Stem cell therapy in inflammatory bowel disease: which, when and how?
Welmoed K van Deen1, Angelos Oikonomopoulos, Daniel W Hommes
1Department of Digestive Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California 90095, USA. wvandeen@mednet.ucla.edu
Current Opinion in Gastroenterology
|May 14, 2013
Summary
Stem cell therapies, including mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs), show promise for inflammatory bowel diseases (IBDs). While MSCs are well-tolerated but inconsistent in efficacy, HSCs are effective but carry safety concerns.
Area of Science:
- Regenerative Medicine
- Gastroenterology
- Immunology
Background:
- Stem cell therapy is a novel approach for treating inflammatory bowel diseases (IBDs).
- Currently, its use is limited to clinical trials, not standard care.
- This review examines clinical outcomes, mechanisms, and future directions.
Purpose of the Study:
- To review the clinical results of stem cell therapy for IBDs.
- To discuss the proposed underlying mechanisms of action.
- To identify future research directions for optimizing stem cell treatments.
Main Methods:
- Review of clinical studies evaluating mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs) for IBD treatment.
- Analysis of reported efficacy and safety data.
- Synthesis of proposed mechanisms of action.
Main Results:
- MSC therapy is explored for fistulizing and luminal Crohn's disease, showing good tolerability but inconsistent efficacy.
- HSC transplantation demonstrates high effectiveness but is associated with frequent serious adverse events.
- Current stem cell therapies are not routinely used for IBD management.
Conclusions:
- Both MSC and HSC therapies hold clinical potential for IBDs.
- MSC therapy is well-tolerated; however, efficacy results are conflicting.
- HSC transplantation is effective but raises safety concerns.
- Stem cell therapy may become a next-generation treatment for severe, refractory IBD cases.
Related Concept Videos
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2),...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab (Humira),...
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel Disease...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...
01:25Inflammatory Bowel Disease III: Crohn's Disease
Crohn’s disease is a chronic, relapsing form of inflammatory bowel disease characterized by segmental, transmural inflammation that can affect any part of the gastrointestinal tract. Its pathogenesis arises from a combination of genetic susceptibility, environmental exposures, epithelial barrier dysfunction, and immune dysregulation. Together, these factors lead to an exaggerated immune response against components of the gut microbiome.Genetic and Environmental InfluencesMultiple genetic...