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P476 Combined therapy with adalimumab and mesenchymal stromal cells contributes to reduction in the degree of inflammation in ulcerative colitis

O. Knyazev1, A. Kagramanova1, D. Kulakov*1, M. Zvyaglova1, A. Parfenov1

1Moscow Clinical Scientific Center named after A. S. Loginov, Department of inflammatory bowel diseases, Moscow, Russian Federation

Background

One of the new promising methods of treatment of patients with ulcerative colitis (UC) is biological therapy using bone marrow mesenchymal stromal cells (MSC). In some cases, simultaneously with MSC, patients receive concomitant anticytokine therapy. Currently, a new strategy for UC therapy is to achieve a deep remission of the disease. To compare the level of immunobiological and histological markers of inflammation—C-reactive protein (CRP), the Geboes Score (GS) and faecal calprotectin (FCP)—in patients with UC receiving cell therapy MSC, anti-cytokine therapy with adalimumab (ADA), and combined therapy of bone marrow MSC and ADA.

Methods

Sixty patients with total ulcerative colitis of moderate severity were divided into groups depending on the therapy. The first group of patients with UC aged from 19 to 56 years (Me-29) (n = 20) received anti-inflammatory therapy with the use of the culture of 2 million MSC/kg according to the scheme the second group of patients with UC (n = 20) aged 23 to 62 years (Me-41) received ADA in accordance with the recommended scheme, the third group of patients with UC (n = 20) aged 20 to 59 years (Me-33) received the MSC+ADA. The level of CRP, PCF and is was assessed 26 weeks after initiation of therapy. The baseline CRP was 25.0 ± 1.9; 26.5 ± 2.1 and 24.0 ± 2.4 mg/l, respectively. Baseline GS in the groups of patients was 4.4 ± 0.2; 4.35 ± 0.2 and 4.5 ± 0.3 points, respectively. The initial level of the FCP made 890.8 ± 88.8; 850.3 ± 83.9 and 910.5 ± 120.5 μg/g, respectively.

Results

After 26 weeks from the start of therapy in the first group of patients, the level of CPP was 6.8 ± 1.1 mg/l, in the second group 7.4 ± 1.3 mg/l, in the third group 7.9 ± 1.0 mg/l (p > 0.05). After 26 weeks from the start of therapy in the first group of patients, the level of FCP was 108.8 ± 9.3 μg/g, in the second group 90.6 ± 6.5 μg/g, in the third group 96.8 ± 6.3 μg/g (p < 0.05 compared with the first and second groups). After 26 weeks from the start of therapy in the first group of patients with GS was 0.7 ± 0.1 points, in the second group 0.65 ± 0.1 points, in the third-0.5 ± 0.06 points (p < 0.001 compared with the first and second groups).

Conclusion

Combined mesenchymal stromal cells and anti-cytokine therapy with adalimumab contributes to a more pronounced reduction in the degree of inflammation of the intestinal mucosa.