Cell therapy for acute respiratory distress syndrome patients: the START study

Every year, 200,000 new cases of acute respiratory distress syndrome (ARDS) occur in the United States alone, with an incidence of 10% among patients admitted to intensive care units (ICU) and a mortality rate of 30–40% (1). In recent decades, new therapeutic strategies have been developed; nevertheless, none has proven effective. Therefore, the management of ARDS is still based on supportive care strategies, such as lung-protective mechanical ventilation and conservative fluid administration. In several experimental models of ARDS, either intravenous or intratracheal administration of mesenchymal stromal cells (MSCs) obtained from various sources (bone marrow, adipose tissue, lung, cord blood, dental pulp, and placenta) resulted in beneficial effects (2). MSCs have been shown to reduce inflammation and alveolar oedema, augment tissue repair, enhance pathogen clearance, improve lung mechanics, and reduce disease associated-mortality (3) in experimental ARDS, prompting the design of clinical trials of this therapy.