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Ultrasound-guided Intracardiac Injection of Human Mesenchymal Stem Cells to Increase Homing to the Intestine for Use in Murine Models of Experimental Inflammatory Bowel Diseases

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Third-party mesenchymal stromal cell infusion is associated with a decrease in thrombotic microangiopathy symptoms

Marc Ansari¹, Dirk Strunk, Katharina Schallmoser

¹Department of Pediatrics, Hematology Unit, University Hospital Geneva, Geneva, Switzerland. marc.ansari@hcuge.ch

Pediatric Transplantation

|December 14, 2011

Summary

Mesencymal stem cell (MSC) infusion temporarily improved symptoms of transplant-associated thrombotic microangiopathy (TA-TMA) in a pediatric aplastic anemia patient. Further research is needed to establish MSCs for long-lasting TA-TMA treatment.

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Area of Science:

Hematology
Immunology
Transplantation Medicine

Background:

Allogeneic hematopoietic stem cell (HSC) transplantation can lead to severe complications, including transplant-associated thrombotic microangiopathy (TA-TMA).
TA-TMA is a significant cause of vascular damage post-HSC transplantation, with an incidence of 4-13%.

Observation:

A 9-year-old girl with refractory aplastic anemia received an unrelated HSC transplant and subsequently developed graft-versus-host disease (GvHD), TA-TMA, and renal insufficiency.
Despite intensive care and various treatments, her condition remained refractory.
On day 106 post-transplant, the patient received mismatched, third-party mesenchymal stem cells (MSCs).

Findings:

Following MSC infusion, schizocyte levels rapidly decreased, and biological parameters normalized within two weeks.
The patient was weaned off erythrocyte and thrombocyte transfusions and remained stable for 10 weeks.
Recurrence of TA-TMA symptoms, viral reactivation, and effusions ultimately led to the patient's death.

Implications:

Allogeneic MSC infusion shows potential in mitigating TA-TMA symptoms.
Further investigation is crucial to determine optimal timing and methods for MSC infusion to achieve sustained therapeutic effects in TA-TMA.
This case highlights the complex management of post-transplant complications and the potential role of cellular therapies.