on PRP injections and eight on cell-based therapies (five from bone marrow, two from adipose tissue, and one from amniotic fluid). The publication trend increased over time, with over 50% of articles published from 2019. The literature analysis showed only six RCTs, all on PRP injections. The mCMS showed an overall fair methodology (mean score 59.4). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results, with the treatment success being inversely proportional to the severity of OA. Further high-level controlled trials are needed before drawing more definitive conclusions on the real potential of orthobiologics for the injective treatment of patients affected by hip OA.
PubMed: 36431138
DOI: 10.3390/jcm11226663 -
Archives of Gynecology and Obstetrics Feb 2024Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation and studies have concluded that approximately 10% of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation and studies have concluded that approximately 10% of the patients who show signs of preterm labor with intact membranes have an underlying intraamniotic infection, mostly subclinical, carrying an increased risk for preterm birth with its subsequent neonatal and maternal complications. The purpose of the present systematic review is to evaluate the impact of antibiotic therapy on preterm birth rates of women diagnosed with AFS.
METHODS
We searched Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar, and Clinicaltrials.gov databases for relevant articles published until the 30th of September 2022. Observational studies (prospective and retrospective) that evaluated the impact of antibiotics on preterm delivery rates of patients with AFS were considered eligible for inclusion. Statistical meta-analysis was performed with RStudio and we calculated pooled risk ratios (OR) and 95% confidence intervals (CI). To evaluate the information size, we performed trial sequential analysis (TSA) and the methodological quality of the included studies was assessed using RoBINS tools.
RESULTS
Overall, four retrospective cohort studies were included in the present systematic review and 369 women were enrolled. We demonstrated that preterm delivery prior to 34, 32 and 28 weeks of gestational age was comparable among the groups of women that had antibiotics and those that did not (OR: 0.34, 95% CI 0.05, 2.14, 0.40 [0.09, 1.66], 0.35 [0.08, 1.58], respectively) but the statistical heterogenicity of the studies included was high for every gestational period that was examined.
CONCLUSIONS
According to our study, we cannot conclude that the use of antibiotics in women with amniotic fluid sludge benefit the prognostic risk to deliver prematurely. It is quite clear that data from larger sample sizes and more well adjusted and designed studies are needed.
Topics: Female; Humans; Infant, Newborn; Amniotic Fluid; Anti-Bacterial Agents; Premature Birth; Prospective Studies; Retrospective Studies
PubMed: 37097312
DOI: 10.1007/s00404-023-07045-1 -
Ultrasound in Obstetrics & Gynecology :... Feb 2023Cytomegalovirus (CMV) DNA is detectable in the amniotic fluid collected by amniocentesis in cases in which the fetus has been infected. However, cases of congenital... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Cytomegalovirus (CMV) DNA is detectable in the amniotic fluid collected by amniocentesis in cases in which the fetus has been infected. However, cases of congenital neonatal CMV infection with a negative amniocentesis result have also been reported in the literature. The aim of the present study was to compare pregnancies with a negative amniocentesis result to those with a positive amniocentesis result in terms of incidence of fetal insult and long-term sequelae.
METHODS
Observational studies that included pregnant women with CMV infection who underwent amniocentesis and that reported their results together with neonatal and/or long-term outcomes of the offspring were included. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale. The rate of severe symptoms at birth, defined as neurological symptoms or multiorgan involvement at birth, and the rate of severe sensorineural hearing loss (SNHL) and/or neurodevelopmental impairment at follow-up were the main outcomes of the study. The secondary outcome was the rate of pregnancy termination due to the presence of CMV-associated central nervous system (CNS) findings or multiorgan involvement on ultrasound/magnetic resonance imaging (MRI).
