Immunomodulatory effects of unselected haematopoietic stem cells autotransplantation in refractory Crohn's disease

Mario Clerici, Andrea Cassinotti, Francesco Onida, Daria Trabattoni, Claudio Annaloro, Aldo Della Volpe, Veronica Rainone, Francesca Lissoni, Piergiorgio Duca, Gianluca Sampietro, Paolo Fociani, Gianluca Vago, Diego Foschi, Sandro Ardizzone, Giorgio Lambertenghi Deliliers, Gabriele Bianchi Porro

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Autologous haematopoietic stem cells transplantation (HSCT) has been shown to be effective in refractory Crohn's disease. Aim: We analysed the effects of HSCT on the immune response of patients treated for moderate-severe Crohn's disease, refractory or intolerant to multiple drugs. Methods: Unselected peripheral blood stem cells were collected after mobilisation with cyclophosphamide (CTX) and G-CSF. The conditioning regimen included CTX and rabbit antithymocyte globulin. Blood samples for immunological analyses were collected at baseline, after mobilisation, and 3, 6 and 12months after transplantation. Immunological analyses evaluated: (1) CD4 +/CD25 high+/FoxP3 + regulatory T cells (T-regs); (2) Toll-like receptor 2-(TLR2) and TRL4-expressing monocytes (CD14 + cells); (3) IL-12, IL-10, TNF-alpha-production by mitogen-stimulated CD14 + cells and IFN-gamma production by CD4 + T cells. Immunological results were compared with healthy donors and associated with clinical and endoscopic response during 12months of follow-up. Results: Overall, T-regs increased, whilst TLR4-expressing cells, as well as TNF-alpha and IL-10, all higher than healthy donors at baseline, significantly decreased after transplantation. Full responders at T 3 had higher T-regs and lower IFN-gamma and IL12. T-regs decreased and IL12 and TLR2 increased in the only relapsed patient. Conclusions: HSCT can induce and maintain clinical and endoscopic remission in refractory Crohn's disease, which is associated with immunomodulation.

Original languageEnglish
Pages (from-to)946-952
Number of pages7
JournalDigestive and Liver Disease
Volume43
Issue number12
DOIs
Publication statusPublished - Dec 2011

Keywords

  • Crohn's disease
  • Immunomodulation
  • Refractory disease
  • Stem cells
  • Transplantation

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

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