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Open Access Highly Accessed Research article

Umbilical cord mesenchymal stem cell transplantation in active and refractory systemic lupus erythematosus: a multicenter clinical study

Dandan Wang1, Jing Li2, Yu Zhang3, Miaojia Zhang4, Jinyun Chen1, Xia Li1, Xiang Hu5, Shu Jiang5, Songtao Shi6 and Lingyun Sun1*

Author Affiliations

1 Department of Rheumatology and Immunology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China

2 Department of Rheumatology, the Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang 212001, China

3 Department of Rheumatology, Subei People’s Hospital of Jiangsu Province, 98 Nantong West Road, 225001 Yangzhou, China

4 Department of Rheumatology, Jiangsu Provincial People’s Hospital, 300 Guangzhou Road, 210029 Nanjing, China

5 Stem Cell Center of Jiangsu Province, Taizhou, China

6 Center for Craniofacial Molecular Biology, School of Dentistry, University of Southern California Los Angeles, Los Angeles, CA, USA

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Arthritis Research & Therapy 2014, 16:R79  doi:10.1186/ar4520

Published: 25 March 2014

Abstract

Introduction

In our present single-center pilot study, umbilical cord (UC)–derived mesenchymal stem cells (MSCs) had a good safety profile and therapeutic effect in severe and refractory systemic lupus erythematosus (SLE). The present multicenter clinical trial was undertaken to assess the safety and efficacy of allogeneic UC MSC transplantation (MSCT) in patients with active and refractory SLE.

Methods

Forty patients with active SLE were recruited from four clinical centers in China. Allogeneic UC MSCs were infused intravenously on days 0 and 7. The primary endpoints were safety profiles. The secondary endpoints included major clinical response (MCR), partial clinical response (PCR) and relapse. Clinical indices, including Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, British Isles Lupus Assessment Group (BILAG) score and renal functional indices, were also taken into account.

Results

The overall survival rate was 92.5% (37 of 40 patients). UC-MSCT was well tolerated, and no transplantation-related adverse events were observed. Thirteen and eleven patients achieved MCR (13 of 40, 32.5%) and PCR (11 of 40, 27.5%), respectively, during 12 months of follow up. Three and four patients experienced disease relapse at 9 months (12.5%) and 12 months (16.7%) of follow-up, respectively, after a prior clinical response. SLEDAI scores significantly decreased at 3, 6, 9 and 12 months follow-up. Total BILAG scores markedly decreased at 3 months and continued to decrease at subsequent follow-up visits. BILAG scores for renal, hematopoietic and cutaneous systems significantly improved. Among those patients with lupus nephritis, 24-hour proteinuria declined after transplantation, with statistically differences at 9 and 12 months. Serum creatinine and urea nitrogen decreased to the lowest level at 6 months, but these values slightly increased at 9 and 12 months in seven relapse cases. In addition, serum levels of albumin and complement 3 increased after MSCT, peaked at 6 months and then slightly declined by the 9- and 12-month follow-up examinations. Serum antinuclear antibody and anti-double-stranded DNA antibody decreased after MSCT, with statistically significant differences at 3-month follow-up examinations.

Conclusion

UC-MSCT results in satisfactory clinical response in SLE patients. However, in our present study, several patients experienced disease relapse after 6 months, indicating the necessity to repeat MSCT after 6 months.

Trial registry

ClinicalTrials.gov identifier: NCT01741857. Registered 26 September 2012.