Immunomodulation and remission of systemic lupus erythematosus/lupus nephritis using immunotherapy with autologous bone marrow expanded mesenchymal stem cells. (axBM-MSC). case report

Systemic lupus erythematosus (SLE) is a severe and progressive autoimmune disease with major complications like kidney failure, joint affectation, hematologic disorders and vascular/endothelial damage. The current treatments include immune suppressors, anti cytokine or anti B cells monoclonal antibodies that may lead adverse effects. Here we present a case of a patient with SLE without response to the advanced treatments, with renal failure, lupus nephritis (Stage IV WHO) peripheral severe vasculitis, arthritis, hepatic and central nervous system affectation. Previously voluntary consent sign and approbation of medical ethical committee, our multidisciplinary medical/surgical group, propose a cellular immunotherapy with axBM-MSC, expanded in vitro during 1 month with a posterior supra selective arterial infusion (June 2014) of the cultured cells by endovascular catheterism in bilateral renal, brachial and femoral arteries. After tree month of the treatment several changes in the patients was documented like improvement in QoL-SLE, and awesome decrease in SLEDAI from 58 to 3 points. Autoantibodies ANAS, anti-dsDNA, ASMA, APA, was negative three month after the therapy with normalization of complement levels. The proteinuria was down and the creatinine depuration was better in the first 4 months of the therapy (changed to Class I WHO). Several beneficent changes in the peripheral clinical immunophenotype and B1 cells were documented by flow cytometric analysis, with documented clinical remission, which maintains until today. We conclude that axBM-MSC and endovascular infused route to the kidney offer an safety opportunity of immune regulation and tissue regeneration in SLE.