Umbilical Cord Mesenchymal Stem Cells in the Treatment of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic, inflammatory autoimmune disease that mainly involves peripheral facet joint disease, which is the main pathological feature as well as joint synovial cell proliferation, inflammatory cell infiltration and pannus.

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems including the skin, eyes, lungs, heart and blood vessels.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues.

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Signs and symptoms of rheumatoid arthritis may include:

• Tender, warm, swollen joints.
• Joint stiffness that is usually worse in the mornings and after inactivity.
• Fatigue, fever and loss of appetite.

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

About 40% of people who have rheumatoid arthritis also experience signs and symptoms that don’t involve the joints. Areas that may be affected include:

• Skin.
• Eyes.
• Lungs.
• Heart.
• Kidneys.
• Salivary glands.
• Nerve tissue.
• Bone marrow.
• Blood vessels.
  

To date, traditional RA treatment mainly involves reducing the symptomatic inflammatory reaction and sequelae, conventional treatment cannot satisfy the clinical requirement of achieving a curative effect. 

Therefore, exploring more effective and safer treatment options is increasingly important. Mesenchymal stem cells (MSCs) are derived from early-development mesoderm pluripotent stem cells and have a high degree of self-renewal and multidirectional differentiation potential; MSCs widely exist in a variety of human tissues and can be cultured in vitro.

They can differentiate into osteoblasts, nerve cells, adipose cells, muscle cells and cardiomyocytes. These cells have great application value in tissue engineering repair and in cell replacement therapy.

Umbilical cord MSCs (UC-MSCs) are derived from human umbilical cord blood and have MSC characteristics and functions. Therefore, UC-MSCs offer the hope of a new treatment option for RA.

In recent years, MSCs have been widely used in the treatment of various diseases including spinal cord injury, cerebral palsy, amyotrophic lateral sclerosis, systemic lupus erythematosus, systemic sclerosis, Crohn’s disease, stroke, diabetes, among other conditions. In clinical research, the main types of MSCs are bone marrow-derived MSCs (BM-MSCs), adipose-derived mesenchymal stromal cells (AD-MSCs) and UC-MSCs.

Compared to BM-MSCs and AD-MSCs, umbilical cord mesenchymal stem cells have the advantages of having lower expression of major histocompatibility complex I (MHC I), MHC II is not expressed, so they do not cause rejection. Also, the growth environment is more pure and they have stronger abilities to proliferate and differentiate, and are easy to culture in vitro. 

UC-MSCs have shown good efficacy and tolerability in RA patients and have emerged as a promising alternative in the management of RA. The pathogenesis of RA is related to disorders of immune mechanisms and cytokines, which UC-MSCs have shown to reduce cytokines and chemokines. They have also shown to have a very good immune regulation and ability to repair tissue damage. 

As they have achieved a certain efficacy and few side effects in clinical practice, they are worthy of further large-sample clinical trials for future evaluation.

Source: 

Lv X, Wang L, Zou X, Huang S. Umbilical Cord Mesenchymal Stem Cell Therapy for Regenerative Treatment of Rheumatoid Arthritis: Opportunities and Challenges. Drug Des Devel Ther. 2021;15:3927-3936

https://doi.org/10.2147/DDDT.S323107

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648