Conditions

Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints of the body, most notably the hand and fingers. Common symptoms of RA include pain, stiffness, inflammation and eventually degradation of joints. Serological markers including rheumatoid factor (RF) and Anti-CCP and inflammatory markers such as ESR and CRP are used in the diagnosis of RA. Standard treatment options for RA include NSAIDS, corticosteroids, biologic drugs, etc. These drugs are intended to reduce pain, reduce inflammation and modulate the immune system. However, these treatments often fail to provide long term effects and in many cases cause adverse effects leading to a discontinuation of the treatment.

Numerous research studies have demonstrated that stem cell therapy is safe, and effective in RA. Stem cell therapy has been shown to reduce inflammatory and serological markers, decrease disease activity and severity, and increase quality of life.

Based on early human clinical trials there appears to be a strong argument for the safe and effective use of stem cell therapy in the treatment of RA. While we wait for phase II/III trials the current data is encouraging and supports use of stem cell therapy in the clinical setting.

PROVEN BENEFITS OF STEM CELL THERAPY IN RHEUMATOID ARTHRITIS:

• The American College of Rheumatology 20 score (ACR20) was improved in 53.3% of patients treated with MSCs and 93.3% in patients treated with UC-MSC and IFN-γ (Xu et al)
• Intravenous UC-MSC was safe for patients with RA (Xu et al, Wang et al, Park et al)
• IV UC-MSC therapy significantly decreased disease activity (Wang et al, Park et al)
• IV UC-MSC therapy reduced inflammation associated with RA (Wang et al)
• IV UC-MSC therapy significantly improved quality of life in patients with RA (Wang et al)
• Therapeutic effects of IV UC-MSCs were maintained for 3 years (Wang et al)
• Intravenous BM-MSC was safe for patients with RA (Ghoryani et al, Shadmanfar et al)
• Intravenous BM-MSC decreased severity and activity of RA (Ghoryani et al)
• Intra-articular injection of BM-MSCs decreased pain and increased pain free walking distance (Shadmanfar et al)
• IV adipose derived stem cells for patients with RA was well tolerated (Álvaro-Gracia et al)

CONCLUSIONS FROM SELECTED STUDIES:

“The results of this study show that IFN-γ is a key factor in determining the efficacy of MSCT in the treatment of RA, and that an MSC plus IFN-γ combination therapeutic strategy can greatly improve the clinical efficacy of MSC-based therapy in RA patients.”

• Combination of human umbilical cord mesenchymal stem (stromal) cell transplantation with IFN-γ treatment synergistically improves the clinical outcomes of patients with rheumatoid arthritis. (Xu et al, 2020)

“Autologous bone marrow derived MSCs ameliorate the severity and activity of refractory RA

• Amelioration of clinical symptoms of patients with refractory rheumatoid arthritis following treatment with autologous bone marrow-derived mesenchymal stem cells: A successful clinical trial in Iran. ( Ghoryani et al, 2018)

“The therapeutic effects of UC-MSC can be maintained for 3 years, with stable clinical outcomes, which significantly improve RA patient’s quality of life.”

• Efficacy and Safety of Umbilical Cord Mesenchymal Stem Cell Therapy for Rheumatoid Arthritis Patients: A Prospective Phase I/II Study. (Wang et al, 2019)

“Considering favorable safety profiles, intravenous infusion of UC‐MSCs may constitute a therapeutic option for patients with RA, who are refractory to or intolerant of methotrexate (MTX).”

• Intravenous Infusion of Umbilical Cord Blood-Derived Mesenchymal Stem Cells in Rheumatoid Arthritis: A Phase Ia Clinical Trial. Stem Cells Translational Medicine. (Park et al, 2018)

“Intra-articular knee implantation of MSCs appeared to be safe and well tolerated. In addition, we observed a trend toward clinical efficacy.”

• Intra-articular knee implantation of autologous bone marrow–derived mesenchymal stromal cells in rheumatoid arthritis patients with knee involvement: Results of a randomized, triple-blind, placebo-controlled phase 1/2 clinical trial. Shadmanfar et al, 2018)

“Cx611 was in general well tolerated, without evidence of dose-related toxicity at the dose range and time period studied. In addition, a trend for clinical efficacy was observed.”

• Intravenous administration of expanded allogeneic adipose-derived mesenchymal stem cells in refractory rheumatoid arthritis (Cx611): Results of a multicentre, dose escalation, randomised, single blind, placebo-controlled phase Ib/IIa clinical trial. ( Álvaro-Gracia et al, 2017)