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Crohn's Disease Forum » Treatment » Stem Cells for Crohn's Disease and other IBD


 
03-16-2013, 09:12 PM   #31
David
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That's awesome jmcbrid2! Would you be interested in sharing in detail what you've experienced? Or are you doing that elsewhere that I haven't found?
05-18-2013, 11:23 AM   #32
Mpatton81
 
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I am scheduled for a stem cell transplant in July. I am in the UK and from what I understand, I will be one of the first here to receive it. The results seem to be pretty good, so I am looking forward to it all being over and being on the road to recovery.

I'm currently on weekly Adilumimab, weekly methotrexate, asacol enema's and sulphaslazine. Been on every medication on the market so far but nothing works and my Crohns is still gradually getting worse. That's why I qualified for this treatment. I am keeping a blog on my progress and experience's.

http://mystemcelljourney.wordpress.com
05-18-2013, 12:10 PM   #33
jmcbrid2
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That's awesome jmcbrid2! Would you be interested in sharing in detail what you've experienced? Or are you doing that elsewhere that I haven't found?
It is in a different thread. Beginning to end. Every detail. Under treatments and titled stem cell journey beginning. Go to my profile and it will have a link. Also my blog has the same info at www. Lifeofacrohnie.blogspot.com
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Jenn
Crohn's Colitis

Previous meds: Asacol, Colosal, Pentasa, Imuran, Remicade, Humira, Methatrexate, Folic Acid, Iron supplements, probiotics, prednisone, cipro, flagyll, aciphex, vancomycin, lortab, compazine, rowasa, , cimzia, Percocet, phenergan, lomotil, dilaudid, zofranTPN, blood transfusion, no surgeries yet

[COLOR="DarkOrchid"]Current meds: tons of transplant and anxiety and migraine meds

Undergoing stem cell transplant
05-18-2013, 12:13 PM   #34
jmcbrid2
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Can a few of you remember show appreciation for my updates on the journey so that i can maintain monitor status and keep helping others! God bless!

Auntie em, how are you feeling lately??
06-03-2013, 03:09 PM   #35
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Hi all I'm from the UK and i have the opportunity to try this treatment but i don't know if i should or not as i have two young children and my partner thinks i could die if i try it lol i shouldn't have taken her to the consult.I do know they dont use siblings stem cells for the graphs only your own in case off rejection
09-14-2013, 06:51 PM   #36
Jison0612
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This is cool stuff hopefully one day this may be the common cure us chronies desperately need!!!! I pray to GOD it is cause I have a son and daughter and if they ever develops this I don't want them to have to live with it I want there to be a normal affective cure like this around for them!!! Praise GOD!!
09-26-2013, 02:28 PM   #37
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I just failed tysabri and am running out of options, trying to save my rectum by clearing fistula. Good chance I do stem cell transplant where they take stem cells from my abdominal wall and use it to help my fistula. Is it always an infusion? I got the impression that they place them there, maybe I just understood him wrong. And does insurance ever cover this type of stuff? or does it have to be a trial? thanks.
09-26-2013, 03:10 PM   #38
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Yeah, it's always done through an infusion. The stem cells are taken from the bone marrow, not from the intestines. They stimulate the bone marrow, and this produces excess stem cells that spill out into the blood stream. They are then collected through a vein, taken away and frozen. After either 30 days or 1 year, they transplant the stem cells back in through a vein, and the cells then make their way back home to the bone marrow through the blood stream. I've never heard of stem cells being collected any other way, or re-infused any other way. Not unless it is another new procedure they are testing out.
01-30-2014, 07:37 PM   #39
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I can't remember who published it, but there is a study out of Japan that determined that stem cells can be created out of blood cells using some type of acid. These types of stem cells have been used on mice and have shown to make improvements. They're getting ready to conduct clinic trials on humans soon. Hopefully through this discovery, stem cell therapy will become a common treatment in a few years.
01-30-2014, 09:41 PM   #40
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Stem cell study sparks new Crohn’s hope


WA Health scientists believe they are on the brink of a major breakthrough in the treatment of people with Crohn's Disease.

Their excitement follows the extraordinary results of a Royal Perth Hospital-led study that is investigating the use of adult stem cells to treat patients with the potentially debilitating gastro-intestinal condition.

