Chronic skin inflammatory diseases, including atopic dermatitis (AD) and psoriasis, are considered uncontrolled responses to systemic inflammation.
Characterized by swelling, irritation, and rash chronic skin inflammatory disease, these common skin inflammatory diseases are estimated to affect 25% of the population, with AD and psoriasis being the most common form of the disease.
Recent methods used to treat AD and psoriasis have been based on inhibition, not regulation, of the condition. Over time, these methods of treatment can result in a number of side effects and drug resistance.
Considering that mesenchymal stem cells (MSCs) have been used to treat a number of immune diseases, Yang et al. believe they present as a promising treatment for chronic skin inflammatory disease. As part of this review, the authors discuss the therapeutic effects of MSCs on AD and psoriasis, provide clinical evaluation of the administration of MSCs, and present a comprehensive vision for the application of MSCs in future research and treatment.
AD and psoriasis are known to be systemic and immune-allergic inflammatory skin diseases caused primarily by the imbalance between pro- and anti-inflammatory factors. MSCs play a role in regeneration and immunomodulation and their function in skin lesions present in these conditions could provide important information about their biological function in the diseases.
Considering that inflammation related to both AD and psoriasis begins at the MSC level, a treatment designed to address abnormal MSCs can potentially improve the pathogenesis of these diseases. While this method appears promising, the authors point out that the therapeutic methods designed to treat lesions associated with MSCs have yet to be determined and treating skin inflammatory disease with these improved MSCs requires further clinical study.
The authors also highlight the potential benefit of preconditioning MCSs as a way to improve the immune regulation capacity in treating a range of immune diseases. Specifically, precondition MSCs have been shown to alleviate allergic inflammation in keratinocytes and reduce inflammation in the skin through the JAK-STAT pathway.
While the benefits associated with preconditioning MSCs for this purpose require further research, Yang et al. believe that preconditioning MSCs with inflammatory factors can more effectively treat skin inflammatory diseases.
In addition to showing the benefits of MSC therapy when treating AD and psoriasis, the authors of this review also point out some limitations associated with the application of MSCs. These limitations include the need for double-blind placebo-controlled studies to indicate the potential clinical application of MSCs in AD and psoriasis and issues with the production and cost of MSCs not being able to reach the standard (making it difficult to translate into clinical treatment).
Despite these limitations, the application of MSCs has shown to be more effective in treating AD and psoriasis than other options that are currently available.
Yang et al. conclude that the advancing technology for administering MSCs and their capability of regeneration, immunomodulation, and differentiation have made them a promising strategy for the treatment of skin inflammatory diseases. The authors also call for additional studies to further uncover the mechanisms of the therapeutic effects of MSCs in AD and psoriasis to help better define therapeutic strategies for treating these diseases.
Source: Yang J, Xiao M, Ma K, Li H, Ran M, Yang S, Yang Y, Fu X and Yang S (2023) Therapeutic effects of mesenchymal stem cells and their derivatives in common skin inflammatory diseases: Atopic dermatitis and psoriasis. Front. Immunol. 14:1092668. doi: 10.3389/fimmu.2023.1092668
Characterized by scaly white or erythematous plaques, psoriasis is a chronic autoimmune dermatological disease most often appearing on the scalp, genitalia, lumbosacral area, and extensor surfaces of the limbs.
Affecting an estimated 125 million people worldwide, the condition most commonly is observed in those between the ages of 15 and 25 years of age.
The most recent advancements in the development of biological treatment have revolutionized the treatment of the condition for those with moderate to severe psoriasis, achieving clear or nearly clear skin with long-term success.
However, these treatments in their current form have not been proven to cure psoriasis completely. Additionally, a growing number of those suffering from severe psoriasis are not responding to these current therapeutic treatment options.
Recently, stem cell therapy, including regulatory T-cells, hematopoietic stem cell transplantation, and mesenchymal stromal cells (MSCs) have been used in patients with recalcitrant psoriasis. In this review, Naik discusses stem cell treatment options available for psoriasis.
Regulatory T-cells, or Tregs, regulate or suppress other immunocytes by modulating their responses to the endogenous environment and antigens, which helps to avoid autoimmune reactions and chronic inflammation. Several treatments for psoriasis, including many biologics currently being used, appear to increase the number of Tregs and their performance in patients with psoriasis. This finding led Naik to conclude that, despite their high cost, Treg-based therapies may have the ability to interfere with the pathogenesis of psoriasis.
MSCs have been found to have a significant role in adaptive immunity. This immune-enhancing activity typically occurs in partnership with a number of immune cells, including neutrophils, dendritic cells, monocytes, natural killer cells, macrophages, B-cells, and T-cells. While several Phase I and II studies have not demonstrated significant toxicity, the author calls for more extensive controlled trials to better understand the efficacy and long-term safety of MSCs in this application.
The favorable results observed when using hematopoietic stem cells (HSCT) in a wide range of autoimmune conditions, including lymphoma, leukemia, lupus, diabetes, rheumatoid arthritis, and multiple sclerosis, led to interest in using these cells in patients with psoriasis. Interestingly, improvements in psoriasis have been observed in patients who have undergone allogeneic (rather than autologous) HSCT, suggesting that hematopoietic stem cells could contribute as a primary cause of psoriasis.
Naik concludes that the application of stem cells in the treatment of psoriasis raises hope for the development of a safe and effective therapy for those suffering from severe forms of the condition. While more data is required before clinical application, MSCs could be a promising therapy for the treatment of psoriasis.
Source: Naik PP. Stem cell therapy as a potential treatment option for psoriasis. An Bras Dermatol. 2022;97(4):471-477. doi:10.1016/j.abd.2021.10.002
Psoriasis is a chronic autoimmune disease that affects more than 7 million people in the United States. Psoriasis is well known to cause red, scaly plaques on the skin, mostly on the elbows, hands, and feet—so-called plaque psoriasis. The condition can be very difficult to treat and the treatments can be harsh and cause many side effects. Most people with moderate to severe plaque psoriasis experience considerable suffering as a result.
In a recent clinical experiment, researchers used a man’s own stem cells to successfully treat his plaque psoriasis. Surgeons removed a small amount of fat, similar to liposuction but on a much smaller scale. They then purified the sample and reinjected the adipose-derived stem cells and mesenchymal stem cells intravascularly. One month after receiving the adipose stem cell injection, the patient had substantially fewer psoriasis symptoms. Over that month, his psoriasis severity score went from a “very severe” score of 50.3 to a “none to mild” score of 0.3.
The patient in this study had struggled with psoriasis for over 20 years prior to treatment. He also reported having a poor quality of life over that time. One year after the single injection of stem cells, the patient still had no psoriasis plaques or symptoms and did not experience any serious adverse effects from the stem cell treatment. He was able to stop his other psoriasis medications. During and at the end of the study, the patient told researchers that his quality of life had substantially improved with stem cell infusion, and he was eager to continue treatments.
The results of this clinical experiment are very impressive and is an exciting development for further studies on adipose-derived stem cell research and treatment.
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