RESULTS
Seven studies were included in the systematic review and meta-analysis. The pooled false-negative rate of amniocentesis was 8.0% (95% CI, 5.0-13.0%). The pooled rate of severe symptoms at birth was 0.0% (95% CI, 0.0-1.0%; I = 0%) in fetuses with a negative amniocentesis result and 22.0% (95% CI, 11.0-38.0%; I = 75%) in those with a positive amniocentesis result. The pooled odds ratio (OR) was 0.03 (95% CI, 0.01-0.10; I = 0%). The pooled rate of severe SNHL and/or neurodevelopmental impairment at follow-up in fetuses with a negative amniocentesis result was 0.0% (95% CI, 0.0-1.0%; I = 0%) and, in those with a positive amniocentesis result, it was 14.0% (95% CI, 7.0-26.0%; I = 64%). The pooled OR was 0.04 (95% CI, 0.01-0.14; I = 0%). The pooled rate of pregnancy termination due to the presence of CMV-associated CNS findings or multiorgan involvement on ultrasound/MRI was 0.0% (95% CI, 0.0-2.0%; I = 0%) in fetuses with a negative amniocentesis result and 20.0% (95% CI, 10.0-36.0%; I = 82%) in those with a positive amniocentesis result. The pooled OR was 0.03 (95% CI, 0.01-0.08; I = 0%). A subgroup analysis including only pregnancies with primary CMV infection and a sensitivity analysis including only prospective studies were carried out, showing very similar results to those of the main analysis.
CONCLUSION
A negative amniocentesis result in pregnant women with CMV infection ensures lack of fetal insult and long-term sequelae to the child, even if transmission has occurred. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Infant, Newborn; Child; Pregnancy; Infant; Female; Humans; Amniocentesis; Pregnancy Complications, Infectious; Prospective Studies; Cytomegalovirus; Cytomegalovirus Infections; Infectious Disease Transmission, Vertical; Observational Studies as Topic
PubMed: 36412976
DOI: 10.1002/uog.26128 -
The Cochrane Database of Systematic... Nov 2014Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from meconium aspiration syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.
OBJECTIVES
The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014).
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
We included two studies with 362 pregnant women. Both studies compared ampicillin-sulbactam (N = 183) versus normal saline (N = 179) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, there was a significant decrease in the risk of chorioamnionitis (RR 0.36, 95% CI 0.21 to 0.62). No serious adverse effects were reported. Drug resistance, duration of mechanical ventilation and duration of admission to NICU/hospital were not reported. Most of the domains for risk of bias were at low risk of bias for one study and at unclear risk of bias for the other study. The quality of the evidence using GRADE was low for neonatal sepsis, postpartum endometritis, and neonatal mortality and morbidity prior to discharge (Neonatal intensive care admissions) and of moderate quality for chorioamnionitis.
AUTHORS' CONCLUSIONS
Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.
Topics: Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Labor, Obstetric; Meconium; Pregnancy; Randomized Controlled Trials as Topic; Sepsis; Sulbactam
PubMed: 25374369
DOI: 10.1002/14651858.CD007772.pub3 -
The Cochrane Database of Systematic... Aug 2016Chorioamnionitis is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims at reducing the adverse effects of chorioamnionitis by dilution of the... (Review)
Review
BACKGROUND
Chorioamnionitis is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims at reducing the adverse effects of chorioamnionitis by dilution of the infective organisms or by an anti-microbial effect of the fluid infused.
OBJECTIVES
The objective of this review was to determine the effect of amnioinfusion on clinical and sub-clinical chorioamnionitis, fetal well-being, fetal heart rate characteristics and perinatal and maternal morbidity and mortality.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2016), PubMed, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 July 2016) and reference lists of retrieved studies.
SELECTION CRITERIA
Randomised clinical trials (RCTs) of amnioinfusion (treatment group) versus no amnioinfusion in women with chorioamnionitis.We would have also considered trials comparing amnioinfusion with sham amnioinfusion; different types or volumes of amnioinfusion fluid but none were identified.Cluster-RCTs and quasi-RCTs were eligible for inclusion but none were identified. We identified one study published in abstract form but it did not contain any numerical data and has therefore been excluded. Studies using a cross-over design are not an appropriate study design and thus were not eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed potential studies for inclusion and assessed trial quality. Both review authors independently extracted data and data were checked for accuracy.
