Mesenchymal Stem Cells in the Treatment of Ulcerative Colitis

Ulcerative colitis (UC) is a chronic, idiopathic inflammation of the large intestine (colon), which is classified as a form of inflammatory bowel disease (IBD). It is characterized by a relapsing and remitting course. Both male and female are affected equally, mostly between the ages of 30-40 years.

The incidence of this autoimmune condition and other immunological diseases has been increasing around the world. The highest annual incidence reported was 24.3 per 100k person-years in Europe and 19.2 per 100k person-years in North America. 

Patients with UC present ulcers and inflammation of the inner lining of the colon and can incur symptoms of abdominal pain, diarrhea and rectal bleeding. The exact cause of the disease remains unknown. Current studies have shown that abnormal activation of the immune system, some hereditary susceptibility and alteration of the intestinal flora may play a role in the pathogenesis of the disease.

The existing clinical management includes the use of anti-inflammatory agents such as 5-aminosalicylic acids, corticosteroids and immunomodulators like azathioprine. Unfortunately, most patients experience at least one relapse every few years. 

The use of mesenchymal stem cells is one of the therapies that has been widely explored. Both animal studies and human studies suggest that MSC has more significant therapeutic potential for UC, compared with conventional therapies. In 7 human trials made using MSC no adverse effects were reported. 

Two types of delivery methods have been evaluated in different studies. One by applying the cells IV and another one by endoscopic injection directly into the mucosa of the colon. Until now there are no studies that are able to determine which administration route is better, but both showed promising results. 

Recent studies indicate that both the innate and adaptive immunity play a role in the pathogenesis of UC. Mesenchymal stem cells might be able to exert protective functions by supporting the epithelial cells in the colon and improve the mucous barriers survival and regeneration through production of different growth factors, exosomes and cytokines. 

As a patient of UC myself and as a physician I have experienced first hand the limitations of the current treatment for the disease. It only decreases the grade of inflammation, but with the occurrence of different adverse effects that can in several ways decrease your quality of life. More studies are needed in order to determine and standardize the appropriate dose and  application of mesenchymal stem cells for the treatment of this condition, but the current results of various clinical studies seem to be on the right track with mostly positive outcomes and with no apparent adverse effects.

Source:

Shi X, Chen Q, Wang F. Mesenchymal stem cells for the treatment of ulcerative colitis: a systematic review and meta-analysis of experimental and clinical studies. Stem Cell Res Ther. 2019 Aug 23;10(1):266.

Source link: https://pubmed.ncbi.nlm.nih.gov/31443677/