Sunday, July 7, 2013

Crohn's and Stem Cells: Review of The Medical Literature

Recently I saw a story about how two HIV patients after bone marrow transplants  so far have no signs of the disease. People forget but HIV does involve the immune system just like Crohn’s disease. Four months after the transplant doctors could still detect HIV in the blood however 6-9 months later all the HIV was gone.

The first case for use of stem cells in Crohn’s was on Joy Weiss who underwent a stem cell treatment in 2001. It was performed by Dr. Richard Burt who is at Northwestern Medical School in Chicago, Illinois. The process for undergoing the stem cell transplant is not fun. Basically you have to undergo chemotherapy to “reboot” the immune system.  After the procedure though Weiss for the first time in 11 years had a remission of Crohn’s. Sadly 3 years after the procedure (in 2004) was performed Joy Weiss passed away.  Speaking of Northwestern in 2010, this study of 24 patients out of Northwestern by Dr. Burt and Dr. Craig showed the clinical free relapse rate was 96% at 1 year, 63% at 3 years, and 36% at 5 years.

This study from Barcelona by Dr. Julian Panes showed that 80% of patients were in remission after 6 years and 20% of patients have shown constant improvement after the transplant. Hospital Clinic de Barcelona has only done the treatment on 6 patients.

.A study from earlier this year in the journal Stem Cells showed that in 43 patients with Crohn’s that were treated using adipose tissue derived stem cells closed fistulas in 82% of patients.  70% of all patients had their fistulas closed after 1 year. I hope more studies are done on this to show that stem cells could really help close fistulas.  The video can be seen here.

A case study for a 36 year old male patient showed the patient was in complete clinical, endoscopical, and histological remission after 9 months of treatment.

This article talks about how at the Royal Perth Hospital in Australia 80% of patients responded to stem cell therapy with more than 50% going into remission. At DDW 2013 this year Dr. Christopher Hawkey from University of Nottingham showed some positive results with stem cells.  The study looked at 45 patients with Crohn’s who failed at least 3 immunosuppressive drugs (they also took patients who were extremely sick and for whom surgery did not help). What bothers me is that the study used a control group. I know scientists need a control group and treatment group. However, when patients are in dire straits with their health is it really ethical to do? The study showed that 50% of patients were in clinical remission and over 66% of the patients who received treatment stopped immunosuppressive therapy. The downside is there were some adverse effects. One patient did die during the study (from sepsis).

According to this article from the New England Journal of Medicine between 1993-1997 1418 people received allogenic hematopotietic cell transplantation. The mortality decreased 52% over this period of time (some of these people had very serious illnesses like cancer).

Stem cells to treat Crohn's looks like it might have an application for patients who have failed medical therapy, surgery, and all other treatments. It is important to note that stem cell therapy does carry risk. However, over time the treatment will become a lot less risky and hopefully become more effective. 

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