Marian Sturm, principal scientist with Royal Perth Hospital's Cell and Tissue Therapies WA Unit says that although the study is still in its early stages, its initial findings are extremely encouraging with 80 per cent of participants responding positively to the treatment and more than half going into clinical remission.

The study is being led by RPH gastroenterologist, Dr Geoff Forbes.

Dr Sturm said that to date, 18 people had taken part in the phase two study. All were severe cases for whom existing therapies for Crohn's Disease had failed.

"To achieve an 80 per cent clinical response, particularly in such severe patients, is pretty amazing," Dr Sturm said.

Study participants were given the cell treatment intravenously, once a week over a period of four weeks. Each treatment consisted of mesenchymal stromal cells (MSC), obtained from the bone marrow of donors and culture-expanded in RPH's Cell and Tissue Therapies WA manufacturing unit.

Dr Sturm said MSCs were versatile cells with unique properties that made them particularly special. These included that they:
were universal donor cells, which meant that anyone's cells could be given to any other person, without the need for tissue matching
home to sites of inflammation.

In the MSC study, patients' response to the cell therapy was gauged using:
endoscopic assessment
Crohn's Disease Activity Index (CDAI) scores.

Participants in RPH's MSC study had initial CDAI scores ranging from 250 to 600, meaning they had moderate to severe activity of their disease. Following the cell treatment, 50 per cent recorded scores lower than 150 – technically putting them into remission and 47 per cent showed significant improvement on endoscopic examination. No adverse affects were noted.

A team of RPH doctors, scientists and nurses instigated the MSC study. The hospital is the lead centre of the project which is being undertaken nationally across five hospitals — RPH and Sir Charles Gairdner Hospital in Perth, The Queen Elizabeth in Adelaide, The Alfred in Melbourne, and Concord Hospital in Sydney.

Dr Forbes said that having demonstrated the new therapy's effectiveness and safety in a small number of patients, the researchers were keen to secure further money to enable progression to a phase three trial.

Crohn's Disease is a form of inflammatory bowel disease that can affect any part of the gastro-intestinal tract. About 28,000 Australians have the condition and about 800 new cases are diagnosed annually, mostly in young adults.

Crohn's Disease commonly causes abdominal pain, diarrhoea and bleeding into the bowel and treatment is usually with medications that suppress activity of the immune system. Patients who do not benefit from anti-tumour necrosis factor (anti-TNF) therapy — used when Crohn's Disease has not been controlled by lesser immune suppressing treatments — will often require surgery.

Dr Sturm revealed that MSCs were being trialled for a range of other medical applications including the treatment of patients with various other auto immune conditions, for donor organ recipients with graft rejection and for patients with graft versus host disease (GVHD), a complication of bone marrow transplantation.

Funding for the phase 2 stage of the study has come from international and national funding agencies including the Broad Medical Research Program of Los Angeles and Australian-based funding agency, Therapeutic Innovations Australia.
01-31-2014, 01:11 AM   #41
jmcbrid2
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I was dying from malnutrition and in a wheelchair because i couldn't walk from the pain. My Crohns was very severe. I had a stem cell transplant in Chicago. One year later Im now showing absolutely no signs of active Crohns!
02-24-2014, 07:15 AM   #42
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I just got back last week from getting stem cell replacement. It was beyond the most amazing thing. I don't regret it one bit!!!!
I want to go for stem cell banking. Can you tell as what things must be taken into consideration while going for the same.
03-03-2014, 06:59 AM   #43
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I want to go for stem cell banking. Can you tell as what things must be taken into consideration while going for the same.
I do know you will have to take shots to boost an increase of stem cells. This can cause some bad bone pain because the stem cells derive from your bones. But they'll give you pain meds to help. Then you'll sit for a day perfectly still Im a chair with a neck IV that drains your blood continually through a machine while it separates the stem cells and simultaneously returns the blood back in to your body. There may be other ways of doing the procedure but this is all i know. My sister harvested hers for me when i got my transplant
04-02-2014, 12:14 PM   #44
thunderfromdownunder
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....

