Introduction
Stem cell therapy is one of the most intriguing fields of modern medicine. Stem cells are undifferentiated, so they have a long division time and can differentiate into multiple cell types. Stem cells vary from other types of cells. The biological underpinnings of these different traits and their potential use in cell-based therapy have sparked intense interest in the scientific community. The power of stem cells to develop into any cell type in the body is unparalleled. For instance, intravenously injected stem cells can locate and restore damaged tissue throughout the body. This article discusses the role of stem cells in rheumatic diseases.
What Is Stem Cell Therapy?
Stem cell therapy is a cutting-edge therapeutic strategy that uses the unique abilities of stem cells, such as self-renewal and differentiation, to repair damaged cells and tissues in the human body or to replace these cells with brand-new, healthy ones that are fully functional. Both autologous (also known as self-to-self therapy), which uses the patient's cells, and allogeneic sources—which use cells from a healthy donor—can be used as the source of stem cells for cell-based therapies.
Arthritis is a cartilage condition resulting in pain and inflammation in the joints. It has been demonstrated that administering hematopoietic stem cells (HSCs) can lessen bone lesions, improve bone regeneration, and speed up the vascularization process in degenerative cartilage.
On MRI examination, an increase in cartilage thickness indicates that cartilage degradation was lessened after administration. Furthermore, the use of CD34+ stem cells was suggested in conjunction with the rehabilitation algorithm, which had three stages: preoperative, hospitalization, and outpatient times, to further increase the therapeutic potential of hematopoietic stem cell therapy (HSCT).
What Is the Role of Stem Cell Therapy in Rheumatic Diseases?
Stem cells may be able to repair damaged tissue to lessen discomfort and improve mobility in Rheumatoid Arthritis patients. The mesenchymal stem cells can reduce inflammation. In individuals with autoimmune diseases, stem cells may be able to control or calm an immune system that is out of balance. According to data, mesenchymal stem cells can immunosuppression the immune system's reaction. They can suppress in vitro cytotoxic T-cell production in response to alloantigens (antigens with genetic variations) and mitogens (a substance inducing cell division). Stem cell therapy (SCT) has been used successfully on autoimmune rheumatic disease (ARD) patients. There are few clinical trials in systemic vasculitis, systemic sclerosis, rheumatoid arthritis, and pediatric ARDs, including juvenile idiopathic arthritis.
Systemic Lupus Erythematosus (SLE)
Over the past two to three decades, traditional SLE therapy, particularly corticosteroids and immunosuppressive medications, has significantly improved survival and slowed the progression to end-stage multi-organ failure. But each substance has substantial toxicities and a wide range of adverse effects. They include steroid-induced dyslipidemia and osteoporosis, gastrointestinal distress and liver dysfunction, hypertension, and nephrotoxicity. In addition, infection is the primary risk for corticosteroid and immunosuppressive therapy adverse effects. Over 2,000 individuals have gotten HSCT, and roughly 500 have received mesenchymal stem cell therapy (MSCT) globally in the last 20 years.
Furthermore, more than ten clinical trials currently evaluate SCT as a treatment for SLE. Despite the promising future for SCT, there are still several restrictions. The major obstacles to auto-HSCT are the high risk of disease relapse and substantial adverse effects caused by conditioning therapy (chemotherapy/monoclonal antibody therapy/radiation).
Systemic Sclerosis
Systemic sclerosis (SSc) patients continue to have a poor prognosis and high mortality rate despite early diagnosis and proper management improvements. Numerous case reports showed that allo-HSCT and MSCT had beneficial therapeutic benefits in SSc patients without any immediate toxicity or severe infection. However, juvenile SSc seems to have a better result than the adult variant.
Rheumatoid Arthritis (RA)
Many RA patients experience a severe, debilitating, refractory condition despite intensive disease-modifying antirheumatic drug (DMARD) methods and effective biologic medicines. In addition to biological treatments, lymphoablative regimens combined with SCT have been used as a treatment option for RA that is resistant to them. However, it is challenging to distinguish between refractory RA patients and those with poor prognosis from HSCT-responsive RA patients from the existing clinical research. Therefore, HSCT for RA patients should only be considered with extreme caution.
Sjogren's Syndrome
Xerostomia, keratoconjunctivitis sicca, and systemic characteristics are frequently seen in patients with Sjogren's syndrome, the most prevalent chronic, slowly progressing ARD. Sjogren's syndrome typically affects the exocrine glands. Clinical data recently demonstrated the viability, safety, and effectiveness of MSCT. The majority had significant improvement in disease activity and organ function after MSCT and a long-lasting rise in salivary flow rate.
Systemic Vasculitis
Primary systemic vasculitis, Behcet's disease, and relapsing polychondritis, which are related diseases, are all autoimmune diseases with significant organ destruction and frequently fatal progression. The prognosis has been substantially changed into a treatable condition with the establishment of early diagnosis and ideal standard therapy. However, SCT is constrained in PSV.
Juvenile Idiopathic Arthritis (JIA)
The most frequent ARD among kids is JIA. JIA's prognosis remains dismal despite innovative treatment regimens, particularly in children with systemic and polyarticular onset. But for refractory JIA, HSCT significantly increased the quality of life. However, as anticipated, the condition of already injured joints remained unchanged. HSCT is likely to reverse what would have otherwise been a permanent defect if managed before the DMARD treatment and before any irreversible severe joint deterioration. As a result, it's critical to carefully choose patients who are likely to benefit from HSCT.
Conclusion
The potential of stem cell therapy to revolutionize treatment methods for rheumatic disorders is quite promising. Stem cells have demonstrated the capacity to repair damaged tissues, control the immune response, and even slow disease progression. Even though the discipline is still developing, early research and clinical investigations have shown positive outcomes. Stem cell therapy presents a potential complement or substitute for conventional therapies, opening up fresh possibilities for bettering patient outcomes in rheumatic disorders. However, more investigation, larger-scale studies, and extensive follow-up are required to determine its safety, effectiveness, and ideal methods. Collaboration between researchers, doctors, and regulatory authorities is crucial to maximizing the benefits of stem cell treatment for treating rheumatic diseases.
