Editorial

Teamwork Makes the Dream Work: IBD Stem Cell Therapy Needs Us All

The narrative surrounding the development of stem cell therapy for the treatment of inflammatory bowel disease was best said by Amy Lightner, MD, when she noted that we as gastroenterologists and colorectal surgeons are still in the early phases of navigating this therapy.

Although the data are promising, it may take a long time for this to become a common therapy for patients with IBD.

However, the most obvious use of stem cells in IBD seems to be within the fistulizing population with Crohn’s disease. There’s a pressing need in fistulizing Crohn’s disease because patients may likely not respond completely to medical therapy, especially if it’s a long-standing fistula. That’s where stem cells may be a useful adjunctive therapy. The stem cells can either be directly injected at the time of an exam under anesthesia, such as the TiGenix trials, or with a stem-cell coated fistula plug.

Being a Part of it

Edward V. Loftus Jr.
Edward V.
Loftus Jr.

William A. Faubion Jr., MD, is a colleague of mine. I had one of my patients enter the phase 1 trial he was a part of that was published in Gastroenterology and that patient clearly improved in the trial. I have seen firsthand how this therapy can be effective.

In fact, we at the Mayo Clinic are going to be involved in an upcoming TiGenix trial that was just activated and I’m looking forward to referring patients to see how it holds up.

Possible Hurdles

I agree with Lightner and Faubion that a collaborative, multidisciplinary team is necessary for the success of stem cell therapy in IBD. Which is why this may be an effort that stays at specialized centers until we work out all the details. Tertiary centers likely have the sufficient expertise that is needed across multiple areas for it to work.

Lightner highlighted that the stem cells are fragile and need to be handled properly, as well as frozen or thawed properly, which likely will take them out of community-based care locations.

Additionally, as Lightner noted, too many people believe that stem cell therapy is this “magic bullet” where we can place stem cells anywhere and it will just do what it’s supposed to do.

But that’s not the case. In fact, some early stem cell studies involved patients with Crohn’s receiving stem cells intravenously under the belief that “oh, we’ll just infuse stem cells and see what happens.” Well, those were negative studies that did not pass muster.

That’s why I think applying stem cells to niche areas like fistulas is a good way to start.

High-risk, High Reward

The whole other part to this narrative is what James Lindsay, PhD, FRCP, is working on.

Lindsay is working with stem cell transplantation, which is a different animal, considering that they’re trying to reset the entire immune system.

I view this as almost high-risk, high-reward because it’s similar to a bone marrow transplant, which on one hand involves inherent risks, but on the other hand it may offer patients a way to achieve remission with possibly fewer medications, or no medications at all.

– Edward V. Loftus Jr., MD

Chief Medical Editor

Healio Gastroenterology and Liver Disease

Disclosure: Loftus reports consulting for AbbVie, Allergan, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Gilead, Janssen, Pfizer, Takeda and UCB Pharma; and research support from AbbVie, Amgen, Celgene, Genentech, Gilead, Janssen, MedImmune, Pfizer, Robarts Clinical Trials, Seres Therapeutics, Takeda, and UCB Pharma.

The narrative surrounding the development of stem cell therapy for the treatment of inflammatory bowel disease was best said by Amy Lightner, MD, when she noted that we as gastroenterologists and colorectal surgeons are still in the early phases of navigating this therapy.

Although the data are promising, it may take a long time for this to become a common therapy for patients with IBD.

However, the most obvious use of stem cells in IBD seems to be within the fistulizing population with Crohn’s disease. There’s a pressing need in fistulizing Crohn’s disease because patients may likely not respond completely to medical therapy, especially if it’s a long-standing fistula. That’s where stem cells may be a useful adjunctive therapy. The stem cells can either be directly injected at the time of an exam under anesthesia, such as the TiGenix trials, or with a stem-cell coated fistula plug.

Being a Part of it

Edward V. Loftus Jr.
Edward V.
Loftus Jr.

William A. Faubion Jr., MD, is a colleague of mine. I had one of my patients enter the phase 1 trial he was a part of that was published in Gastroenterology and that patient clearly improved in the trial. I have seen firsthand how this therapy can be effective.

In fact, we at the Mayo Clinic are going to be involved in an upcoming TiGenix trial that was just activated and I’m looking forward to referring patients to see how it holds up.

Possible Hurdles

I agree with Lightner and Faubion that a collaborative, multidisciplinary team is necessary for the success of stem cell therapy in IBD. Which is why this may be an effort that stays at specialized centers until we work out all the details. Tertiary centers likely have the sufficient expertise that is needed across multiple areas for it to work.

Lightner highlighted that the stem cells are fragile and need to be handled properly, as well as frozen or thawed properly, which likely will take them out of community-based care locations.

PAGE BREAK

Additionally, as Lightner noted, too many people believe that stem cell therapy is this “magic bullet” where we can place stem cells anywhere and it will just do what it’s supposed to do.

But that’s not the case. In fact, some early stem cell studies involved patients with Crohn’s receiving stem cells intravenously under the belief that “oh, we’ll just infuse stem cells and see what happens.” Well, those were negative studies that did not pass muster.

That’s why I think applying stem cells to niche areas like fistulas is a good way to start.

High-risk, High Reward

The whole other part to this narrative is what James Lindsay, PhD, FRCP, is working on.

Lindsay is working with stem cell transplantation, which is a different animal, considering that they’re trying to reset the entire immune system.

I view this as almost high-risk, high-reward because it’s similar to a bone marrow transplant, which on one hand involves inherent risks, but on the other hand it may offer patients a way to achieve remission with possibly fewer medications, or no medications at all.

– Edward V. Loftus Jr., MD

Chief Medical Editor

Healio Gastroenterology and Liver Disease

Disclosure: Loftus reports consulting for AbbVie, Allergan, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Genentech, Gilead, Janssen, Pfizer, Takeda and UCB Pharma; and research support from AbbVie, Amgen, Celgene, Genentech, Gilead, Janssen, MedImmune, Pfizer, Robarts Clinical Trials, Seres Therapeutics, Takeda, and UCB Pharma.