Harnessing and honing mesenchymal stem/stromal cells for the amelioration of graft-versus-host disease

Allogeneic hematopoietic stem cell transplantation is a deterministic curative procedure for various hematologic disorders and congenital immunodeficiency. Despite its increased use, the mortality rate for patients undergoing this procedure remains high, mainly due to the perceived risk of exacerbating graft-versus-host disease (GVHD). However, even with immunosuppressive agents, some patients still develop GVHD. Advanced mesenchymal stem/stromal cell (MSC) strategies have been proposed to achieve better therapeutic outcomes, given their immunosuppressive potential. However, the efficacy and trial designs have varied among the studies, and some research findings appear contradictory due to the challenges in characterizing the in vivo effects of MSCs. This review aims to provide real insights into this clinical entity, emphasizing diagnostic, and therapeutic considerations and generating pathophysiology hypotheses to identify research avenues. The indications and timing for the clinical application of MSCs are still subject to debate.

Key Words: Mesenchymal stem/stromal cells, Graft-versus-host disease, Immunomodulatory, Adaptive immunity, Exosomes

Core Tip: This article provides insights into the use of validated mesenchymal stem/stromal cells (MSCs) as a potential treatment strategy for graft-versus-host disease (GVHD) in hematopoietic stem cell transplantation (HSCT). Current prevention and treatment options involve immunosuppression, which can hinder immune recovery and limit the graft-versus-tumor effect. By using MSCs, clinicians can effectively treat GVHD, identify high-risk patients, and stratify patients based on disease severity. Therefore, MSCs can aid in promoting engraftment, ameliorating acute GVHD, and preventing chronic GVHD, making them an attractive option for HSCT.

• Citation: Jaing TH, Chang TY, Chiu CC. Harnessing and honing mesenchymal stem/stromal cells for the amelioration of graft-versus-host disease. World J Stem Cells 2023; 15(4): 221-234
• URL: https://www.wjgnet.com/1948-0210/full/v15/i4/221.htm
• DOI: https://dx.doi.org/10.4252/wjsc.v15.i4.221