The severe respiratory consequences of the coronavirus disease 2019 (COVID-19) pandemic have prompted urgent need for novel therapies. Cell-based approaches, primarily using mesenchymal stem (stromal) cells (MSCs), have demonstrated safety and possible efficacy in patients with acute respiratory distress syndrome (ARDS), although they are not yet well studied in respiratory virus-induced ARDS. Limited pre-clinical data suggest that systemic MSC administration can significantly reduce respiratory virus (influenza strains H5N1 and H9N2)-induced lung injury; however, there are no available data in models of coronavirus respiratory infection. There is a rapidly increasing number of clinical investigations of cell-based therapy approaches for COVID-19. These utilise a range of different cell sources, doses, dosing strategies and targeted patient populations. To provide a rational strategy to maximise potential therapeutic use, it is critically important to understand the relevant pre-clinical studies and postulated mechanisms of MSC actions in respiratory virus-induced lung injuries. This review presents these, along with consideration of current clinical investigations.

Original languageEnglish
Article number2000858
JournalEuropean Respiratory Journal
Issue number6
StatePublished - 1 Jun 2020

Bibliographical note

Funding Information:
Support statement: This work was partially supported by grants from Agencia Nacional de Investigación y Desarrollo, ANID, formerly known as CONICYT (FONDEF 2016, IT16I10084). Funding information for this article has been deposited with the Crossref Funder Registry.

Publisher Copyright:
© 2020 ERS.


  • Animals
  • Betacoronavirus
  • Cell- and Tissue-Based Therapy
  • Coronavirus Infections
  • Culture Media, Conditioned
  • Extracellular Vesicles
  • Humans
  • Influenza A Virus, H5N1 Subtype
  • Influenza A Virus, H9N2 Subtype
  • Influenza, Human
  • Lung Injury
  • Mesenchymal Stem Cell Transplantation
  • Mesenchymal Stem Cells
  • Orthomyxoviridae Infections
  • Pandemics
  • Peptidyl-Dipeptidase A
  • Pneumonia, Viral
  • Respiratory Distress Syndrome, Adult
  • Serine Endopeptidases


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