Last edited by thunderfromdownunder; 05-29-2014 at 08:23 AM.
04-30-2014, 08:59 PM   #45
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I was reading a book called "Abundance: Why the Future is Better Than You Think" and came across just a sentence or two about a process for using stem cells for immune diseases. After googling the doctor's name I ended up at cellmedicine.com, where they describe using "allogeneic mesenchymal stem cells" harvested from human umbilical cord tissue (HUCT).

I'm pretty new at all of this, but it sounds to me like the accepted way to use stem cells (the examples of treatment done in the US) is to "reboot" a person's immune system. And that requires killing off the existing immune system?

This treatment doesn't sound like it requires that:
* Medical evaluation and blood testing (day 1)
* 2 intravenous (IV) injections of human umbilical cord tissue-derived mesenchymal stem cells (day 2)
* 1 IV injection of HUCT mesenchymal stem cells (day 3)
* 1 IV injection of HUCT mesenchymal stem cells (day 4)
* Medical consult for hormone evaluation
* 1-month supply of Stem Kine supplement (only after medical evaluation in Panama)
This doesn't sound like something I would dare try, hehe. But I figured maybe, just maybe, someone here had heard of someone more desparate than I that researched this, or something like it.
05-13-2014, 12:48 PM   #46
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Study participants were given the cell treatment intravenously, once a week over a period of four weeks. Each treatment consisted of mesenchymal stromal cells (MSC), obtained from the bone marrow of donors and culture-expanded in RPH's Cell and Tissue Therapies WA manufacturing unit.
Both this, and the HUCT treatment I mention above, both use MSC. The cells are derived from different sources, but are supposed to home-in on inflamation. One may conclude that the positive results from the formal study might transfer to the HUCT treatment you can buy today. I bet it's really expensive, though.

Neither of these require the patient to kill-off existing immune functionality before proceeding. That just seems extreme to me. But adding stem cells to the blood and letting them find their way to the problem...that sounds awesome...if it really works!
05-28-2014, 12:15 PM   #47
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Hi Mpatton81 any updates on how your stem cell transplant went did it put you in remission ?
06-03-2014, 10:56 PM   #48
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Is anyone aware of stem cells from cord blood being used instead of from bone marrow?

06-05-2014, 10:43 AM   #49
7vNH
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Is anyone aware of stem cells from cord blood being used instead of from bone marrow?
Yeah, that post I made a while back that referenced cellmedicine.com. It sounds like if you have the money, you can go down to Panama and have the treatment.
07-02-2014, 10:30 AM   #50
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A Phase 1 Study of Autologous Mesenchymal Stromal Cell Coated Fistula Plug in Patients With Fistulizing Crohn s Disease.
http://www.mayo.edu/research/clinica...s/cts-20003314
07-16-2014, 01:45 PM   #51
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Hello,
Very good information you can find on the website of ddr. heinrich from vienna.
He is spezialiced on stem cell therapies.
He has several videos and interviews on youtube where he explains this kind of treatments.
Regards
01-22-2015, 06:37 PM   #52
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At my visit with my GI yesterday at UCLA I asked her about Prochymal and she said I would be a candidate!
I said what 2-3 years away at least right?
She said its now "open label"! She floored me with that remark! But I don't qualify yet as I haven't officially failed everything
I am now on ENTYVIO and MTX and steroid taper now at 20 mg pred 3mg budesonide but feeling pretty good
Nice to know there are options if entyvio fails.
BTW for all the pediatric Crohnies this might be a godsend as it is already approved for pediatric gvhd in Canada and probably soon in the U S. I know many have been struggling and going through treatment options fast. Kids seem to suffer the most and the longest. Hopefully this can help many of you!
Open label means no placebo and you can get it if you fail everything then they will give it to you. That's how I got my first Remicade infusions 15 years ago
Also must mean phase 3trials went well.
Anyone desperate should inquire through their GI if he/she is associated with a major research hospital and works closely with the pharma cos. otherwise go directly to one
My doc is Chritina Ha I highly recommend her she is the CROHNS expert at UCLA but she is strictly mainstream medicine. I do my alternative stuff on my own.
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DX. Crohns 50 yrs. with fistulas for 20 years until remicade
Meds: MTX,ENTYVIO 9/14' augmentin,
pred. 10mg.
probiotics
d3, calcium, k2' magnesium, resveratrol,
Turmeric,paleo, bone broths
Past: humira no response after 6 mos., remicade amazing for 10 years then stopped working.
Entocort
6mp, Imuran never helped nasty side effects liver problems, caught pneumonia
Asacol, rowasa no response
Flagyl worked well but got PN cipro same.
01-22-2015, 11:34 PM   #53
Jennifer
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Thanks for the information Robrich. I also see Christina Ha and like her a lot.
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Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
02-09-2015, 12:21 AM   #54
24601
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Anyone currently having or pursuing a stem cell transplant for Crohn's?
05-11-2015, 04:58 PM   #55
Robrich
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I am talking with the mayo clinic about participating in their autologous SC fistula plug trial
CROHNS 2357 referenced it in an earlier post
Thanks
https://clinicaltrials.gov/ct2/show/...disease&rank=5
They take the cells from your fat tissue and grow it for 2weeks then coat the fistula Plug with it so it goes directly into the fistula track.
Anyone else look into or have any insight?
Only 10 participants so far. Results are very good.
05-11-2015, 05:06 PM   #56
David
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Thanks for sharing Robrich. I hope everything goes well with the trial! Let us know if you get in.
05-12-2015, 02:52 AM   #57
Crohn2357
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Results are very good.
Indeed. I have an opportunity to participate an autologus mesenchymal stem cell trial for crohn's, so I have made some research about the treatment, procedure and its effectiveness on crohn's disease. It seems very efficient for crohn's fistulas(they inject the cells directly to the fistulas) but not very efficient for crohn's disease in general (inflammation). For crohn's disease they give the cells intravenously. The procedure has not matured for crohn's disease yet but it seems very safe.

