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A clinical case study of IPF following SC transpla

09/03/23

Pulmonary fibrosis is an interstitial pulmonary fibrosis lung disease characterized by decreased lung function and respiratory failure, and is the ultimate result of many lung diseases. For example, acute respiratory distress syndrome, idiopathic pulmonary fibrosis, pneumoconiosis, etc.. The patient's condition is severe, mortality is high, and there is still a lack of effective intervention.

干细胞移植肺纤维化的临床研究案例

Pulmonary fibrosis is characterized by alveolar epithelial cell damage and activation, interstitial inflammation, fibroblast proliferation, extracellular matrix collagen deposition, and autoimmune abnormalities. Therefore, the key link to effectively control the progression of pulmonary interstitial fibrosis is to regulate abnormal autoimmune inflammation, which will target the abnormal cells to proliferate the fibroblasts and induce functional lung epithelial cell repair.

Studies have found that mesenchymal stem cells (MSCs) can inhibit the occurrence of inflammation in patients, promote the repair of epithelial tissues, and inhibit the abnormal proliferation of fibroblasts. These findings are expected to bring new ideas for the regulation of pulmonary fibrosis.

As a new type of biomedical technology, MSCS have been applied to clinical intervention of various diseases and achieved good results.

Mechanisms of action of stem cell transplantation

1. Homing function: According to literature reports, exogenous MSCS have strong migration ability. When alveolar epithelial cells are present and damaged.Stem cell can locate in the damaged lung tissue, exhibit the shape of epithelioid cells, and reduce inflammatory response and fibrotic lesions.

2. A large number of studies have shown that MSCs can secrete a variety of bioactive factors.

① anti-inflammatory factors, such as tumor necrosis factor, induced protein 6(TSG-6), prostaglandin E2(PGE2), interleukin-10 (IL-10), interleukin-1 receptor antagonist (IL-1ra), soluble tumor necrosis factor receptor-1 (STNFR1), etc., thus inhibiting the inflammatory response;

② Growth factors such as angiopoietin-1 and antimicrobial peptides (Ang-1), hepatocyte growth factor (HGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF), etc., to improve the response of endothelial or epithelial cells to injury.

③ High concentration of nitric oxide (NO)2, 3-dioxygenase (IDO) aggregates peripheral immune cells, inhibits T cell proliferation, and regulates immune response.

Clinical Application Cases

1. In 2017, 9 patients received stem cell therapy, all with mild-to-moderate pulmonary fibrosis. The investigators transplanted the same allogeneic MSCS into the patients. 9 patients were divided into three groups with different MSCS concentrations in each group. After 15 months of follow-up, it was found that the lung index decreased significantly, and the patient had no adverse reactions. The findings were published in the prestigious journal Chest.

2. In 2019, the Journal of Stem Cell Translational Medicine reported that 20 patients participated in stem cell therapy, 10 people in a group, and the two groups were compared, one group was infused with MSCS, and the other group was infused with placebo. One group was found to effectively alleviate pulmonary fibrosis, and the other group had no significant change. There were no adverse effects in either group, suggesting that stem cell therapy is effective in treating pulmonary fibrosis.

3. A foreign university research team performed MSCS transplantation on 8 patients, all of whom were moderate IPF patients. These donated MSCS placentas were obtained from healthy individuals unrelated to the patient and were transplanted at a dose of 1*106 or 2*106/kg. Within 6 months of follow-up, the patient's lung indexes improved, and both doses of stem cells were well tolerated by the patient without side effects.

In conclusion, pulmonary fibrosis after stem cell transplantation has no obvious adverse reactions and can significantly improve the clinical symptoms of patients. Numerous animal experiments, clinical cases, and experiences with MSC modulating other diseases give clinicians and patients confidence in MSC intervention in pulmonary fibrosis.