Efficacy of mesenchymal stem cells in the treatment of peritoneal fibrosis in animal models: a systematic review and meta-analysis

Background: Peritoneal fibrosis is a serious complication of long-term peritoneal dialysis, often resulting in functional deterioration and withdrawal from therapy. Mesenchymal stem cells (MSCs) have demonstrated immunomodulatory and antifibrotic effects in various models. This meta-analysis evaluated the efficacy of MSCs therapy in animal models of peritoneal fibrosis. Methods: A comprehensive search of PubMed, the Cochrane Library, Web of Science, and EMBASE was conducted for studies published up to April 27, 2024. Two independent reviewers (LQZ and WMC) screened studies for inclusion, extracted data, and analyzed outcomes using RevMan 5.3 and STATA 17.0. Result: Fifteen studies met the inclusion criteria. MSC therapy significantly reduced inflammatory cytokines, including IL-6, TGF-beta (SMD = -1.79, 95% CI: -2.32, -1.25, p < 0.00001), and TNF-alpha (SMD = -1.57, 95% CI: -2.71, -0.44, p = 0.006) levels. Additionally, MSCs reduced submesothelial thickness (MD = -63.14, 95% CI: -78.52, -47.76, p < 0.00001), Collagen I and Collagen III levels. MSCs treatment also improved ultrafiltration capacity (MD = 1.21, 95% CI: 0.64, 1.77, p < 0.0001), D/D0 of glucose and E-cadherin levels. However, no significant differences were observed in VEGF, D/P of Na, D/P of BUN, D/P of protein, or glucose mass transfer between the MSCs treatment group and the control group. Conclusion: MSC therapy significantly improves peritoneal function and attenuates fibrotic and inflammatory responses in animal models. These findings highlight the potential of MSCs as a promising therapeutic strategy for managing peritoneal fibrosis in clinical settings.