Stem cell therapy was found to be potentially effective and a possible alternative treatment for patients with refractory active Crohn’s disease, according to a meta–analysis review study.
Toxicity remains the most significant barrier to systemic stem cell therapy in patients with Crohn’s, researchers found.
The study, “Systematic review with meta-analysis: the efficacy and safety of stem cell therapy for Crohn’s disease,” was published in the journal Stem Cell Research & Therapy. It was led by a team of researchers from the Department of Gastroenterology at the First Affiliated Hospital of Sun Yat-sen University in China.
This therapeutic approach for the treatment of Crohn’s disease is still in development, and whether stem cell therapy will produce improved outcomes has been unclear.
To find out if stem cell therapy did result in better patient outcomes, researchers used electronic databases to search for studies that reported the use of stem cells in the treatment of people living with Crohn’s disease. Raw data from included studies was then pooled for estimates. Sub-group analyses were conducted to explore heterogeneity in all outcomes.
The team of Sun Yat-sen researchers analyzed 21 studies comprising 514 patients with active Crohn’s disease. A random-effects meta-analysis of stem cell therapy as systemic infusion showed 56% (150 patients) achieved clinical response.
Among other results, a random-effects meta-analysis of all perianal Crohn’s disease studies also demonstrated that 57% (251 patients) had healed fistulas after stem cell therapy.
A subsequent Egger test (used to measure publication bias, or when the outcome of an experiment influences the decision on whether to publish the results) suggests no publication bias existed for fistula healing, but it did exist for clinical response.
Immunosuppressive drugs are the standard of care for Crohn’s disease, but some patients don’t respond well to these treatments, which leaves room for much needed alternatives.
Hematopoietic stem cell transplants (HSCT) might play a role in some of these treatment–resistant cases, as previous studies have suggested that allogeneic HSCT (cells from a donor) might reset the immune system at a genetic level.
Autologous HSCT, which uses the patient’s own stem cells, also eliminates aberrant clones by immunoablation and replaces uncommitted stem cells, leading to a new generation of altered T-cells.
Previous reports describe long–term, treatment–free disease progression with autologous and allogeneic stem cells in some, but not all, patients with Crohn’s disease. However, the recent Autologous Stem Cell Transplantation International Crohn Disease trial failed to demonstrate a statistically significant improvement in sustained disease remission after one year compared to conventional therapy, which raised doubts about stem cell therapy for patients with refractory Crohn’s disease.
The authors concluded that until now, not enough studies have been able to clearly demonstrate the superiority of stem cell therapy for Crohn’s disease, and that while findings are encouraging, they are not conclusive.
The meta–analysis showed that stem cell therapy has potential for refractory Crohn’s disease and has high efficacy in inducing fistula healing.