Abstract
To compare the efficacy and safety of umbilical cord blood mononuclear cells (CBMNC) and azathioprine (AZA) in the treatment of patients with steroid-dependent or -resistant ulcerative colitis. One hundred and six patients diagnosed with steroid-dependent or -resistant ulcerative colitis were studied retrospectively, including 36 patients treated with CBMNC and 70 treated with AZA. To reduce confounding bias due to retrospective nature of this study, the propensity score matching system was applied to equipoise the pretreatment data of two groups. After matching, 35 matched pairs (1:1) were created. The ratios of clinical remission, clinical response and endoscopic mucosal healing, Mayo score, and major complications were compared between two groups at weeks 8, 16, and 36 after treatment. The results demonstrated that the ratios of clinical remission (80% vs. 57%, P < 0.05) and mucosal healing (74% vs. 51%, P < 0.05) were significantly higher in CBMNC-treated patients compared with those in AZA-treated patients at week 8. The erythrocyte sedimentation rate was significantly decreased in CBMNC group compared with that in AZA-treated group (14.5 ± 3.9 mm/h vs. 18.0 ± 5.7 mm/h, P < 0.01) at week 8. In AZA group, 2 patients had neutropenia and 3 patients had elevated alanine aminotransferase levels, whereas no obvious side-effects were observed in CBMNC-treated group. Our results reveal that CBMNC therapy appears to be an effective and safe strategy for patients with steroid-dependent or -resistant ulcerative colitis. Further prospective studies are needed to define the potential roles and mechanisms of CBMNC in the treatment of refractory ulcerative colitis.
Highlights
Ulcerative colitis (UC) is a common gastroenterological disorder which is characterized by chronic progressive inflammatory diseases in the gastrointestinal tract
Our results reveal that cord blood mononuclear cells (CBMNC) therapy appears to be an effective and safe strategy for patients with steroid-dependent or -resistant ulcerative colitis
Baseline characteristics patients who were diagnosed with steroiddependent or -resistant UC in Chinese PLA General Hospital of Jinan Military Command were randomly spilt into CBMNC-treated group and AZA-treated group according to their initial treatment strategy
Summary
Ulcerative colitis (UC) is a common gastroenterological disorder which is characterized by chronic progressive inflammatory diseases in the gastrointestinal tract. The adverse effect is major limitation in the use of corticosteroids, especially for the steroid-dependent or -resistant UC patients Immunosuppressants such as azathioprine (AZA) or 6-mercaptopurine are dominant drugs most frequently used in inducing and maintaining remission in refractory UC patients, there is still about 30% of UC patients dropped the AZA therapy due to the side-effects or lack of clinical efficacy [7, 8]. Biological agents such as infliximab and adalimumab provide a new therapy for inflammatory bowel disease (IBD), but the looming risks including opportunistic infection and malignancy, lymphoma limit their clinical application [9]. New optimal therapies aim at a cure for UC are warranted, which should focus on blocking intestinal mucosal inflammation, and enhancing intestinal mucosal proliferation and coordinately remodeling during the ulceration-healing process [11]
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