Abstract
Although radiotherapy is effective in managing abdominal and pelvic malignant tumors, radiation enteropathy is still unavoidable. This disease severely affects the quality of life of cancer patients due to some refractory lesions, such as intestinal ischemia, mucositis, ulcer, necrosis or even perforation. Current drugs or prevailing therapies are committed to alleviating the symptoms induced by above lesions. But the efficacies achieved by these interventions are still not satisfactory, because the milieus for tissue regeneration are not distinctly improved. In recent years, regenerative therapy for radiation enteropathy by using mesenchymal stem cells is of public interests. Relevant results of preclinical and clinical studies suggest that this regenerative therapy will become an attractive tool in managing radiation enteropathy, because mesenchymal stem cells exhibit their pro-regenerative potentials for healing the injuries in both epithelium and endothelium, minimizing inflammation and protecting irradiated intestine against fibrogenesis through activating intrinsic repair actions. In spite of these encouraging results, whether mesenchymal stem cells promote tumor growth is still an issue of debate. On this basis, we will discuss the advances in anticancer therapy by using mesenchymal stem cells in this review after analyzing the pathogenesis of radiation enteropathy, introducing the advances in managing radiation enteropathy using regenerative therapy and exploring the putative actions by which mesenchymal stem cells repair intestinal injuries. At last, insights gained from the potential risks of mesenchymal stem cell-based therapy for radiation enteropathy patients may provide clinicians with an improved awareness in carrying out their studies.
Highlights
Epinal case report reveals the specific effectiveness of mesenchymal stem cells in managing pelvic radiotherapyinduced lesions in rectum and bladder lesions
Radiation-induced intestinal injuries/ toxicities are known as radiation enteropathy (RE), which can be classified into two phases
Several clinical trials revealed the immunomodulatory benefits of mesenchymal stem cells (MSCs) in treating graft versus host disease (GVHD), inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE) and arthritis.[19,20,21,22]
Summary
Due to most of radiation enteropathy patients are cancer survivors, is really that mesenchymal stem cells will initiate or promote their tumor growth?. MSCs, a population of undifferentiated cells deriving from early ectoderm and can be harvested from various tissues and organs.[15] MSCs can secret various types of growth factors, immune mediators and anti-fibrotic effectors, which are potent in mediating tissue regeneration.[16,17,18] And several clinical trials revealed the immunomodulatory benefits of MSCs in treating graft versus host disease (GVHD), inflammatory bowel disease (IBD), systemic lupus erythematosus (SLE) and arthritis.[19,20,21,22] four patients, suffering from pelvic radiotherapy-induced injuries in rectum and in bladder, were successfully treated in Epinal Medical Center by using MSCs.[6,23] The effectiveness of MSCs lies in reducing abdominal pain, stanching rectal hemorrhage and healing fistula.[23] On this basis, we propose that managing RE patients by using MSCs will be an attractive therapeutic approach in the future. We show the homeostasis of intestinal epithelium regulating by CBC stem cells
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