Treatment of Rheumatoid Arthritis by hematopoietic stem cells
Rheumatoid arthritis (RA) is the autoimmune disease and this means that it is extremely difficult to treat. In general, the conventional drugs only slow down the progress of the disease and reduce inflammatory processes. Currently, the rheumatoid arthritis is treated by such immunosuppressive agents as the aminoquinolines, gold salts, D-penicillamine, cytostatic drugs, sulfasalazine and levamisole. However, most of them only relieve the symptoms, such as pain or inflammation of joints, but do not affect the causes of the diease. These therapeutic methods are not able to restore the disease ruined tissues of the joints. In the number of cases, physicians may resort to the surgery to repair the function of the joint; however, it is quite difficult and often impossible to eliminate the initial cause of the disorder by conventional therapeutic methods. The stem cells (SCs) hold promise for a comprehensive therapy of the rheumatoid arthritis. There have been a lot of trials that search for new treatment that would be able to promote regeneration of the damaged tissues and not only remove the pain. First, the stem cell transplantation was tested on animals with different types of RA and showed positive outcomes. The stem cells that were injected to horses suffering from the diseases of joints led to their rapid repair. Currently, this method is also applied to humans, even though it is still considered experimental. The experience has shown that the stem cell therapy may lead to the regeneration of RA damaged tissues and to contribute to the recovery of the immune system. The stem cells not only promote healing of the damaged tissue, but also modulate the immune system so that it preserves its ability to combat the disease. The stem cells, in particular, the mesenchymal or hematopoietic stem cells, are administered into the inflamed tissues and produce the anti-inflammatory cells. These mediators provide local effect and do not suppress the immune reaction of the entire organism of the patient. In addition, the mesenchymal stem cells induce production of the immune cells whose function is to protect the organism from the internal immunologic attacks.
The stem cells for RA therapy are obtained from various sources: bone marrow hematopoietic progenitors (CD34+ CD45-), patients’ autologous adipose tissue or donor umbilical cord blood and tissues (allogeneic mesenchymal and CD34+ cells).
We obtain the hematopoietic stem cells and progenitor cells through the procedure of the leucopheresis of the peripheral blood following the stimulation of a patient’s or a healthy donor’s bone marrow with granulocyte colony-stimulating factor. To obtain the adipose-derived stem cells, the samples of the adipose tissue are isolated in the procedure of the micro-liposuction under a general anesthesia. Then the stem cells are separated from the fat tissue. Before administration, the obtained stem cells are examined for bacterial, anaerobic and aerobic inclusions and endotoxins. Other source of the stem cells is the donor umbilical blood. Prior to the transplantation the cells are tested for the infections and viruses.
We prefer to apply the hematopoietic stem and progenitor cells. These cells are injected intravenously. The first several days are intended for diagnostic examinations. After that the harvest of HSCs and HPCs is started and then the patient has to recover for a few days after the harvest of HSCs and HPCs. After the harvest the stem cells are tested for the absence of viruses and infections, three intravenous injections of hematopoietic stem cells and, sometimes, one injection of stem cells from the umbilical blood are given. If necessary, the intra-articular injections may be additionally prescribed. The therapeutic protocol depends on the condition of the patient and the results of medical examination.