Mesenchymal Stem Cell Therapy for Neurological Complications of Prematurity: A Narrative Review

Area of Science:

• Regenerative Medicine
• Neonatal Research
• Stem Cell Biology

Background:

• Preterm birth is a major cause of neonatal mortality and disability.
• Prematurity causes organ damage via inflammation, oxidative stress, hypoxia, and poor vascular growth.
• Current treatments offer supportive care, lacking regenerative capabilities.

Purpose of the Study:

• To evaluate Mesenchymal Stem Cell (MSC)-based therapies for enhancing endogenous repair in conditions associated with preterm birth.
• To explore the mechanisms of MSC therapeutic action, focusing on paracrine signaling.
• To assess the potential of cell-free approaches using MSC-derived extracellular vesicles.

Main Methods:

• Review of preclinical models and early clinical trials of MSC therapy in neonatal injury, particularly brain injury.
• Analysis of MSC mechanisms, including cytokine, growth factor, and extracellular vesicle release.
• Examination of cell-free therapeutic strategies.

Main Results:

• MSCs primarily exert therapeutic effects through paracrine signaling, not long-term engraftment.
• MSC administration reduces inflammation, promotes angiogenesis, and supports tissue repair.
• Preclinical studies show MSC therapy improves oligodendrocyte maturation and reduces white matter injury in neonatal brain injury models.
• Early clinical trials indicate feasibility and short-term safety of MSCs for neonatal encephalopathy, but require larger sample sizes and longer follow-up.
• MSC-derived extracellular vesicles show potential for similar benefits with potentially fewer safety and regulatory concerns.

Conclusions:

• MSC-based therapies offer a promising regenerative strategy for managing complications of prematurity.
• Large-scale, rigorous clinical trials with standardized protocols and long-term follow-up are essential.
• Further research is needed to optimize delivery, confirm efficacy, and establish safety in preterm infants.