Expanded Umbilical Cord Mesenchymal Stem
Cells (UC-MSCs) as a Therapeutic Strategy In
Managing Critically Ill COVID-19 Patients: The
Case for Compassionate Use
Authors: Manchikanti Laxmaiah 
Published: March 2021

COVID-19 has affected the United States leading to a national emergency with health care
and economic impact, propelling the country into a recession with disrupted lifestyles not seen
in recent history. COVID-19 is a serious illness leading to multiple deaths in various countries
including the United States. Several million Americans satisfy the Center for Disease Control and
Prevention (CDC) criteria for being high risk. Unfortunately, the available supply of medical beds
and equipment for mechanical ventilation are much less than is projected to be needed. The
World Health Organization (WHO) and multiple agencies led by the CDC in the United States
have attempted to organize intensive outbreak investigation programs utilizing appropriate
preventive measures, evaluation, and treatment.
The clinical spectrum of COVID-19 varies from asymptomatic forms to conditions encompassing
multiorgan and systemic manifestations in terms of septic shock, and multiple organ dysfunction
(MOD) syndromes. The presently approved treatments are supportive but not curative for the
disease. There are multiple treatments being studied. These include vaccines, medications
Remdesivir and hydroxychloroquine and potentially combination therapy. Finally, expanded
umbilical cord mesenchymal stem cells or (UC-MSCs) may have a role and are being studied.
The cure of COVID-19 is essentially dependent on the patients’ own immune system. When the
immune system is over activated in an attempt to kill the virus, this can lead to the production
of a large number of inflammatory factors, resulting in severe cytokine storm. The cytokine
storm may induce organ damage followed by the edema, dysfunction of air exchange, acute
respiratory distress syndrome (ARDS), acute cardiac injury, and secondary infection, which may
lead to death. Thus, at this point, the avoidance of the cytokine storm may be the key for the
treatment of HCOV-19 infected patients.
In China, where there was limited availability of effective modalities to manage COVID-19
several patients were treated with expanded UC-MSCs. Additionally, the Italian College of
Anesthesia, Analgesia, Resuscitation and Intensive Care have reported guidelines to treat
coronavirus patients with stem cells in the hope of decreasing the number of patients going to
the ICU, and, also relatively quickly getting them out of ICU.
In this manuscript, we describe the urgent need for various solutions, pathogenesis of
coronavirus and the clinical evidence for treatment of COVID-19 with stem cells. The limited
but emerging evidence regarding UC MSC in managing COVID-19 suggests that it might be
considered for compassionate use in critically ill patients to reduce morbidity and mortality in
the United States.
The administration and Coronavirus Task Force might wish to approach the potential of
expanded UC-MSCs as an evolutionary therapeutic strategy in managing COVID-19 illness with
a 3-pronged approach: If proven safe and effective on a specific and limited basis…
1. Minimize regulatory burden by all agencies so that critically ill COVID-19 patients will have access regardless of their financial circumstance.2. Institute appropriate safeguards to avoid negative consequences from unscrupulous actors.
3. With proper informed consent from patients or proxy when necessary, and subject to accumulation of data in
that cohort, allow the procedure to be initiated in critically ill patients who are not responding to conventional
therapies.
Key words: Coronavirus, COVID-19, cytokine storm, multiorgan failure, expanded umbilical cord mesenchymal stem cells