I have downloaded some materials on Autologus MSC for crohn's. Here some copy paste:

Autologous bone marrow-derived mesenchymal stromal cell treatment for refractory luminal Crohn's disease: results of a phase I study.
Duijvestein M1, Vos AC, Roelofs H, Wildenberg ME, Wendrich BB, Verspaget HW, Kooy-Winkelaar EM, Koning F, Zwaginga JJ, Fidder HH, Verhaar AP, Fibbe WE, van den Brink GR, Hommes DW.
Author information
Abstract
BACKGROUND AND AIM:
Mesenchymal stromal cells (MSCs) are pluripotent cells that have immunosuppressive effects both in vitro and in experimental colitis. Promising results of MSC therapy have been obtained in patients with severe graft versus host disease of the gut. Our objective was to determine the safety and feasibility of autologous bone marrow derived MSC therapy in patients with refractory Crohn's disease.
PATIENTS AND INTERVENTION:
10 adult patients with refractory Crohn's disease (eight females and two males) underwent bone marrow aspiration under local anaesthesia. Bone marrow MSCs were isolated and expanded ex vivo. MSCs were tested for phenotype and functionality in vitro. 9 patients received two doses of 1-2×10(6) cells/kg body weight, intravenously, 7 days apart. During follow-up, possible side effects and changes in patients' Crohn's disease activity index (CDAI) scores were monitored. Colonoscopies were performed at weeks 0 and 6, and mucosal inflammation was assessed by using the Crohn's disease endoscopic index of severity.
RESULTS:
MSCs isolated from patients with Crohn's disease showed similar morphology, phenotype and growth potential compared to MSCs from healthy donors. Importantly, immunomodulatory capacity was intact, as Crohn's disease MSCs significantly reduced peripheral blood mononuclear cell proliferation in vitro. MSC infusion was without side effects, besides a mild allergic reaction probably due to the cryopreservant DMSO in one patient. Baseline median CDAI was 326 (224-378). Three patients showed clinical response (CDAI decrease ≥70 from baseline) 6 weeks post-treatment; conversely three patients required surgery due to disease worsening.
CONCLUSIONS:
Administration of autologous bone marrow derived MSCs appears safe and feasible in the treatment of refractory Crohn's disease. No serious adverse events were detected during bone marrow harvesting and administration.