MAIN RESULTS
We included one small trial (with data from 34 participants) comparing transcervical amnioinfusion with no amnioinfusion. The trial was considered to be at a high risk of bias overall, due to small numbers, inconsistency in the reporting and lack of information on blinding. Meta-analysis was not possible. Transcervical amnioinfusion was with room temperature saline at 10 mL per minute for 60 minutes, then 3 mL per minute until delivery versus no amnioinfusion. All women received intrauterine pressure catheter, acetaminophen and antibiotics (ampicillin or, if receiving Group B beta streptococcal prophylaxis, penicillin and gentamycin). We did not identify any trials that used transabdominal amnioinfusion.Compared to no amnioinfusion, transcervical amnioinfusion had no clear effect on the incidence of postpartum endometritis (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.29 to 7.87; absolute risk 176/1000 (95% CI 34 to 96) versus 118/1000;low-quality evidence). Nor was there a clear effect in the incidence of neonatal infection (RR 3.00, 95% CI 0.13 to 68.84; absolute risk 0/1000 (95% CI 0 to 0) versus 0/1000; low-quality evidence). The outcome of perinatal death or severe morbidity (such as neonatal encephalopathy, intraventricular haemorrhage, admission to intensive/high care) was not reported in the included trial.In terms of this review's secondary outcomes, the rate of caesarean section was the same in both groups (RR 1.00, 95% CI 0.35 to 2.83; absolute risk 294/1000 (95% CI 103 to 832) versus 294/1000; low-quality evidence). There was no clear difference in the duration of maternal antibiotic treatment between the amnioinfusion and no amnioinfusion control group (mean difference (MD) 16 hours, 95% CI -1.75 to 33.75); nor in the duration of hospitalisation (MD 3.00 hours, 95% CI -15.49 to 21.49). The study did not report any information about how many babies had a low Apgar score at five minutes after birth.Women in the amnioinfusion group had a lower temperature at delivery compared to women in the control group (MD -0.38°C, 95% CI -0.74 to -0.02) but this outcome was not pre-specified in the protocol for this review.The majority of this review's secondary outcomes were not reported in the included study.
AUTHORS' CONCLUSIONS
There is insufficient evidence to fully evaluate the effectiveness of using transcervical amnioinfusion for chorioamnionitis and to assess the safety of this intervention or women's satisfaction. We did not identify any trials that used transabdominal amnioinfusion. The evidence in this review can neither support nor refute the use of transcervical amnioinfusion outside of clinical trials. We included one small study that reported on a limited number of outcomes of interest in this review. The numbers included in this review are too small for meaningful assessment of substantive outcomes, where reported. For those outcomes we assessed using GRADE (postpartum endometritis, neonatal infection, and caesarean section), we downgraded the quality of the evidence to low - with downgrading decisions based on small numbers and a lack of information on blinding. The included study did not report on this review's other primary outcome (perinatal death or severe morbidity).The reduction in pyrexia, though not a pre-specified outcome of this review, may be of relevance in terms of benefits to the fetus of reduced exposure to heat. We postulate that the temperature reduction found may be a direct cooling effect of amnioinfusion with room temperature fluid, rather than reduction of infection. Larger trials are needed to confirm and extend the findings of the trial reviewed here. These should be randomised controlled trials; participants, women with chorioamnionitis; interventions, amnioinfusion; comparisons, no amnioinfusion; outcomes, maternal and perinatal outcomes including neurodevelopmental measures.Further research is justified to determine possible benefits or risks of amnioinfusion for chorioamnionitis, and to investigate possible benefits of reducing temperature in fetuses considered at risk of neurological damage. Research should include randomised trials to examine transcervical or transabdominal amnioinfusion compared with no infusion for chorioamnionitis and examine outcomes listed in the methods of this review.
