Immunogenicity of decidual stromal cells in an epidermolysis bullosa patient and in allogeneic hematopoietic stem cell transplantation patients.
Level 4 - case-series / case-control
Case report of a single JEB patient combined with a small case series of 16 HSCT recipients
PubMed 25658253 · doi:10.1089/scd.2014.0568
What was done
Evaluated the therapeutic and immunogenic profile of placenta-derived allogeneic decidual stromal cells (DSCs) in an 11-month-old patient with generalized severe junctional epidermolysis bullosa (JEB) who received five DSC infusions over 3 months combined with topical amniotic membranes. Immune responses were also examined in 16 allogeneic hematopoietic stem cell transplant (HSCT) patients receiving DSCs for graft-versus-host disease or hemorrhagic cystitis, supplemented by in vitro lymphocyte proliferation and mouse xenoreactivity assays.
What was found
In the JEB infant, wound healing was transient. Following two DSC infusions, the patient developed multispecific anti-HLA class I antibodies, high anti-bovine serum albumin antibody titers that bound DSCs, and heightened peripheral blood mononuclear cell proliferation against DSCs versus third-party controls (no anti-laminin-332 antibodies formed). Among the 16 HSCT patients, 2 had a positive flow cytometric crossmatch (one had pre-existing anti-HLA antibodies; one never developed anti-HLA antibodies). In mice, DSCs and mesenchymal stromal cells generated comparable xenoreactivity.
Why it matters
Shows that allogeneic DSCs are not universally immunoprivileged and can provoke an active alloimmune response in immunocompetent recipients, though alloimmunization risk appears lower in immunocompromised individuals.
Limits
The primary clinical observation comes from a single patient (n=1), making therapeutic efficacy impossible to separate from natural disease variation or the concurrent use of amniotic membranes. The HSCT cohort is small (n=16) and lacks an untreated control group.
Cited by
- contradicts Placental stem cells have not been thymized and do not provoke an immune reaction when administered to any recipient.