Y’all, I just got home from a whirlwind trip where I met some of the most interesting people! I had lunch with this serial entrepreneur who showed me a bunch of pictures of his ridiculously cool meteor collection, exchanged ideas with one of the people responsible for the first case of fully functioning 3D printed organs, and heard two of the coolest ladies ever share their personal experiences with bone marrow derived adult stem cell therapy. It surprised me when one of them said her physician came at her with a hammer, but it turns out she just has a great sense of humor. And also really appreciates shock value.
During the course of these adventures in the snowy Pacific Northwest (no, there really wasn’t any snow but it was mid-winter weather for this native Texan), I met a number of people looking for answers to their health conditions. One such person asked me a variety of questions about systemic lupus erythematosus, aka lupus. So today I’m going to talk about stem cells and lupus, because a lot of people want to know if stem cells can help. And I’d rather they get information from some peer-reviewed, Pub Med listed sources here on ISY than Dr. Oz. Because Dr. Oz is really great on camera, but he provides about as much scientific value as an episode of Rainbow Bright.
So let’s jump right in and see what lupus is and how stem cells can legitimately help. Or not. It’ll be a surprise!
Lupus Makes Your Immune System A Traitor
In a previous post I mentioned the basic functions of the immune system, but let’s review anyway. Your immune system does a million jobs, but they all come together to accomplish two broad goals: (1) distinguish between you and not you. (2) viciously attack and kill anything that is not you. But every once in a while, things get murky, much like that time Dick Cheney accidentally shot one of his friends in a hunting accident. You know, glasses get foggy, lots of things happen all at the same time, and them bam – you mistake your friend for a quail. Or your own body for an invading microorganism. It’s not intentional, but the consequences sure are serious.
When this happens in the immune system, there are fewer late night talk show jokes and more long term repercussions. Depending on how generalized this confusion is, the immune system may attack one specific tissue or many different ones. With lupus, the confusion seems fairly general affecting a variety of body systems including joints, skin, kidneys, blood cells, the brain, heart, and lungs.
Doctors Use Steroids to Treat Lupus
When the immune system goes full Benedict Arnold like this, it can cause massive inflammation in the affected tissues. Remember in my last post how I said corticosteroids (cortisone shots) chew up cartilage and joints? And that you definitely shouldn’t get them unless your life depends on it? Well lupus happens to be one of the times you might really need steroids. Because steroids can quickly control systemic inflammation. But at what cost?
Well, those high doses of corticosteroids can lead to a condition called osteonecrosis. And if you think that sounds like dead bone, you’re absolutely correct. The steroids kick off a process that makes blood vessels retreat from bone. And then that bone basically starves and starts dying. Which is not only gross but super painful as well and can lead to joint replacement.
But what if you don’t want to be Terminator 0.0 with a titanium hip?
Bone Marrow Can Treat Osteonecrosis
Even in lupus. I’ve posted about osteonecrosis before, but I didn’t discuss a study that came out this past July. No, I’m not just lazy. Though I do sometimes binge-watch The Great British Baking Show for hours without moving from the best spot on the couch. Mary Berry is the best, y’all. But I digress. I didn’t cover this study before on account of already having waaaaaay too much information in that post. But now that we’re on the topic of lupus we can dive in.
Researchers in Japan have been treating lupus patients’ osteonecrosis with concentrated bone marrow since the early 2000s. In this study, 52 lupus patients with 92 cases of hip osteonecrosis were treated with their own concentrated bone marrow. Physicians first did a core decompression. You can learn about that procedure from this uncomfortably narrated video. I think whoever made that video wanted any watcher to feel as uncomfortable listening to it as a patient with osteonecrosis feels. And they were successful in that endeavor.
Oh no y’all, I just go to the middle of that video where the narrator enunciates “Or. A. Deceased. Donor.” And I can’t stop laughing. Please ignore that comment, and focus only on the part where they show you the decompression. Everything else in that video is marginally incorrect and seems to have been written by a robot with no experience communicating with humans.
Back to this study. After decompressing the osteonecrotic bone, the physician(s) injected concentrated bone marrow (not deceased. donor. tissue.). And then the mesenchymal and hematopoietic stem cells in that bone marrow got to work. They hoped that the concentrated bone marrow treatment would prevent these patients from needing a hip replacement.
