Can Stem Cell Therapy be a Viable Rheumatoid Arthritis Treatment?

Less than a decade ago, adult stem cells were still believed to have intrinsic limitations as to their ability to become other types of cells (believed to be limited to becoming only blood cells). This inaccuracy is still believed today by some scientists in spite of the obvious. What is radically new and is causing a change in the way we view health and wellness is the discovery that adult stem cells in the bone marrow have the ability to become virtually any kind of cell types in the body. Meaning to say that they constitute the natural renewal system of the body.

Isn’t this interesting? From the day when I decided to collect and store umiblical cord stem cells for both of my kids, I have been constantly keeping track with the progress of stem cells breakthrough and what it may mean for me, my children, our health and our future. Indirectly, it also leads me to think about whether stem cell therapy can be a viable alternative treatment for Rheumatoid Arthritis at all. So, I began researching… (Keep reading).

What are Stem Cells and What Makes Them Special?

Cells in our body have many different functions – nutrients transportation, energy production, reproduction, etc – and they ‘stem’ from simpler cells that are not yet specialised. These simpler cells are known as stem cells. What this means is that a stem cell is basically a cell that does not yet have a specific job in the body.

BUT, when a stem cell divides, the new cell can become a different cell with a more specific function, that is, they become the many specialised cells that constitute tissues such as heart and skin. In fact, groups of stem cells in some adult tissues also give rise to replacement cells that are destroyed through injury, disease or age.

Source: http://www.nbcnews.com

Stem cells are different from the other types of cells in the human body. Although they can be harvested from various sources, they all share some of the same properties. In fact, stem cells are essentially a repair system in the human body. They can divide in unlimited numbers to replenish other cells, with new cells remaining a stem cell or becoming a more specialised cell with a specific purpose.

Due to these special attributes, stem cells present huge potential to benefit different areas of disease research and management. Its intriguing and promising area of science is interesting and have prompted questions and controversy which cannot be answered with definitive conclusion but I would be interested to learn more about any future research that can provide a breakthrough in the health industry.

To learn more about stem cells, do watch this video in which Dr. Riordan discusses about mesenchymal stem cells (MSCs) harvested from fat tissue and the role they play in reducing inflammation, repairing tissue and modulating the immune system.

The Promise of Stem Cells Therapy Holds for Rheumatoid Arthritis

In the journal, Induction of remission of severe and refractory rheumatoid arthritis by allogeneic mixed chimerism, by Burt et al, American College of Rheumatology, first published in 2004, it was reported that researchers from Northwestern University in Chicago alleged that a 52-years old woman with RA in 38 joints has successfully been treated with stem cells from a sibling.

The results: The woman’s morning stiffness disappeared before she was released from the hospital. 9 months after the stem cell transplantation, her rheumatoid nodules disappeared. 1 year after the transplant, she is said to be free of the disease and not taking drugs to suppress her immune system. Prior to transplant, the woman was given several drugs to allow her body to accept the new cells. There was no evidence of either complication.

The researchers also concluded that the procedure ‘may be performed safely, without the development of graft-vs-host disease (ie rejection of the new transplanted cells) or serious infection, and results in… marked resolution of disease manifestations of RA”.

Mesenchymal stem cells (MSCs) are adult stem cells that can be isolated from most adult tissues, including bone marrow, adipose, liver, amniotic fluid, lung, skeletal muscle and kidney. Recently, MSCs have been shown to possess immunomodulatory properties. These include suppression of T cell proliferation and immune modulation; and hence being tested in four main areas: tissue regeneration for cartilage, bone, muscle, tendon and neuronal cells for treatment of immune diseases such as RA, MS, etc.

In another research, Mesenchymal stem cells: Re-establishing immunological tolerance in autoimmune rheumatic diseases, by GI et al, 2011, stated that:

Immunological tolerance is critical in preventing autoimmune disease and maintaining immune homeostasis. Increased understanding regarding cytokine networks led to the development of neutralizing antibodies against TNF alpha, IL-1 and IL-6 signalling in the treatment of rheumatoid arthritis (RA). However, there remains an unmet need given the significant number of patients not achieving remission nor responding to these drugs. Mesenchymal stem cells (MSCs) are promising tools for the repair of damaged joint tissues such as cartilage, bone and tendons.

They also have potent anti-inflammatory and immunomodulatory properties both in vitro and in vivo [1]. Research into MSC therapy for Crohn’s disease, type I diabetes, graft-versus-host disease (GvHD) and multiple sclerosis continues apace with phase II/III trials ongoing. There have been conflicting reports regarding their effects in the autoimmune rheumatic diseases, particularly in the collagen-induced arthritis mouse model of RA [2-8].

