Therapy with stem cells in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) affects a part of the young population and has a strong impact upon quality of life. The underlying etiology is not known, and the existing treatments are not curative. Furthermore, a significant percentage of patients are refractory to therapy. In recent years there have been great advances in our knowledge of stem cells and their therapeutic applications. In this context, autologous hematopoietic stem cell transplantation (HSCT) has been used in application to severe refractory Crohn’s disease (CD), with encouraging results. Allogenic HSCT would correct the genetic defects of the immune system, but is currently not accepted for the treatment of IBD because of its considerable risks. Mesenchymal stem cells (MSCs) have immune regulatory and regenerative properties, and low immunogenicity (both autologous and allogenic MSCs). Based on these properties, MSCs have been used via the systemic route in IBD with promising results, though it is still too soon to draw firm conclusions. Their local administration in perianal CD is the field where most progress has been made in recent years, with encouraging results. The next few years will be decisive for defining the role of such therapy in the management of IBD.

Keywords: Mesenchymal stem cell; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Haematopoietic stem cell transplantation

Core tip: Treatments with mesenchymal and hematopoietic stem cells offer a potential that requires in-depth investigation. Existing studies are encouraging yet inconclusive. We are at a point of inflexion where these new therapies are seen to afford major curative potential. The coming years will be decisive. The information obtained from ongoing and future clinical trials may lead a revolution in inflammatory bowel disease management and its impact upon patients. Undoubtedly, as twenty-first century gastroenterologists, we must expand the scope of our specialty and seek multidisciplinary interaction for the benefit of our patients.