Autoimmune diseases occur when the immune system begins to attack the body’s own cells and tissues, perceiving them as foreign. Instead of protecting the body from pathogens (viruses, bacteria), the immune system mistakenly triggers inflammation and damages healthy organs and systems. The causes of autoimmune diseases are not fully understood, but it is believed that these are multifactorial disorders, including genetic predisposition, environmental influences, infections and hormonal changes.
Main causes and risk factors for autoimmune diseases
Genetic predisposition
Autoimmune diseases are common in people whose family has already had cases of such disorders. For example, HLA genes (a group of genes responsible for recognizing foreign proteins) can predispose to errors in the immune system.
Genetic predisposition can be expressed in different ways: one family member may have type 1 diabetes, another – rheumatoid arthritis.
Hormonal changes
Women suffer from autoimmune diseases more often than men (example: systemic lupus erythematosus and Hashimoto’s thyroiditis), which indicates that sex hormones may play a role.
Changes in estrogen and progesterone levels during pregnancy, the menstrual cycle, and menopause may trigger autoimmune reactions.
Infections
Some viruses and bacteria can trigger autoimmune diseases through a mechanism called “molecular mimicry.” The immune system begins to attack its own tissues because their structure resembles pathogens. Example: Epstein-Barr virus infection may be associated with the development of multiple sclerosis.
Environmental and environmental factors
Chronic stress, pollution, smoking, and exposure to toxins (such as pesticides) increase the risk of autoimmune reactions.
Vitamin D deficiency or excess also affects the immune system.
Medications and intoxications
Certain medications, such as anticonvulsants and antihypertensives, can cause autoimmune reactions. For example, drug-induced lupus syndrome develops under the influence of certain medications.
Dysregulation of the immune system
When regulatory T cells (T-regulators) malfunction, the immune system does not properly control autoimmune reactions, leading to chronic inflammation and tissue damage.
Why are autoimmune diseases difficult to treat?
Unknown root cause: Since the exact mechanisms that trigger autoimmune reactions are not fully understood, therapy is primarily aimed at eliminating symptoms and suppressing the immune response.
Chronic course: Most autoimmune diseases are chronic in nature with periods of exacerbations and remissions.
Diversity of affected organs: Since autoimmune processes can affect different body systems, treatment requires an individual approach.
How stem cells can stop the autoimmune response
Stem cells have unique abilities to modulate the immune response, which makes them a promising tool for the treatment of autoimmune diseases. They can stop or reduce autoimmune reactions, preventing tissue damage and restoring balance in the immune system. The main effects of such cells include immunomodulation, inflammation suppression and tissue regeneration.
Mechanisms of action of stem cells in autoimmune diseases
1. Immunomodulation and regulation of T cells
Mesenchymal stem cells (MSCs) suppress the activity of T helpers (Th1 and Th17), which play a key role in the development of autoimmune reactions.
They promote the activation of T regulatory cells (Treg), which suppress excessive immune reactions and restore the tolerance of the immune system to its own tissues.
MSCs also reduce the activity of cytotoxic T cells, preventing damage to healthy cells in the body.
2. Suppression of inflammation and cytokine production
MSCs secrete anti-inflammatory cytokines such as interleukin-10 (IL-10) and transforming growth factor-beta (TGF-β), which reduce inflammation.
They suppress the production of pro-inflammatory cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), which reduces chronic inflammation.
3. Effects on B cells and antibody production
MSCs reduce the excessive activity of B lymphocytes, which in autoimmune diseases produce abnormal antibodies that attack their own tissues.
This helps reduce the level of autoantibodies (e.g. anti-DS-DNA in systemic lupus erythematosus or anti-GAD in type 1 diabetes).
4. Regeneration of damaged tissues
In addition to immunomodulation, stem cells promote the regeneration of tissues damaged by autoimmune reactions. For example:
In the case of type 1 diabetes, stem cells can stimulate the regeneration of pancreatic beta cells.
In multiple sclerosis, they promote the restoration of myelin sheaths of neurons.
5. Prevention of fibrosis and tissue scarring
MSCs prevent excessive accumulation of collagen, reducing the risk of fibrosis that can develop with chronic inflammation (for example, with autoimmune hepatitis or scleroderma).
