Juvenile Idiopatic Arthritis (JIA) is a malignancy of the connective tissue , which affects approximately 1 in 1’000 children in any given year, with about 1 in 10’000 having a more severe form. JIA usually appears in children between 6 months and 16 years old. The first signs are often joints pain and swelling. The prognosis of the disease is variable : in some cases these symptoms may decrease until they disappear. The greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission. The causes of this autoimmune disorder are still unknown but both genetic and environmental factors (such as infection by certain viruses) are involved.
The pharmacologic management of this disease consists of nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), intra-articular/oral steroids, and biological agents aiming to relieve pain and control inflamation. However, these traditional treatments are not effective because they decrease the symptoms temporarily but they cannot completely adjust the immune responses of the JIA patients. This explains why the symptoms continue to occur repeatedly and gives a new perspective to look for approaches to repair the patient immune response. Mesenchymental Stem Cells (MSCs), were shown to be a potential source for regenerative medicine, because they are multipotent and more importantly, they secrete molecules which regulate the immune response and repair the damaged tissue. Umbilical cord derived MSCs (UC- MSCs) have further advantages : they have a low immunogenicity and they have a long survival time in the host.
Recently, the employment of UC-MSCs for JIA therapy was clinically observed by a chinese group on ten severe JIA inpatients of the Cell Therapy Center of Xi’an, in collaboration with the University of Oklahoma Health Sciences Center (Oklahoma City, USA). The patients, aged 2-15 years, hab been treated repeatedly with steroids, NSAIDS, disease-modifying antirheumatic drugs (DMARDs) and biological agents, but these treatments showed no significantly beneficial effect.
The severity of their disease was estimated with the 28-joint disease activity score (DAS28) and by measuring some molecular markers of inflammation in the blood : the white blood cell count (WBC), the C-reactive protein (CRP), the erithrocyte sedimentation rate (ESR) and the level of IL-6, TNF-alpha and T-regulatory cells.
All patients recieved an intravenous infusion of UC-MSCs derived from the same newborn umbilical cord, while they were still on their antirhematic drugs treatment. Three months later, the disease severity and inflammation markers were evaluated and then a second infusion was administered, followed by a second evaluation, another three months later. All patients were followed-up one year later and four of them were further tracked two years later.
Followed up data showed significant improvements already 3 months after the first infusion: DAS28 scored lower and reached a low activity of the disease and WBC, ESR, CRP, and IL-6 and TNF- reduced, whereas Tregs (which are immunosuppressive) increased significantly. The same trend was observed another 3 months later after the second infusion and the patients were able to decrease their dose of antirheumatic drugs with good tolerance. The data for the 1- and 2-year follow-up study showed that the patients enjoyed long-term alleviation of symptoms and pain relief, which promoted their physical development substantially and consequently their wellness.