What is 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.
What is the Clinical Presentation?
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.
Signs and Symptoms
The symptoms may vary, depending on the severity of inflammation and where it occurs. They may include:
- Diarrhea, often with blood or pus.
- Abdominal pain and cramping.
- Rectal pain.
- Rectal bleeding.
- Urgency to defecate.
- Weight loss and fatigue.
- Failure to grow in children
Types of Clinical presentations
It can be often classified according to the affected location:
- Ulcerative proctitis. Inflammation if confined to the area closest to the anus (rectum), and rectal bleeding may be the only sign of the disease.
- Proctosigmoiditis. Inflammation involves the rectum and sigmoid colon, the lower end of the colon. Signs and symptoms include bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus).
- Left-sided colitis. Inflammation extends from the rectum up through the sigmoid and descending colon. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and urgency to defecate.
- Pancolitis. This type often affects the entire colon and causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue and significant weight loss.
What are the Current Treatment Options?
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.
Antiinflammatory drugs are often the first step in the treatment of ulcerative colitis. These drugs include 5-aminosalicylates like sulfasalazine and mesalamine. Another treatment option are corticosteroids, which include prednisone and budesonide and are generally reserved for moderate to severe cases that don’t respond to aminosalicylates. Due to their side effects, they are not usually given long term.
Immune system suppressors are often used in this condition. They also reduce inflammation but they do so by suppressing the immune system response that starts the process of inflammation. Some examples of medications used are azathioprine, cyclosporine and monoclonal antibodies, such as tofacitinib and adalimumab.
Alternative treatments with Stem Cells
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.
A review of clinical research in humans from Shi X and colleagues found a total of 182 patients with UC in six trials that were treated with bone marrow-derived mesenchymal stem cells and 34 patients in 1 trial with umbilical cord-derived mesenchymal stem cells. In both cases no major adverse events were reported and had good results in repairing injured intestinal mucosa.
Mesenchymal Stem Cell Therapy at Zignagenix
As a patient of UC myself and as a physician I have experienced first hand the limitations of the current treatment options for the disease. The available treatments only help decrease the degree of inflammation, but with the occurrence of different adverse effects that in several ways can 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.
At our clinic in Zignagenix we utilize high quality umbilical cord-derived mesenchymal stem cells. They are infused intravenously and are combined with exosomes to increase the efficacy of the therapy. Due to the immunomodulatory capabilities of these types of stem cells makes them a perfect treatment option for this and other types of autoimmune conditions.
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.