Speaker
Description
Introduction
Allogeneic hematopoietic stem cell transplantation (HSCT) is the treatment of choice for malignant blood diseases. However, long-term results are limited by the high morbidity and mortality associated with the development of graft versus host disease (GVHD). The use of mesenchymal stem cells (MSCs) has emerged as a safe and effective therapeutic option for GVHD due to its immunomodulatory potential.
Aim
In this review we discuss the use of MSCs for the prevention or treatment of GVHD in HSCT and their efficacy and safety in these clinical applications.
Methodology
Using PubMed, Scopus and Web Of Science databases and applying the search algorithm: (“Mesenchymal Stem Cells" OR "Mesenchymal Stromal Cells" OR "Bone Marrow Mesenchymal Stem Cells" OR “MSC”) AND ("Graft vs Host Disease" OR "Graft-Versus-Host Disease" OR "Disease, Graft-Versus-Host" OR "Graft Versus Host Disease" OR GVHD), 103 international scientific publications were found that correspond to clinical studies, among which 75were included in this review.
Results
We included in this review 24 articles related to the use of MSCs as prophylaxis and 51 articles related to their use as treatment for GVHD. In them we identified that the main MSCs sources are: bone marrow, adipose tissue, cord blood and placenta. The route of administration is intravenous infusions and the dose is 1x106cells/kg.
It is known that MSCs are characterized by their low immunogenicity due to their low expression levels of major histocompatibility complex I (MHC), no expression of MHC II and costimulatory molecules, such as CD80, CD86, and CD40, therefore they are able to evade allogeneic rejection. Increasing evidence has emerged suggesting that these cells possess the abilities to secretea variety of cytokines that may create a more favorable bone marrow microenvironment, improvingdonor engraftment by supporting the hematopoiesis. Besides MSCs can modulate immune responses and reduce the risk of GVHD through the inhibition of the activation and proliferation of T and B lymphocytes and the downregulation of inflammatory cytokine expression such as TNF-α, IL2R-α, elafin and INF-γ.
Conclusion
In conclusion, the immunomodulatory properties of MSCs after and during allogeneic HSCT are very useful in the clinical setting to prevent and treat GVHD.
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