Topics: Amniotic Fluid; Anti-Bacterial Agents; Cervix Uteri; Cesarean Section; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Infections; Length of Stay; Perinatal Death; Pregnancy
PubMed: 27556818
DOI: 10.1002/14651858.CD011622.pub2 -
The Cochrane Database of Systematic... Apr 2017Oro/nasopharyngeal suction is a method used to clear secretions from the oropharynx and nasopharynx through the application of negative pressure via a suction catheter... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oro/nasopharyngeal suction is a method used to clear secretions from the oropharynx and nasopharynx through the application of negative pressure via a suction catheter or bulb syringe. Traditionally, airway oro/nasopharyngeal suction at birth has been used routinely to remove fluid rapidly from the oropharynx and nasopharynx in vigorous and non-vigorous infants at birth. Concerns relating to the reported adverse effects of oro/nasopharyngeal suctioning led to a practice review and routine oro/nasopharyngeal suctioning is no longer recommended for vigorous infants. However, it is important to know whether there is any clear benefit or harm for infants whose oro/nasopharyngeal airway is suctioned compared to infants who are not suctioned.
OBJECTIVES
To evaluate the effect of routine oropharyngeal/nasopharyngeal suction compared to no suction on mortality and morbidity in newly born infants.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 3), MEDLINE via PubMed (1966 to April 18, 2016), Embase (1980 to April 18, 2016), and CINAHL (1982 to April 18, 2016). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
SELECTION CRITERIA
Randomised, quasi-randomised controlled trials and cluster randomised trials that evaluated the effect of routine oropharyngeal/nasopharyngeal suction compared to no suction on mortality and morbidity in newly born infants with and without meconium-stained amniotic fluid.
DATA COLLECTION AND ANALYSIS
The review authors extracted from the reports of the clinical trials, data regarding clinical outcomes including mortality, need for resuscitation, admission to neonatal intensive care, five minute Apgar score, episodes of apnoea and length of hospital stay.
MAIN RESULTS
Eight randomised controlled trials met the inclusion criteria and only included term infants (n = 4011). Five studies included infants with no fetal distress and clear amniotic fluid, one large study included vigorous infants with clear or meconium-stained amniotic fluid, and two large studies included infants with thin or thick meconium-stained amniotic fluid. Overall, there was no statistical difference between oro/nasopharyngeal suction and no oro/nasopharyngeal suction for all reported outcomes: mortality (typical RR 2.29, 95% CI 0.94 to 5.53; typical RD 0.01, 95% CI -0.00 to 0.01; I = 0%, studies = 2, participants = 3023), need for resuscitation (typical RR 0.85, 95% CI 0.69 to 1.06; typical RD -0.01, 95% CI -0.03 to 0.00; I = 0%, studies = 5, participants = 3791), admission to NICU (typical RR 0.82, 95% CI 0.62 to 1.08; typical RD -0.03, 95% CI -0.08 to 0.01; I = 27%, studies = 2, participants = 997) and Apgar scores at five minutes (MD -0.03, 95% CI -0.08 to 0.02; I not estimated, studies = 3, participants = 330).
AUTHORS' CONCLUSIONS
The currently available evidence does not support or refute the benefits or harms of routine oro/nasopharyngeal suction over no suction. Further high-quality studies are required in preterm infants or term newborn infants with thick meconium amniotic fluid. Studies should investigate long-term effects such as neurodevelopmental outcomes.
