Early signs that patient's own bone-marrow stem cells could treat multi-drug resistant tuberculosis

Findings of a preliminary study published in The Lancet Respiratory Medicine suggest that a patient's own bone-marrow stromal (stem) cells could be used to treat multidrug-resistant and extensively-drug tuberculosis.

"Conventional treatment for MDR-TB uses a combination of TB drugs (antibiotics) which are harmful (toxic) to patients. Our new approach, using the patients' own bone-marrow is safe and could help overcome the body's excessive inflammatory response, repair and regenerate inflammation-induced damage to lung tissue, and lead to improved cure rates", explains Professor Markus Maeurer from Karolinska University Hospital in Stockholm, Sweden who led the research.

WHO estimates that in Eastern Europe, Asia, and South Africa 450 000 people have MDR-TB, and around half of these will fail to respond to existing treatments.

TB bacteria trigger an inflammatory response in immune cells and surrounding that can cause immune dysfunction and tissue damage. Bone-marrow mesenchymal stromal cells (MSCs) are known to migrate to areas of lung injury and inflammation and repair damaged tissue. They also modify the body's immune response and could boost the clearance of TB bacteria.

In this phase 1 safety study, 30 patients with MDR or XDR TB aged 21 years old receiving standard TB antibiotic treatment were also given an infusion of around 10 million of their own stromal cells. The cells were obtained from the patient's own bone marrow, then cultured into large numbers in the laboratory before being re-transfused into the same patient.

MSC infusion was generally safe and well tolerated. During the 6 months follow-up, no serious adverse events were recorded. The most common grade 1 or 2 adverse events were high cholesterol levels (14 of 30 patients), nausea (11 patients), and lymphopenia or diarrhoea (10 patients).

Further analyses showed 16 patients treated with MSCs were deemed cured at 18 months compared with only 5 of 30 TB patients with similar disease not treated with MSCs.

According to Professor Maeurer longer follow up with more patients is needed to establish the safety and efficacy of MSC therapy. "The procedures for obtaining stromal from the patient's own are relatively simple, and if successful in phase 2 trials, will provide a viable adjunctive therapy for with MDR-TB not responding to conventional drug treatment or those with severe lung damage", he concludes.

Co-author Professor Alimuddin Zumla from University College London, UK adds, "The results of this novel and exciting study show that the current challenges and difficulties of treating MDR-TB are not insurmountable, and they bring a unique opportunity with a fresh solution to treat hundreds of thousands of people who die unnecessarily of drug-resistant TB. Further evaluation in phase 2 trials is now urgently required to ascertain efficacy and further safety in different geographical regions such as South Africa where MDR-TB and XDR-TB are rife."

Writing in a linked Comment, Professor Robert J Wilkinson from Imperial College London, UK discusses the "long history" of adjunctive immunotherapy against TB, concluding that, "This field is…complex with an underlying problem being a relatively poor understanding of what constitutes protective and pathological immunity in human tuberculosis or even whether these are precisely separable. Nevertheless, the potential to investigate an increasing range of more specific biological therapies or the repurposing of existing anti-inflammatory agents continues to attract interest. Whether relatively complex and expensive MSC therapy will join this list remains to be determined."

add to favorites email to friend print save as pdf

Related Stories

New hope for improved TB treatments

Aug 09, 2013

Researchers at the University of Southampton have identified new markers of tuberculosis (TB) that may help in the development of new diagnostic tests and treatments.

Recommended for you

Evidence-based recs issued for systemic care in psoriasis

15 hours ago

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

15 hours ago

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

16 hours ago

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

Discovery of genes that predispose a severe form of COPD

18 hours ago

A study by Ramcés Falfán-Valencia, researcher at the National Institute of Respiratory Diseases (INER), found that the mestizo Mexican population has a number of variations in certain genes that predispose ...

On the environmental trail of food pathogens

19 hours ago

Tracking one of the deadliest food contamination organisms through produce farms and natural environments alike, Cornell microbiologists are showing how to use big datasets to predict where the next outbreak could start.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.