异基因脐带间充质干细胞移植治疗类风湿关节炎疗效及安全性

Allogenic Derived Mesenchymal Stem Cells Transplantation for 4 Patients with Rheumatoid Arthritis

目的探讨异基因脐带间充质干细胞(uhcMSC)移植治疗难治性类风湿关节炎(RA)的疗效及安全性。方法从足月顺产供者脐带中分离培养MSC,给予3例RA患者行MSCs移植治疗,移植细胞数(1×106/kg体重)。评价患者移植前后的临床表现和实验室检查指标的改变。结果异基因MSC移植后,3例RA患者随访9～11个月,所有患者均无移植相关并发症。移植后1月疾病活动评分(DAS-28)由5.13降低为2.16(n=3),1例血液系统受累患者血细胞(中性粒细胞、红细胞、血小板)均上升。移植前后比较抗环瓜氨酸(CCP)抗体滴度降低。1例患者移植前后比较Th17细胞明显升高,Treg细胞降低。结论异基因脐带MSC移植治疗难治性RA有效、安全。uhcMSC取材方便,扩增迅速,输注安全经济。

Objective To explore the clinical efficacy and safety of allogenic derived mesenchymal stem cells transplantation（MSCT） in patients with refractory rheumatoid arthritis（RA）.Methods Three patients with refractory RA（all were female patients） aged 43-47 were enrolled in the study and the Ethics Committee of the Affiliated The Shanxi Medical University approved informed consent was obtained for each patient.The umbilical cord of healthy donors were aspirated and the mesenchymal stem cells（MSC） were expanded in vitro.MSC 1×106/kg body weight was infused intra-venously for each patient.Before MSCT,all patients were administrated with cyclophosphamide（CTX） 400-600 mg.The clinical manifestations and laboratory tests were compared before and after MSCT.Results The three patients were followed up for nine to eleven months after MSCT.No patient had developed transplantation related complications.The rheumatoid arthritis disease activity scord（DAS-28） score decreased from 5.13 to 2.16 one month after MSCT（n=3）.Erythrocyte sedimentation rate（ESR） decreased significantly one month after MSCT（n=3）.Three patients were followed up for nine months,anti-cyclic citrullinated peptide（anti-CCP） antibody titer decreased significantly.One patients had increased whole blood cell counts one month after MSCT.Bone pain disappeared one month after MSCT.In two patients,blood Treg cells fell down mildly and Th17 cell were increased.Conclusion Treating refractory RA with allogenic MSCT is effective and safe.However,further observation is required to evaluate long term efficacy.