Combined transplantation of autologous hematopoietic stem cells and allogenic mesenchymal stem cells increases T regulatory cells in systemic lupus erythematosus with refractory lupus nephritis and leukopenia.
Autologous hematopoietic stem cell (HSC) and mesenchymal stem cell (MSC) transplantation is currently being evaluated as a novel treatment for autoimmune diseases, such as systemic lupus erythematosus (SLE). Here we report a case of autologous HSC transplantation combined with MSCs in a 25-year-old severe SLE patient with multiple life-threatening complications and refractory to conventional cyclophosphamide (CYC) therapy. After being pretreated with CYC, ﬂudarabine and antithymocyte globulin, the patient was transplanted with autologous CD34+HSCs and MSCs by intravenous infusion. Hematopoietic regeneration was observed on day 12 thereafter. After HSC and MSC transplantation, the patient's clinical symptoms caused by SLE were remitted, and the SLEDAI score decreased. Moreover, CD4+CD25+FoxP3+Treg cells increased in peripheral blood mononuclear cells (PBMCs) after transplantation. This result suggests that the combined transplantation of HSCs and MSCs may reset the adaptive immune system to re-establish self-tolerance in SLE. A 36-month follow-up showed that the clinical symptoms remained in remission. Although a longer follow-up is required for assessing the long-term efficacy, our present results suggest that the combined transplantation of HSCs and MSCs may be a novel and effective therapy for refractory SLE.
Division of Rheumatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Wang
Division of Hematology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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S
Qian
Division of Hematology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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J
Li
Division of Rheumatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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N
Che
Division of Rheumatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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L
Gu
Division of Rheumatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Wang
Division of Rheumatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China Division of Hematology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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Y
Liu
Division of Rheumatology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China meihpnj@sina.com.
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Mei
D000328:Adult; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000473:pathology; D007970:Leukopenia / Q000276:immunology / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000276:immunology* / Q000628:therapy*; D008181:Lupus Nephritis / Q000276:immunology* / Q000628:therapy*; D045164:Mesenchymal Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D050378:T-Lymphocytes, Regulatory / Q000276:immunology* / Q000473:pathology; D014182:Transplantation, Autologous
D003520:Cyclophosphamide
Hematopoietic stem cell transplant; Treg cells; mesenchymal stem cells; systemic lupus erythematosus