Resetting the immune system with immunoablation and autologous haematopoietic stem cell transplantation in autoimmune diseases

Clin Exp Rheumatol. 2016 Jul-Aug;34(4 Suppl 98):53-7. Epub 2016 Jul 20.

Abstract

Over the past 20 years, immunoablation followed by transplantation of autologous haematopoietic stem cells (ASCT) has emerged as a promising treatment option for patients with severe forms of autoimmune diseases (ADs) that insufficiently respond to standard immunosuppressive or novel biologic treatment. Meanwhile, mechanistic studies have provided the proof-of-concept that the long-term, treatment-free remissions achieved by ASCT are associated with the eradication of the autoreactive immunologic memory and a fundamental reconfiguration of the immune system. The latter comprises regeneration of naive B cells and a stable thymic reactivation with re-emergence of thymic-derived naive T cells, including Foxp3+ regulatory T cells, with new antigen receptors, i.e. immune reset. In this article, we discuss mechanistic studies that investigated how such immune renewal after ASCT may rewire a faulty immune system in ADs into a self-tolerant state, to induce long-term remissions.

Publication types

  • Review

MeSH terms

  • Animals
  • Autoantibodies / immunology
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / surgery*
  • Autoimmunity*
  • B-Lymphocytes / immunology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hematopoietic Stem Cells / immunology*
  • Humans
  • Immunologic Memory
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use*
  • Phenotype
  • Remission Induction
  • Self Tolerance
  • Severity of Illness Index
  • T-Lymphocytes, Regulatory / immunology
  • Time Factors
  • Transplantation, Autologous
  • Treatment Outcome

Substances

  • Autoantibodies
  • Immunosuppressive Agents