Aug. 16, 2013

Adult Stems Cells in the Treatment of Lupus - Where are we now?

Cell based therapies are a growing interest in all areas of medicine as they are viewed as long term solutions rather than temporary fixes. A recent journal article “Hematopoetic and mesenchymal stem cell transplantation in the treatment of refractory systemic lupus erythematosus -Where are we now?” in Clinical Immunology highlights progress made in better understanding the potential for two basic types of adult stem cells: hematopoetic, which mature into blood cells, and mesenchymal, which mature into skin, bone, and cartilage cells. It is important to note that neither of these stem cells are considered embryonic, because they are derived after birth, usually from adults.

Studies using hematopoetic stem cells have shown to be very successful in patients with severe, life-threatening disease and have failed with conventional therapy. This is a very small population. A challenge is that the procedure requires significant expertise in a center that is experienced with stem cell transplants. A primary concern is side effects and mortality, as up to 10 percent of patients die from the therapy. If the procedure could be done with less mortality it would be more widely available.

Studies with mesenchymal stem cells are promising, but there are no controlled trials to confirm their efficacy. The promising aspect of mesenchymal stem cells is that the patient does not need to be pretreated to wipe out their own immune system which is required for hematopoetic stem cell transplants. Therefore, it appears safe with minimal side effects, and they are used in a variety of other diseases with no reports of major side effects when given by an experienced center.

The next step is to perform controlled clinical trials to determine how the cells work. Stem cells hold great promise, but we still need to understand how safe stem cells are, and prove they are better and safer than standard therapies. We also need to determine the best source or the cells, how many to give, and how often.

Hematopoetic and mesenchymal stem cell transplantation in the treatment of refractory systemic lupus erythematosus - Where are we now?
Collins E, Gilkeson G.
Clin Immunol. 2013 Sep;148(3):328-34. doi: 10.1016/j.clim.2013.01.009. Epub 2013 Jan 27.
PMID: 23411031 [PubMed - in process]

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