Potential role of autologous mesenchymal stromal cells in the treatment of multidrug and extensively drug-resistant tuberculosis

There is an urgent need for novel treatments for multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) to improve outcomes. Autologous mesenchymal stromal cell (MSC) infusion is one such possible treatment due to its potential to repair damaged lung tissue and boost the immune response. We analyzed outcome data from 72 M/XDR-TB patients in Belarus that received chemotherapy. Thirty-six patients (“cases”) also had MSCs extracted, cultured and re-infused; the other 36 patients were “study controls”. We identified another control group: 36 patients from the Belarussian surveillance database (“surveillance controls”) matched to cases on drug resistance profile, baseline smear status and previous treatment status. We analyzed culture conversion rates at 2 and 6 months, radiology at baseline and 8 months and final treatment outcomes. Successful outcomes were observed in 81% of cases, 42% of surveillance controls and 39% of study controls. Adjusting for age, odds of a successful outcome was 6.5 (95% Confidence Interval: 1.2 – 36.2, p=0.032) times greater for cases than surveillance controls. Adjusting for other potential confounders increased the effect estimate whilst maintaining statistical significance. Cases were less likely (p=0.01) to be culture negative at 2 months than surveillance controls, indicating a poorer initial prognosis in cases before MSC infusion. Radiological improvement was more likely in cases than study controls. Conclusions. MSC treatment could vastly improve outcomes for M/XDR-TB patients. Large, randomized studies are urgently needed to confirm our findings and allow implementation of this treatment.