Mesenchymal stem cell transplantation as a potential therapy for refractory lupus nephritis: A systematic review

• Published in: Rheumatology & autoimmunity (Print) Vol. 3; no. 3; pp. 140 - 148
• Main Authors: Parlindungan, Faisal, Damanik, Johanda, Araminta, Abirianty P., Soetedjo, Ariel V., Hidayat, Rudy, Kusumo Wibowo, Suryo A., Arianne, Anna, Sumariyono, Sumariyono
• Format: Journal Article
• Language: English
• Published: Wiley 01-09-2023
• Subjects: lupus nephritis; mesenchymal stem cells; systemic lupus erythematosus; transplantation
• ISSN: 2767-1410; 2767-1429
• DOI: 10.1002/rai2.12082

Background
Lupus nephritis (LN) results in high morbidity and mortality in patients with systemic lupus erythematosus. Refractory cases of standard immunosuppressive therapy have been recorded. Mesenchymal stem cell transplantation (MSCT) shows potential use in autoimmune diseases. We aim to review MSCT in the treatment of refractory LN.
Methods
Published articles were systematically extracted from the databases in May 2022. The quality of the studies was assessed using the Oxford Centre for Evidence‐Based Medicine critical appraisal checklist.
Results
Four studies were included. All studies recruit severe or refractory LN patients and show significant improvement in post‐MSCT 24‐h proteinuria. However, the improvement of renal function after MSCT is inconsistent between studies after a 1‐month follow‐up, with one study showing deterioration of the estimated glomerular filtration rate after 3 months and one study showing an increase in serum creatinine at 6 and 9 months. Moreover, all studies show improvement in Systemic Lupus Erythematosus Disease Activity Index scores after MSCT, while two studies show that a decrease in anti‐double‐stranded DNA (anti‐dsDNA) levels after MSCT is only evident for up to 1‐month period.
Conclusions
MSCT can be effective, especially in severe or refractory LN. More randomized‐controlled trials are needed to support this evidence.
Mesenchymal stem cell transplantation (MSCT) showed improvement in 24‐h urine protein and Systemic Lupus Erythematosus Disease Activity Index score when compared with standard treatment in severe or refractory lupus nephritis (LN). This systematic review showed that MSCT has a potential role for the treatment of refractory or severe LN and more studies to clarify this role needed to be done in the future.
Key points
Refractory lupus nephritis (LN) has been an emerging problem associated with high morbidity and mortality, in conjunction with the limitation of novel treatment discovery.
Mesenchymal stem cell transplantation (MSCT) has been shown to be effective in several autoimmune and rheumatic diseases, hence it is hypothesized to play a role in LN.
In this systematic review, MSCT showed improvement in 24‐h urine protein and Systemic Lupus Erythematosus Disease Activity Index score when compared with the standard treatment but showed inconsistent results in renal function and anti‐dsDNA titers.
MSCT can potentially be a selected treatment for refractory LN, but further randomized‐controlled trials are needed to clarify its role in LN treatment.