CELL THERAPY IN RHEUMATOLOGY: POSSIBLE DIRECTIONS
Summary. Purpose of the study: to analyze modern experimental and clinical approaches to the treatment of rheumatological diseases based on the use of stem cells. Material and methods. The paper presents topical issues of developing methods of cell therapy for rheumatological diseases based on own research of hematopoietic stem and multipotent stromal cells, as well as information search in Medline and PubMed and data in the periodical world scientific literature. Results and discussions. For the first time, recommendations for the use of stem cells for the treatment of autoimmune diseases, agreed by the European Antirheumatic League (EUL) and the European Group for Blood and Bone Marrow Transplantation (EBMT), were published in 1997. Hematopoietic stem cell (HSC) transplantation after myeloablation is used to replace the immune system affected by the autoimmune process with healthy donor immune cells — derived from HSC. There are two main HSC drugs. These are bone marrow cells containing HSCs and CD34+ HSCs sorted from peripheral blood, mobilized into circulation by cyclophosphamide and GCSF (granulocyte colony — stimulating factor). Currently, preference is given to autologous transplantation of HSCs, which take root better, do not induce transplant reactions, and reduce infectious, autoimmune and oncological risks. In addition, this procedure does not require deep myeloablation, which results in a low incidence of unwanted complications. Clinical studies have shown an increase in the effectiveness of the treatment of autoimmune diseases with transplantation, especially with HSC autotransplantation. The most promising method of cell therapy is the transplantation of multipotent stromal cells (MSCs) of various origins, which can be in allogeneic and autologous combinations. The motivation for the use of MSCs was the data on the pronounced dysfunction of these cells in autoimmune diseases in the experiment and clinic. MSC transplantation does not require conditioning, does not induce incompatibility reactions, and practically does not cause adverse reactions. On genetic and pristane-induced experimental models, as well as as a result of clinical studies, a pronounced effect of MSCs, which normalizes the activity of the immune system, and a noticeable promising therapeutic effect have been established. Conclusions. The results of transplantation of HSCs and MSCs in rheumatological diseases indicate an increase in the effectiveness of treatment. The methods are promising and can be recommended for further development and implementation.
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