Effectiveness of a novel cellular therapy to treat multidrug-resistant tuberculosis.
BACKGROUND
We urgently need novel treatments for multidrug-resistant tuberculosis (MDR-TB). Autologous mesenchymal stromal cell (MSC) infusion is one such possibility due to its potential to repair damaged lung tissue and boost immune responses. We aimed to assess the effectiveness of MSC to improve outcomes among MDR-TB patients.


METHODS
We analyzed outcomes for 108 Belarussian MDR-TB patients receiving chemotherapy. Thirty-six patients ("cases") also had MSCs extracted, cultured and re-infused (average time from chemotherapy start to infusion was 49 days); another 36 patients were "study controls". We identified another control group: 36 patients from the Belarussian surveillance database ("surveillance controls") 1:1 matched to cases.


RESULTS
Of the cases, 81% had successful outcomes versus 42% of surveillance controls and 39% of study controls. Successful outcome odds were 6.5 (95% Confidence Interval: 1.2-36.2, p=0.032) times greater for cases than surveillance controls (age-adjusted). Radiological improvement was more likely in cases than study controls. Culture analysis prior to infusion demonstrated a poorer initial prognosis in cases, yet despite this they had better outcomes than the control groups.


CONCLUSIONS
MSC treatment could vastly improve outcomes for MDR-TB patients. Our findings could revolutionize therapy options and have strong implications for future directions of MDR-TB therapy research.
Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus; Department of Intensive Care and Anesthesiology, Belarus State Medical University, Minsk, Belarus.
Aliaksandr
A
Skrahin
Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA.
Helen E
HE
Jenkins
Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
Henadz
H
Hurevich
Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
Varvara
V
Solodovnikova
Laboratory of Cellular Biotechnology and Cytotherapy, Belarussian Research Centre for Paediatric Oncology, Haematology and Immunology, Minsk, Belarus.
Yanina
Y
Isaikina
Department of Monitoring and Evaluation, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
Dzmitri
D
Klimuk
Laboratory Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
Zoya
Z
Rohava
Clinical Department, Republican Research and Practical Centre for Pulmonology and TB, Minsk, Belarus.
Alena
A
Skrahina
extensively drug resistant; mesenchymal stromal cells; outcomes; treatment