Stem cells are filled with possibility. These “building block” cells divide to make other types of cells, including blood, brain, and heart cells. When coaxed the right way in a lab, they can divide into specific cells to fix or replace ones that disease has damaged.
Doctors already use stem cell therapy – also called bone marrow transplants – to treat blood cancers like leukemia and lymphoma. Now they're studying stem cells as a possible treatment for autoimmune conditions like Crohn's disease.
Why Use Stem Cells to Treat Crohn's Disease?
Crohn's disease is a type of inflammatory bowel disease (IBD). It's an autoimmune disease, which means your immune system turns against your own body. In Crohn's disease, your immune system attacks your intestines, causing swelling and symptoms like belly pain and diarrhea.
Current Crohn's disease treatments like steroids and biologic drugs suppress your immune system to bring down inflammation in your GI tract, but they don't always work.
About 1 in 4 people with Crohn's disease don't get better with medication. Another 50% stop responding to medicines that once worked for them.
If medicine doesn't help you, surgery to remove the damaged part of your intestine might be the only way to relieve your symptoms.
Doctors have been looking for new ways to stop the immune system attack and help the intestines heal. Stem cells are a promising option because they divide to form new, healthy cells.
Stem cells might work against Crohn's disease for a couple of reasons. Some stem cells release chemicals that ease inflammation and repair the lining of the intestine that Crohn's disease damages. Others "reset" the immune system by making new, healthy white blood cells that won't attack the intestines the way your old cells do.
What Types of Stem Cells Can Treat Crohn’s?
Crohn’s disease studies have used two types of stem cells:
- Hematopoietic stem cells (HSCs) divide into all types of blood cells, including the white blood cells of the immune system.
- Mesenchymal stem cells (MSCs) divide into many types of cells, including bone, fat, connective tissue, and blood vessels.
The cells used to treat Crohn's disease can come from either your own body or from an adult donor.
How Do You Receive Stem Cells?
Stem cells can be delivered in a couple of ways. A shot sends these cells straight to the area where they're needed. A stem cell transplant wipes out your faulty immune cells and replaces them with healthy stem cells.
Before a stem cell transplant, you'll have chemotherapy to kill off the damaged stem cells in your bone marrow. Afterward, you'll get an IV of healthy stem cells.
Those healthy cells will travel to your bone marrow and make new stem cells. The hope is that the healthy stem cells will reset your immune system and stop it from attacking your intestines.
How Well Does Stem Cell Therapy Work?
That's hard to say. Most stem cell treatments for Crohn's disease are still experimental. This therapy hasn't been studied in enough people to prove that it works, but there’s reason to be hopeful.
In studies done so far, stem cell therapy eased inflammation, helped the intestines heal, and improved quality of life in people with Crohn's disease.
One review looked at 18 studies that included 360 people with Crohn's disease. People who received stem cell therapy had less active disease than those who didn't get this treatment. Over 70% of people who got stem cell therapy were in remission – meaning they had no signs of the disease – 3 months later. More than half were still in remission 1 to 2 years after their treatment. Some people said their quality of life improved after the stem cell treatment.
In the studies, HSCs worked better against Crohn's disease than MSCs. Stem cells that were taken from a person's own body helped more than cells from a donor.
Stem Cell Therapy for Crohn's Complications
The evidence is stronger about the benefits of stem cell therapy for Crohn's disease complications.
About 20% of people with Crohn's disease get an abnormal tunnel between their intestines and their anus, called a perianal fistula. This can be very painful. It causes some people to lose control of their bowel movements.
Very few treatments help with perianal fistulas. Up to 90% of people who have this complication need surgery to fix it.
Stem cell therapy could offer a less invasive way to treat perianal fistulas. A few studies have shown that stem cells taken from fat tissue help close and heal fistulas.
Darvadstrocel (Alofisel) is a stem cell treatment that has been fast-tracked by the FDA. Alofisel treats adults with complex perianal fistulas that haven't improved with other treatments. The FDA considers Alofisel a regenerative medicine advanced therapy (RMAT). This means it may help, but it may not be available at every medical center or covered by insurance.
You get this treatment as an outpatient procedure, which means you go home on the same day. The doctor injects stem cells taken from the fat tissue of a donor into the fistula.
Researchers are also studying stem cell injections as a treatment for strictures – narrowed areas of the intestines that affect some people with Crohn's disease. So far, trials have only tested this treatment on a few people.
Possible Complications of Stem Cell Therapy for Crohn’s
The most common side effects from Alofisel are swollen pockets of pus, called abscesses, and pain in the rectum.
A stem cell transplant comes with some risks. Some side effects are mild, like a headache and fever. Others are more serious. The chemo you get to kill your own stem cells wipes out your immune system, which leaves you more likely to get infections.
Your body might recognize the new cells as foreign and attack them. This is called graft-versus-host disease, and it can be life-threatening.
A stem cell transplant may not be worth the risks unless your Crohn's disease is very severe.
What’s the Outlook for Stem Cell Therapy and Crohn’s?
Stem cell therapy may be a breakthrough in the treatment of Crohn's disease, but it still has a long way to go before it can become an approved treatment. We need more high-quality studies with larger numbers of people to prove that it works and it's safe.
Doctors still have a few things to learn about stem cell therapy for Crohn's disease, including:
- Which type of stem cells work best
- How many cells to use
- How to deliver the stem cells
- How often to give this treatment
Because stem cell transplants for Crohn's disease are still experimental, the only place to get this treatment is in a clinical trial. If you're interested in joining one of these studies, ask the doctor who treats your Crohn's disease if a clinical trial might be right for you.
