Introduction
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract with recurrent nature of the flow. The frequency of exacerbations is approximately 20-25% at 1 year and 75% for 3 years. If the remission lasted less than 12 months, there is a 65% chance that the aggravation comes in the next 18 months. For the duration of remission for 12 months or more the likelihood of an explosion in the next 18 months is reduced to 20%.
Aims & Methods
To evaluate the influence of culture of allogeneic mesenchymal stromal cells (MSCs) of bone marrow for the duration of remission in patients with refractory CD.
Materials and Methods. The first group of patients with CD (n=30) received MSCs, the dose of prednisone was not more than 20 mg/day. The second group of patients (n=30) received standard anti-inflammatory drug therapy of 5-aminosalicylic acid (5-ASA) and glucocorticosteroids (GCS). Age of patients ranged from 19 to 49 years (Me-36 years). The disease was of moderate and high activity, length of damage - ileokolit, ileitis and colitis, the observation time ranged from 68 to 118 months. Clinical activity was assessed by the Crohn's disease activity index (CDAI). The culture of allogeneic MSCs injected drip at 2.5 million per 1 kg of body weight (0-1-26-52 weeks and twice a year).
Results
CDAI in the 1-st group was 242,6±11,7 points, in the 2-nd 240,9±12,9 points (p=0,83), CRP levels in 1-st group was 29,3±6.4 mg/l, the 2-nd - 27,8±4,8 (p=0,47). After 1 year of follow-CDAI in 1-st group was 70,0±11,0 points, in the 2-nd - 133,8±22,2 points (p<0,001), CRP levels in 1-st group was 6,36±1,5 mg/l, in the 2-nd - 12,2±2,9 (p<0,001). After 5 years - the CDAI in 1-st group - 120,0±22,3 points, in the 2-nd - 208,7±17,6 points (p<0,001), CRP levels in 1-st group - 11,3±2,6 mg/l, in the 2-nd - 15,5±2,4 (p<0,001). After 10 years - the CDAI in 1-st group - 126,0±23,8 points, in the 2-nd - 248,7±14,6 points (p<0,001), CRP levels in 1-st group was 12, 3±2,8 mg/l, in the 2-nd - 19,5±3,1 (p <0,001). In the first group of patients in remission after 1, 5 and 10 years was kept at 70%, 46.7% and 43.3%, respectively. In the second group of patients at 1, 5 and 10 year remission was maintained at 36.6%, 6.67% and 6.67%, respectively.
Conclusion
Transplantation of MSCs contributes to longer-term clinical and endoscopic remission in patients with refractory Crohn's disease compared with therapy with corticosteroids.