[Use of allogeneic mesenchymal stem cells in the treatment of intestinal inflammatory diseases].
[Article in Russian]
Lazebnik LB, Konopliannikov AG, Kniazev OV, Parfenov AI, Tsaregorodtseva TM, Ruchkina IN, Khomeriki SG, Rogozina VA, Konopliannikova OA.
Abstract
AIM:
to determine the whether mesenchymal stem cells (MSC) may be used in the treatment of patients with chrOnic intestinal inflammatory diseases (IID).
SUBJECTS AND METHODS:
Thirty-nine patients with ulcerative colitis (UC) (Group 1) and 11 with Crohn's disease (CD) (Group 2) were examined. Comparative groups included 30 patients with UC (Group 2) and 10 with CD (Group 4). Two-three days before MSC administration, immunodepressants were discontinued, the dosage of corticosteroids was reduced to 15-20 mg/day, and that of aminosalicylates remained to be 2 g/day. The results were quantified using the mean values of the Rachmilewich clinical activity index, the Crohn's disease activity index and the Mayo and Gebs scales. The patients were followed up for 4-8 months. Humoral immunological indices (cytokines, autologous antibodies) were determined. Bone marrow cells were obtained from the donor sternum or iliac crest. Cultivation at the end of weeks 5-6 provided a population of allogeneic donor MSC in a quantity of (1.5-2) x 10(8) tells required for transplantation to a patient. MSC cultures were once injected intravenously in a dropwise fashion.
RESULTS:
A statistically significant decrease in the indices of the clinical and morphological activities of an inflammatory process was noted in 39 patients with UC and in 11 patients with CD as compared with the comporison groups after MSC transplantation. Clinicomorphological remission occurred in 40 patients. Inclusion of MSC into the treatment program was ineffective in 8 patients with UC and in 2 patients with CD. The use of MSC made it possible to discontinue corticosteroids in 34 of the 50 patients with the hormone-dependent and hormone-resistant forms of UC and CD and to reduce the dose of prednisolone to 5 mg/day in 7 patients, by administering 5-aminosalicylic acid only.
CONCLUSION:
The use of MSC may be appreciated as a new strategic direction of therapy for IID. The intravenously administered stem cells exert a potent immunomodulatory effect, reduce the activity of autoimmune inflammation, and stimulate a reparative process in the intestinal mucosa.

Negative impact of bone-marrow-derived mesenchymal stem cells on dextran sulfate sodium-induced colitis.
Nam YS1, Kim N1, Im KI1, Lim JY1, Lee ES1, Cho SG1.
Author information
Abstract
AIM:
To investigate the effects of mesenchymal stem cells (MSCs) on dextran sulfate sodium-induced inflammatory bowel disease (IBD).
METHODS:
C57BL/6 mice were fed 3.5% (g/L) dextran sulfate sodium. On day seven, the mice received intraperitoneal injections of 1 × 10(6) MSCs. The survival rate, disease activity index values, and body weight, were monitored daily. On day ten, colon lengths and histopathologic changes were assessed. In addition, immunoregulatory changes following MSC administration were evaluated by determining the levels of effector T cell responses in the spleen and mesenteric lymph nodes, and the expression levels of inflammatory cytokines in homogenized colons.
RESULTS:
Intraperitoneal administration of MSCs did not prevent development of colitis and did not reduce the clinicopathologic severity of IBD. No significant difference was evident in either survival rate or disease activity index score between the control and MSC-treated group. Day ten-sacrificed mice exhibited no significant difference in either colon length or histopathologic findings. Indeed, the MSC-treated group exhibited elevated levels of interleukin (IL)-6 and transforming growth factor-β, and a reduced level of IL-10, in spleens, mesenteric lymph nodes, and homogenized colons. The IL-17 level was lower in the mesenteric lymph nodes of the MSC-treated group (P = 0.0126). In homogenized colons, the IL-17 and tumor necrosis factor-α (P = 0.0092) expression levels were also lower in the treated group.
CONCLUSION:
MSC infusion provided no significant histopathologic or clinical improvement, thus representing a limited therapeutic approach for IBD. Functional enhancement of MSCs is needed in further study.

