Haematopoietic stem cells and their potential for treating Crohn’s disease, an idiopathic inflammatory bowel disease. A literature review.
Crohn’s disease (CD) is a non-curable idiopathic inflammatory disease of the gastrointestinal tract. Critical evaluation of peer-reviewed scientific articles using keywords “Crohn’s disease” and “haematopoietic stem cell” or “stem cells” elucidated gaps in current knowledge and limitations of treatment protocol. All treatment options are associated with unacceptable risks and limitations necessitating larger comparable stem cell trials and development of more efficacious drug combinations to facilitate long-term remission, if not alternatively an outright cure for CD. The potential of haematopoietic stem cell treatment (HSCT) for this disease of unknown aetiology has proven to have limited success despite two different approaches, autologous and allogeneic. The risks associated with allogeneic HSCT preclude it from standard protocol. Whereas myeloablation for autologous HSCT can result in irreversible aplasia of the bone marrow, non-myeloablation is considered a safer alternative option. Too few HSCT trials have been completed to view it as the superior treatment option for CD patients. The efficacy of current pharmacological treatment necessitates development of new drugs with improved patient response, which results in long-term remission. Data indicate that 15% of patients are intolerant to the immunosuppressant, azathioprine, and 30% are non-responders. Surgery does not guarantee remission even though 100% of CD patients will be subjected to this procedure during the natural course of the disease. The use of mesenchymal stem cells (MSC) offers a non-toxic treatment preference however trials, to date, are too small and varying in stem cell sources to definitively mark it as the ultimate choice. Limitations of MSC treatment include relatively short half-life and adequate delivery to site of inflammation. The use of nanotechnology in the form of Buckminsterfullerenes may negate those limitations and offer the best long-term patient outcome.