BRONCHOPULMONARY DYSLASIA OF NEWBORNS AND PROSPECTS OF CELL THERAPY IN UKRAINE AND WORLDWIDE

Abstract

Introduction. Premature birth is a serious challenge for modern medicine – in the world, about 14.9 million babies are born before 37 weeks of pregnancy, which is approximately 11.0% of all newborns. Bronchopulmonary dysplasia (BLD) is the most common form of chronic lung disease that affects premature babies and contributes to their morbidity and mortality. BPD develops in approximately 25.0% of infants with a birth weight of less than 1,500 g. Among infants born at less than 28 weeks' gestational age, the overall incidence of BPD is estimated to be 48–68%. The limited possibilities of BPD pharmacotherapy prompted the search for new therapeutic approaches. One of the alternatives is biological therapy based on mesenchymal stem cells (MSCs), secretome of MSCs, cryopreserved tissue extracts, etc. The aim of the study: to characterize current information on the therapeutic potential of mesenchymal stem cells in the treatment of newborns with bronchopulmonary dysplasia. Materials and methods. Publications were selected based on the databases PubMed, Clinical Key Elsevier, Cochrane Library, eBook Business Collection, and Google Scholar, which covered information about the pathogenesis of BPD and the prospects for the use of MSCs in the treatment of newborns. Results. Over the past decades, the understanding of the pathogenesis of BPD has evolved from a complication of secondary lung damage after mechanical ventilation and the effect of increased oxygen concentration to a multifactorial disease in which prenatal and postnatal factors are involved. Adult stem cells have been found to be naturally capable of sustaining, generating and replacing terminally differentiated cells. Stem cells function in response to physiological cell turnover or tissue damage due to trauma caused by mechanical ventilation, barotrauma, volutrauma, and hyperoxia in preterm infants. It is believed that the therapeutic effect of MSCs is related to their immunomodulatory, anti-inflammatory, angiogenic, antibacterial and regenerative effects. According to ClinicalTrials.gov, out of 301 clinical studies devoted to BPD, 18 clinical studies are currently known to study the effectiveness of MSCs in the treatment of newborns with BPD, which have already involved 770 newborns. The largest number of studies is conducted in East Asian countries (5 in China, 5 in the Republic of Korea, and 2 in Taiwan). Conclusions. Currently, research into the clinical therapy of BPD with stem cells is mainly focused on umbilical cord blood MSCs, umbilical cord MSCs, and bone marrow MSCs. Success in proving the safety and feasibility of incorporating stem cells for BPD led to the appearance of the biological drug PNEUMOSTEM® – a product of allogeneic MSCs obtained from human umbilical cord blood.