A phase I clinical trial of the treatment of Crohn's fistula by adipose mesenchymal stem cell transplantation.
García-Olmo D1, García-Arranz M, Herreros D, Pascual I, Peiro C, Rodríguez-Montes JA.
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Abstract
PURPOSE:
The effective management of fistulas in patients with Crohn's disease presents an extremely challenging problem. Mesenchymal adult stem cells extracted from certain tissues, such as adipose tissue, can differentiate into various cell types. Therefore, we have tried to use such cells to stimulate healing of Crohn's fistulas.
METHODS:
We designed a prospective Phase I clinical trial, involving five patients with Crohn's disease, to test the feasibility and safety of autologous stem cells transplantation in the treatment of fistulas. We also studied the expression of various cell markers and the growth rates of the lipoaspirate-derived cells that were used for transplantation.
RESULTS:
One patient was excluded because of bacterial contamination of cultured cells. We inoculated nine fistulas in four patients with autologous adipose tissue-derived stem cells at Passage 3 or earlier. Eight inoculated fistulas were followed weekly for at least eight weeks. In six fistulas, the external opening was covered with epithelium at the end of Week 8, and, thus, these fistulas were considered healed (75 percent). In the other two fistulas, there was only incomplete closure of the external opening, with a decrease in output flow (not healed; 25 percent). No adverse effects were observed in any patient at the end of the follow-up period (minimum follow-up,12 months; maximum follow-up, 30 months; follow-up average, 22 months).
CONCLUSIONS:
To our knowledge, this is the first report of a clinical trial of cell therapy using autologous stem cells obtained from a lipoaspirate. Our results indicate that our protocol is feasible and safe for the treatment of fistulas in Crohn's disease. The number of patients included and the uncontrolled nature of Phase I clinical trials do not allow demonstration of the effectiveness of the treatment. However, the results of the present study encourage to perform further studies in Phase II.

----------------------------------------------




For free full text articles, search these on google:

>>>Mesenchymal stem cells: a new trend for cell therapy
Xin WEI1, Xue YANG2, Zhi-peng HAN3, Fang-fang QU3, Li SHAO1 , *, Yu-fang SHI2, *
Acta Pharmacologica Sinica (2013) 34: 747–754
© 2013 CPS and SIMM All rights reserved 1671-4083/13 $32.00
www.nature.com/aps

>>>Successful Outpatient Treatment of Refractory Crohn’s Disease Using Adult Mesenchymal Stem Cells -------- (prochymal trial results, you can find this on their website.)
Data was presented at the October 2006 American College of Gastroenterology conference
Jane Onken, MD; Dianne Gallup, MS; John Hanson, MD; Michael Pandak, MD; Linda Custer, PhD*, Duke Clinical Research Institute, Durham NC and *Osiris Therapeutics, Baltimore MD

>>>Biol Res 45: 269-277, 2012
* Corresponding author: Fernando E. Figueroa, MD. Laboratorio de Inmunología Celular y Molecular, Facultad de Medicina Universidad de los Andes, Av. San Carlos de Apoquindo 2200,
Las Condes. Santiago, Chile. Postal Code: 7620001. Tel: (56)-2-4129455. E-mail address: ffi [email protected] (F. Figueroa)
Received: Abril 5, 2012 . In Revised form: July 21, 2012. Accepted: September 3, 2012
Mesenchymal Stem Cell treatment for autoimmune diseases: a
critical review

Fernando E. Figueroa1,3,*, Flavio Carrión1, Sandra Villanueva2, Maroun Khoury3.

>>>Role of mesenchymal stem cell therapy in Crohn’s disease
Jignesh Dalal1, Kimberly Gandy1 and Jos Domen1
05-12-2015, 08:10 AM   #58
David
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Crohn2357, do you think you'll be taking part in the trial?
05-12-2015, 11:15 AM   #59
Crohn2357
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I don't think I will. They give you 2 infusions (2 weeks after first infusion you get the second infusion) and they expect you to get better (the primary endpoint is remission or at least a dramatic reduction of disease activity) either permanently or for a long time. From what I've read, it is most probably not going to happen. Participation isn't worth the effort for me. Even if you get better for some time and require new infusions, you can't get them. As I said, the procedure of MSC for crohn's is very immature right now and they are trying to improve it with these trials. I guess there are very similar trials in Spain and (not sure, could be wrong) in other south European countries.
Although it seems quite safe, I would like to trust the mechanism and effectiveness before being a guinea pig. I'm not too desperate to try this.

Last edited by Crohn2357; 05-12-2015 at 11:34 AM.
05-12-2015, 01:27 PM   #60
David
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I think that is a point of frustration for some potential participants in many trials. Even if you show improvement they can't keep giving you the drug in many cases, even if you relapse. I know that would make me think twice as well
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