Topics: Amniotic Fluid; Brain Ischemia; Humans; Infant; Infant Mortality; Infant, Newborn; Infections; Intensive Care Units, Neonatal; Intention to Treat Analysis; Meconium; Nasopharynx; Oropharynx; Randomized Controlled Trials as Topic; Resuscitation; Suction
PubMed: 28419406
DOI: 10.1002/14651858.CD010332.pub2 -
Revista Do Instituto de Medicina... 2023Toxoplasmosis is an infection of vast worldwide distribution whose etiologic agent is Toxoplasma gondii. This disease can cause problems ranging from mild symptoms to... (Meta-Analysis)
Meta-Analysis
Toxoplasmosis is an infection of vast worldwide distribution whose etiologic agent is Toxoplasma gondii. This disease can cause problems ranging from mild symptoms to serious conditions, such as encephalitis, miscarriage and blindness. Therefore, it is of utmost importance to perform a diagnosis with reproducible techniques in order to obtain a good prognosis. The aim of this review was to analyze the efficiency of toxoplasmosis diagnostic techniques based on sensitivity and specificity results. Five research platforms in English language were used (Eric, Elsevier, Google Scholar, PubMed and SciELO), which contained data on the diagnosis of toxoplasmosis. The search and selection were performed for studies published prior to June 2021. The search resulted in the inclusion of 13 articles published from 2005 to 2020. The data revealed the use of different samples in the standardization of techniques such as serum, total blood, colostrum and amniotic fluid. The flow cytometry, lateral flow immunoassay and qPCR techniques showed 100% sensitivity, whereas the ELISA, western blotting, qPCR and RE-LAMP techniques achieved 100% specificity. Significantly, the qPCR and LAMP techniques were more accurate when the likelihood ratio was assessed. The meta-analysis identified that ISAGA and western blotting have low sensitivity values and LIASON, ELFA and ELISA, using a silica bioconjugate, also have low specificity values. It was noted that a wide range of methods have high values of sensitivity and specificity. Therefore, the choice of the method will be based on the conditions and its financial viability.
Topics: Humans; Toxoplasmosis; Toxoplasma; Enzyme-Linked Immunosorbent Assay; Immunoassay; Sensitivity and Specificity; Antibodies, Protozoan
PubMed: 36921207
DOI: 10.1590/S1678-9946202365019 -
Stem Cells Translational Medicine Sep 2021Regenerative, cell-based therapy is a promising treatment option for diabetic kidney disease (DKD), which has no cure. To prepare for clinical translation, this... (Meta-Analysis)
Meta-Analysis Review
Regenerative, cell-based therapy is a promising treatment option for diabetic kidney disease (DKD), which has no cure. To prepare for clinical translation, this systematic review and meta-analysis summarized the effect of cell-based interventions in DKD animal models and treatment-related factors modifying outcomes. Electronic databases were searched for original investigations applying cell-based therapy in diabetic animals with kidney endpoints (January 1998-May 2019). Weighted or standardized mean differences were estimated for kidney outcomes and pooled using random-effects models. Subgroup analyses tested treatment-related factor effects for outcomes (creatinine, urea, urine protein, fibrosis, and inflammation). In 40 studies (992 diabetic rodents), therapy included mesenchymal stem/stromal cells (MSC; 61%), umbilical cord/amniotic fluid cells (UC/AF; 15%), non-MSC (15%), and cell-derived products (13%). Tissue sources included bone marrow (BM; 65%), UC/AF (15%), adipose (9%), and others (11%). Cell-based therapy significantly improved kidney function while reducing injury markers (proteinuria, histology, fibrosis, inflammation, apoptosis, epithelial-mesenchymal-transition, oxidative stress). Preconditioning, xenotransplantation, and disease-source approaches were effective. MSC and UC/AF cells had greater effect on kidney function while cell products improved fibrosis. BM and UC/AF tissue sources more effectively improved kidney function and proteinuria vs adipose or other tissues. Cell dose, frequency, and administration route also imparted different benefits. In conclusion, cell-based interventions in diabetic animals improved kidney function and reduced injury with treatment-related factors modifying these effects. These findings may aid in development of optimal repair strategies through selective use of cells/products, tissue sources, and dose administrations to allow for successful adaptation of this novel therapeutic in human DKD.
Topics: Animals; Diabetes Mellitus; Diabetic Nephropathies; Fibrosis; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Umbilical Cord
PubMed: 34106528
DOI: 10.1002/sctm.19-0419