Science, or Science Fiction?

The use of hematopoietic stem cell transplant (HSCT) is not a new concept for diseases such as lymphoma and leukemia. The science of HSCT has come a long way since the early days of bone marrow transplants that caused excessive pain for the donor, excessively long hospitalizations for patients, most of which was spent in a virtually sterile environment, and not the best of outcomes for many patients who endured the high dose chemotherapy and radiation that prepared them for the transplant. Today, with the use of autologus stem cell transplants in which a patient uses their own stem cells for transplant to matched unrelated donor transplants we have seen better outcomes for our patients and donors. But the area that still intrigues me and makes me sometimes wonder is this science or science fiction is the use of HSCT to treat autoimmune diseases.

Currently such diseases as rheumatoid arthritis, scleraderma, and systemic lupus erythematosus are being treated with HSCT. We’ve all heard the news reports of research using embryonic stem cells to treat diseases like Parkinson’s disease (PD) and others. So many people have suffered long hard battles with these autoimmune diseases. I’m not sure how I would really feel knowing that my own body is attacking itself. The idea then—that we can reset our own immune system using our own stem cells—is fascinating to me. I have the good fortune to work at a large metropolitan teaching institution that supports ongoing research in many areas. We have a wonderfully gifted program that has been using HSCT to treat several autoimmune diseases for quite some time with wonderful results. And the research continues to find even more diseases and disorders that can be effectively treated and cured.

I have always been fascinated by this area, but even I had to take a few extra steps back a couple of years ago when I heard the story of this patient being treated on my unit. I was getting reports on a patient and the previous nurse told me that the patient had peripeheral vascular disease (PVD). Further into the plan of care she reported that the doctor was planning on coming and injecting her with stem cells. Well I was sure this young, new nurse had that wrong. First of all you don’t inject stem cells, you infuse them. And why would we be doing this for a patient with PVD?

I needed to get the story straight and find out if there was anything special I needed to do to prepare this patient for their supposedly upcoming transplant. Were we moving her to the transplant unit? We couldn’t do a transplant here, we weren’t prepared. But to my utter surprise, that nurse was indeed correct. The physician had been doing research with PVD and found that if you actually injected the patient with stem cells above the area of concern that there was potential for a “new improved” circulatory system to develop leaving the damaged, occluded system to no longer be needed. When I asked the physician if there were anything we needed to do special for this patient, he very calmly replied that we just needed to care for them like we would any patient, nothing out of the ordinary. He was going to come to the unit with the syringe of cells and inject them later that day.

The patient did fine; no untoward effects. By the time they were discharged, there was some indication that circulation in her leg was improving, which was amazing to me. This is when I really first started seeing the very fine line between what some may think of as science and others as science fiction. What we can accomplish with research and the knowledge we already have is beyond comprehension. It takes one person to think maybe this can work and then work at it. As we advance in medical technology and advancing healthcare, I cannot even imagine what we may see down the very short road ahead. Perhaps we should revisit some of those old Twilight Zone episodes and realize that things were not so far fetched as we might have thought.

Go to http://www.nature.com/ncprheum/journal/v4/n4/full/ncprheum0756.html for a nice overview of HSCT used for autoimmune diseases titled “Technology Insight: hematopoietic stem cell transplantation for systemic rheumatic disease.”