Combination of human umbilical cord mesenchymal stem (stromal) cell transplantation with IFN-γ treatment synergistically improves the clinical outcomes of patients with rheumatoid arthritis

Objectives To clarify the key role of circulating interferon-gamma (IFN-gamma) and to improve the clinical efficacy of mesenchymal stem cell (MSC) transplantation (MSCT) in patients with rheumatoid arthritis (RA). Methods Study of wild-type or IFN-gamma R-/-MSCT was first evaluated in a murine model of collagen-induced arthritis (CIA) following which a phase 1/2 randomised controlled study was conducted in 63 patients with RA who responded poorly to regular clinical treatments. Subjects were randomly assigned to an MSCT monotherapy group (n=32) or an MSCT plus recombinant human IFN-gamma treatment group (n=31), with 1 year of follow-up. The primary end points consisted of efficacy as assessed as good or moderate EULAR response rates and the proportion of patients at 3 months attaining American College of Rheumatology 20 (ACR20) response rates. Results In the murine studies, wild-type MSCT significantly improved the clinical severity of CIA, while IFN-gamma R-/-MSCT aggravated synovitis, and joint and cartilage damage. Transitioning from the murine to the clinical study, the 3-month follow-up results showed that the efficacy and ACR20 response rates were attained in 53.3% patients with MSCT monotherapy and in 93.3% patients with MSCT combined with IFN-gamma treatment (p<0.05). No new or unexpected safety issues were encountered in 1-year follow-up for either treatment group. Conclusions The results of this study show that IFN-gamma is a key factor in determining the efficacy of MSCT in the treatment of RA, and that an MSC plus IFN-gamma combination therapeutic strategy can greatly improve the clinical efficacy of MSC-based therapy in RA patients.