Only 27 of 92 treated hips ended up needing a hip replacement, which the authors noted was fewer than in other reported studies. It was also higher than several of the other studies I’ve discussed, which makes sense. This study population all had lupus, and other studies would have excluded patients with lupus.
So the same type of technique used in patients without lupus also seems to work in patients with lupus, just not quite as well. Some studies have found that mesenchymal stem cells in lupus patients behave differently than those from non-lupus patients. Which may play into the reduced efficacy we see here. Either way, concentrated bone marrow does seem to improve outcomes for lupus patients with osteonecrosis.
But what about stem cells actually treating lupus, not just its side effects?
Adult Stem Cells Have Treated Lupus
Sort of. At least a couple of times anyway. Since I don’t want to write an entire encyclopedia (and you probably wouldn’t read one anyway), I’m only going to cover the most recent study today. In February of this year, researchers in China published this study in which drug-resistant lupus patients were treated with donor mesenchymal stem cells (MSCs). Their thinking in choosing MSCs from donors came down to previous studies in which using the patient’s own MSCs did not work out well. Given the fact that lupus patients’ MSCs do seem to behave oddly in some circumstances, and the objective here was immune suppression, it makes sense that they chose donor cells.
22 patients in this study were treated with MSCs from healthy donors, and the remaining 59 received MSCs from umbilical cords. All of the patients received the cells via IV infusion.
Side Note: IV Infusion Doesn’t Entirely Make Sense
I discuss this fact with physicians all. the. time. The marketing machine of pseudo regenerative medicine popularized the idea that you can mainline stem cells right into a vein and get them to the whole body efficiently. But science says otherwise. In a well-known study (and several others), researchers demonstrated that upwards of 80% of infused MSCs get stuck in the lungs. The first time they see them. So before that blood ever goes to the rest of the body, almost all of the cells accumulate in the lungs.
Which is great if you want to get cells to the lungs. But not so great if you want to send cells all over the body. Now, in a similar study, researchers saw that after a few hours those cells ended up in other places like the kidneys, liver, and spleen. So IV infusion of cells does get them into the body and into some organs, but it doesn’t necessarily distribute them evenly throughout every tissue.
Using IV infusion in an effort to sprinkle MSCs into every single tissue doesn’t make all the sense in the world, but we do lack other options. So a lot of people do it anyway. And in this lupus study, it did seem to have a positive effect.
End: IV Infusion Side Note
So after receiving an IV infusion of either donor or umbilical cord MSCs, 27% of treated patients reported complete remission at five year follow-up. In older studies using the patient’s own hematopoietic stem cell (HSC) transplant, only 21% of patients experienced complete remission. And HSC transplants carry a lot of additional risk. Scary amounts of additional risk.
The simple take home message from this study comes directly from the authors:
[donor MSC transplant] had at least comparable if not better clinical efficacy than [HSC transplant], but with fewer adverse events and significantly lower cost in treating drug-refractory active [lupus] patients
Stem Cells Are Not Clinically Available for Lupus*
Outside of a study. So even though the study above and others have gotten promising results, your local physician shouldn’t offer them at this point. The scientific community still needs to learn a few more things before broadly launching this type of treatment. This way you and your doctor can have some reassurance of safety and efficacy when the time comes. And if you do find a local practitioner offering stem cells for lupus, definitely make sure it’s through a study. A legitimate, clinical study.
*With the exception of bone marrow concentrate for osteonecrosis. That’s legit and available all over the US.
Want to join a study? Antidote matches patients to appropriate clinical trials, and Smart Patients helps you find clinical trials for your condition.
The moral of this story:
Bone marrow concentrate can treat osteonecrosis, though less effectively in lupus patients than non-lupus patients – now (currently available in the US). And donor mesenchymal stem cells may one day help treat lupus as a whole.
Not sure if your doctor is part of a study? Confused by my affinity for tangents and appalling run-on sentences? Feel free to let me know in the comments, or drop a a line directly in my inbox!
Photo by Tiago Muraro on Unsplash