6. Secretion of exosomes and molecules that regulate the immune response
Exosomes secreted by stem cells contain microRNAs and proteins that promote the restoration of immune tolerance and suppress inflammatory reactions. These exosomes can penetrate various tissues, changing the behavior of target cells and stimulating regeneration.
What types of stem cells are used to treat autoimmune diseases?
Mesenchymal stem cells (MSCs)
They are used in multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis.
They have strong anti-inflammatory and immunomodulatory properties.
Hematopoietic stem cells (HSCs)
They are used to treat diseases such as multiple myeloma and systemic scleroderma. HSCs can completely “restart” the immune system after an autoimmune failure.
Induced pluripotent stem cells (iPSCs)
They can be reprogrammed into any cell type, which makes them promising for the regeneration of damaged organs (for example, in the case of type 1 diabetes or myasthenia).
Benefits of Using Stem Cells
Long-lasting effect: Stem cell therapy can eliminate the cause of an autoimmune disease, rather than simply suppressing the symptoms.
Complex effect: They simultaneously suppress inflammation and restore tissue.
Minimal risk of side effects: Unlike immunosuppressants, stem cells selectively modulate the immune response without suppressing the entire immune system.
Why donor stem cells provide the best treatment results
Using donor stem cells in autoimmune diseases can provide a number of benefits. The main reasons for choosing donor cells are related to the effectiveness of restarting the immune system, eliminating defects in one’s own cells, and reducing the likelihood of relapse. Let’s look at the key aspects.
Reasons for using donor stem cells:
Resetting the immune system (“immune reconfiguration”)
Autoimmune diseases are often caused by defects in the patient’s immune cells. Donor hematopoietic stem cells (HSCs) can replace these defective cells, creating a new, healthy immune system.
This process is used in allogeneic (from a donor) HSC transplants, especially in diseases such as systemic lupus erythematosus or multiple sclerosis.
No “memory” of autoimmune reactions
Immune cells created from donor stem cells have no “memory” of previous autoimmune attacks, which reduces the likelihood of relapses.
In some cases, the patient’s own cells retain an autoimmune predisposition, and the introduction of donor cells avoids this problem.
Effectiveness in severe forms of diseases
In severe forms of autoimmune diseases (for example, refractory rheumatoid arthritis that does not respond to treatment), donor cells may have a more pronounced effect compared to the patient’s cells.
They can better suppress inflammation and provide long-term remission.
Reduced risk of mutations and genetic defects.
In patients with a genetic predisposition to autoimmune diseases (for example, mutations in the HLA genes), their own stem cells may contain defects. Donor cells provide the opportunity to replace them with healthy cells with normal genes.
Donor stem cells are effective in treating autoimmune diseases due to their ability to restart the immune system and eliminate defective cells. They reduce the risk of relapse and allow damaged tissue to be replaced.
How long can remission (stoppage) of the disease last
The duration of remission after treatment of autoimmune diseases with stem cells can vary greatly depending on the type of disease, the method of therapy and the individual characteristics of the patient. In some cases, remission can last several years, and in others – for life, especially if it is possible to achieve a stable immune restructuring.
Factors Affecting the Duration of Remission:
Type of Autoimmune Disease
For some diseases, remission after stem cell therapy is longer:
Multiple Sclerosis: Remission can last from 5 to 10 years or longer.
Systemic Lupus Erythematosus: In some cases, stable remission of up to 7 years or more can be achieved.
Rheumatoid Arthritis: Remission after stem cell therapy can last for several years, but sometimes repeated cell administration is required.
Age and Condition of the Patient
In young patients, regenerative processes occur faster, and remission can be longer.In severe and advanced forms of the disease, the likelihood of long-term remission is lower, and repeated therapy may be required.
Examples of remission from clinical practice
Multiple sclerosis: Studies show that after treatment with donor stem cells, 70-80% of patients remain in remission for 5-7 years. Some patients have recorded relapse-free periods of more than 10 years.
Systemic scleroderma: In large studies, remission after therapy lasted an average of 5 years, with a gradual decrease in fibrosis symptoms.
Type 1 diabetes: With stem cell therapy (for example, with donor mesenchymal cells), some patients can reduce their insulin requirements for several years, but complete recovery is observed in up to 28%.
The duration of remission after stem cell therapy depends on the type of disease and individual factors. In some cases, it can last 10 years or more, especially if complete immune restructuring is achieved. For some severe diseases, maintenance therapy may be required every few years to prevent relapses.