If the graft has not taken root
Russian doctors proposed to inject stem cells into the pelvis
Injection of mesenchymal stromal cells into the iliac spine triggers hematopoiesis in those who have not been helped by a red bone marrow transplant.
Employees of the National Medical Research Center of Hematology of the Ministry of Health of the Russian Federation have found a way to start hematopoiesis in patients who were not helped by hematopoietic stem cell transplantation (HSC). They proposed to introduce multipotent mesenchymal stromal cells (MMSCs) into the spongy substance of the iliac bone in parallel with the source of HSC – donor bone marrow. This approach worked for six out of eight patients whose body rejected the first red bone marrow transplant. The scientific article was published in the journal Stem Cells International.
Transplantation of one of the types of hematopoietic tissue – red bone marrow – is sometimes necessary for patients who have their own similar tissue affected as a result of tumors. However, the material taken from donors (allograft) does not always take root. In case of rejection of the allograft, the patient's own hematopoiesis cannot be started, which is why he usually dies.
In order to increase the percentage of successful red bone marrow transplant operations, Russian doctors suggested using multipotent mesenchymal stromal cells (MMSCs). This is one of the types of stem cells from which many variants of "mature" cells can be formed – both bone, cartilage, and fat. MMSCs are also involved in the formation of hematopoietic stem cells, their main source is also red bone marrow. Multipotent mesenchymal stromal cells were previously tried to be injected intravenously in parallel with HSC to increase the likelihood of hematopoiesis restoration. However, after that, MMSCs were almost impossible to detect in the bone marrow of the recipients. This means that the effectiveness of their intravenous injections is low.
The authors of the work decided to inject MMSC directly into the red bone marrow of eight patients whose hematopoiesis did not recover within a month after HSC transplantation. MMSCs filtered from the bone marrow of donors were injected into the spongy substance in the bones of the iliac bones of the pelvis and, in parallel, HSCs were reintroduced. Both types of cells for each recipient were obtained from the same donor.
1-2, 4-5 and 9 months after the procedure, scientists took samples of red bone marrow from patients and measured the activity of HSCs and the proportion of donor MMSCs in them. By the end of the first month after the procedure, 6 out of 8 study participants had their own hematopoiesis restored, and two died from infectious complications. In the red bone marrow of the iliac bones of the survivors, scientists found an average of 9.4 percent of MMSC donors. This suggests that the introduction of such cells directly into the site of HSC formation is significantly more effective than intravenous.
However, the exact reasons why MMSC transplantation simultaneously with hematopoietic stem cells increases the likelihood of activation of hematopoiesis are unknown. They probably act as immunomodulators and thereby reduce the likelihood of rejection of donor HSCs.
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