[Hematopoietic stem cell transplantation in treatment of autoimmune diseases]

Hematopoietic stem cell transplantation (HSCT) has become an effective therapeutic option for the treatment of severe cases of autoimmune diseases (AD). Hematopoietic stem cells (HSC) can be collected from the patient (autologous), identical twin (syngenic) or HLA identical donor (allogenous). In allogenous transplantation autoagressive immunological effector cells are substituted with non-autoagressive cells of the donor. Possible graft versus host reaction (GVHD) makes this type of transplantation less attractive. On the other hand, autologous transplantation can induce the >>resetting<< of immunological clock without any fear of GVHD, but it requires previous conditioning. As an alternative option, transplantation ofmesenchymal stem cells (MSS) was developed. MSS has a strong immunosuppressive effect, while it doesn't require previous conditioning, nor does it induce GVHD. Due to the treatment related mortality, these therapeutic option should remain reserved for the most severe cases of AD. Nevertheless, they present a great opportunity for these patients, and even a chance for full recovery.