[Inflammatory bowel diseases in the XXI century]

Modern strategy of the treatment of inflammatory bowel disease (IBD), aimed at molecular targets of inflammation, is described in the article. It has reviewed the successe and failure of anticytokine therapy based on the application of Infliximab, Adalimumab and Certolizumab. The Results of Priority researchs of transplantation of mesenchymal stromal cells (MSCs) in the Central Scientific Research Institute of Gastroenterology are shown in the article. Clinical observations of patients with ulcerative colitis (UC) and Crohn's disease (CD) showed that intravenous infusion of allogeneic MSCs significantly increases the duration of remission, reduces the risk of recurrence and is comparable to the effectiveness of Infliximab. The use of MSCs allowed to cancel the corticosteroids and cytotoxic agents, except 5-ASA drugs, in the majority of patients with UC and CD. MSCs have a multidirectional regulatory impact on the inflammatory process: stimulate the functional activity of the suppressed immune system, reduce the intensity of the autoimmune reactions and the activity of immunopathological processes. The program and indications for treatment with MSCs are developed and suggested for clinical practice. Transplantation of MSCs is indicated in patients with hormone resistant, hormone-dependent forms of IBD characterized by high activity of the inflammatory process at the early stages of the disease. Accumulated clinical experience demonstrates the reducing of antibodies to infliximab after systemic MSC transplantation that helps to prevent and to overcome the secondary inneficiencies of anticytokine therapy. It has been possible to achieve significant improvement and even complete elimination of disease activity in patients resistant to all previous treatments.