Conversely, promising results in patients with systemic lupus erythematosus (SLE) were recently reported [9] even in the face of conflicting results in murine models of SLE. In this article we will examine MSCs as a possible cellular therapy for RA, SLE and systemic sclerosis (SSc) and critically review possible reasons for conflicting results in the literature. We will also address whether MSC dysfunction could play a role in the aetiopathogenesis of these conditions.

Findings from other clinical studies related to rheumatic diseases are appended below:

Mao JJ. Stem-cell-driven regeneration of synovial joints. Biol Cell 2005; 97(5): 289-301.
“The author suggests that mesenchymal stem cells may be of benefit in repairing injury in the synovial joint with both cartilage and bone components.”

Jorgensen C, Gordeladze J, Noel D. Tissue engineering through autologous mesenchymal stem cells. Curr Opin Biotechnol 2004; 15(5): 406-10.
“Cartilage regeneration can potentially be achieved through cell and/or gene therapy. Mesenchymal stem cells are progenitor cells of multiple lineages, including bone, cartilage, muscle, fat and astrocytes. Mesenchymal cells seem to be good candidates for regenerating injured arthritic tissue. The long term behavior of mesenchymal stem cells when implanted in pathological joints needs further research.”

Grisar J, Aletaha D. Steiner CW, Kapral T, Steiner S, Seidinger D, Weigel G, Schwarzinger I, Wolozcszuk W, Steiner G, Smolen JS. Depletion of endothelial progenitor cells in the peripheral blood of patients with rheumatoid arthritis. Circulation 2005; 111(2): 204-11.
“Rheumatoid arthritis (RA) is characterized by an increase in cardiovascular disease that is not explained by traditional cardiovascular risk factors. The number of endothelial progenitor cells in the peripheral blood is inversely correlated with cardiovascular risk. The authors therefore studied the levels of endothelial progenitor cells in 52 patients with rheumatoid arthritis and 16 normal controls. The patients were divided into 36 patients with active disease and 16 patients with low disease activity. Endothelial progenitor cells (CD34, KDR, AC133) were significantly decreased in patients with active RA. The frequency of circulating endothelial progenitor cells from patients with low disease activity was comparable to that of the healthy control subjects. The authors conclude that active RA is associated with a depletion of circulating endothelial progenitor cells and this may be a contributing factor to increased cardiovascular risk.”

I encourage you to watch this video that intrigues your imagination on how the use of fat stem cells can be a viable treatment for Rheumatoid Arthritis.

My Thoughts

I’ve read up on many amazing stories and testimonials of how stem cells work wonder for different conditions. In one case, stem cells harvested from patients’ stomachs help the body regrow tissue and cartilage damaged by the crippling, incurable condition. Other studies showed that fat-derived stem cell therapy has been startlingly successful in the treatment of Osteoarthritis in pets and now being used in humans. Others treat joint and tendon disease by injecting the stem cells into the affected area, replacing lost or damaged cells. Such jabs reduce inflammation and encourage repair and regrowth of healthy tissues inside the joint.

Although the stem cells research and discovery is still considerably overwhelming at its infancy/developmental stage and many questions have yet to be understood and answered, early results show it may help cartilage regeneration, delay need for joint replacement by 10 to 20 years. And perhaps, if disease like RA is treated at an early stage, it may halt its degenerative progress altogether.

Nonetheless, with its long term effects unknown, we should ALWAYS exercise caution if we, one day, decide to consider stem cell therapy for RA management. After all, as I’ve said, stem cell is still in its early stage of development; and they are not the ‘magic bullets’ at this point in time. There are several challenges faced by researchers that must be overcome before stem cell therapies can become a successful reality for those suffering from diseases like RA.

The existing challenges with using stem cell therapy for treatment of disease lies with the difficulties in identification of stem cells within an actual tissue culture. Cultures contain many different cells and it remains a challenge to identify specific cell types. When the stem cells are identified and then isolated from tissues, the appropriate solutions must be created to trigger these cells to develop into desired cell types. Finally, there are additional issues following identification, isolation and regrowth of these cells, which are the implantation issues of these new cells in a person and how they must then essentially learn how to effectively function alongside the person’s own tissues; or else the body immune system may recognise the transplanted cells as foreign bodies which can trigger immune reaction that results in rejection of the new cells.

Researchers do expect to eventually move beyond these challenges but the unfortunate reality is that those suffering from RA have little time to wait for treatment given that RA is both progressive and crippling in nature. Nonetheless, the future does look exciting for finding stem cell treatments that can eventually improve the quality of lives for all RA sufferers. These said, I hold the view that stem cell therapy IS a viable RA treatment option only when I can confidently believe that they can be successfully implemented.