Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 199-205
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.199
Hematopoietic stem cell transplantation for auto immune rheumatic diseases
Subramanian Ramaswamy, Sandeep Jain, Vinod Ravindran
Subramanian Ramaswamy, Department of Rheumatology and Immunology, JSS Medical College, Mysuru 570015, Karnataka, India
Sandeep Jain, Department of Medical Oncology, Mayo Clinic Health System, Albert Lea, MN 56007, United States
Vinod Ravindran, Centre for Rheumatology, Near Chevarambalam Junction, Kozhikode 673009, Kerala, India
Author contributions: Jain S and Ravindran V conceptualized this review and defined the objectives; Ramaswamy S did the literature search, identified studies and wrote the first draft; all three authors critically revised the manuscript and approved the final version.
Conflict-of-interest statement: All authors have none to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sandeep Jain, MBBS, MRCP (UK), Senior Associate Consultant, Department of Medical Oncology, Mayo Clinic Health System, 404 W Fountain St., Albert Lea, MN 56007, United States. drsandeepjain@gmail.com
Telephone: +1-507-3792050 Fax: +1-507-3792059
Received: July 9, 2015
Peer-review started: July 14, 2015
First decision: September 22, 2015
Revised: November 4, 2015
Accepted: December 17, 2015
Article in press: December 18, 2015
Published online: March 24, 2016
Processing time: 253 Days and 3.1 Hours
Abstract

Stem cells have their origins in the embryo and during the process of organogenesis, these differentiate into specialized cells which mature to form tissues. In addition, stem cell are characterized by an ability to indefinitely self renew. Stem cells are broadly classified into embryonic stem cells and adult stem cells. Adult stem cells can be genetically reprogrammed to form pluripotent stem cells and exist in an embroyonic like state. In the early phase of embryogenesis, human embryonic stem cells only exist transiently. Adult stem cells are omnipresent in the body and function to regenerate during the process of apoptosis or tissue repair. Hematopoietic stem cells (HSC) are adult stem cells that form blood and immune cells. Autoimmune responses are sustained due to the perennial persistence of tissue self autoantigens and/or auto reactive lymphocytes. Immune reset is a process leading to generation of fresh self-tolerant lymphocytes after chemotherapy induced elimination of self or autoreactive lymphocytes. This forms the basis for autologous HSC transplantation (HSCT). In the beginning HSCT had been limited to refractory autoimmune rheumatic diseases (AIRD) due to concern about transplant related mortality and morbidity. However HSCT for AIRD has come a long way with better understanding of patient selection, conditioning regime and supportive care. In this narrative review we have examined the available literature regarding the HSCT use in AIRD.

Keywords: Transplant related mortality; Hematopoietic stem cell transplantation; Systemic sclerosis; Stem cell therapy; European Group for Blood and Marrow Transplantation

Core tip: Hematopoietic stem cell transplantation for the management of autoimmune rheumatic diseases has come a long way. It is being recognized as a viable option in severe autoimmune diseases, in particular for systemic sclerosis.