Prospects and progress in cell therapy for acute respiratory distress syndrome

Introduction: Despite progress in understanding the pathophysiology of the acute respiratory distress syndrome (ARDS), it remains a devastating clinical disorder associated with high mortality rates, and those who survive can experience significant long-term morbidity. Recent advances in the management of ARDS have mostly been achieved in supportive care, including the use of protective mechanical ventilation, neuromuscular blocking agents, prone positioning, and conservative fluid strategies. However, to date, no pharmacologic therapy has been able to act effectively on disease-specific pathways or to reduce mortality. In this context, current advances in understanding the potential roles of alternative approaches, such as cell therapy, offer new hope for ARDS. Areas covered: This review discusses the use of mesenchymal stromal (stem) cells (MSCs) in pre-clinical experimental models of ARDS and in ongoing clinical trials. Expert opinion: Through the secretion of soluble mediators and extracellular vesicles, MSCs have been shown to modulate inflammation, enhance bacterial clearance, and reduce organ injury and death, making them a potential novel treatment for ARDS. Initial clinical trials have demonstrated the safety of MSC administration in patients with ARDS but further investigations are required to further characterize the efficacy profile of these therapies.