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14 Articles in Volume 19, Issue #1
Analgesics of the Future: NKTR-181
Antidote to CDC Guideline; Plantar Fasciitis; Patient Input
Assessing and Treating Migraine in Women and Men
Demystifying Opioid-Induced Hyperalgesia
Editorial: Have We Gone Too Far? Can We Get Back?
How to Compel Patients to Complete Home Exercises
Inflammation Targeted Nanomedicine
Intravenous Stem Cell Administration for Ileitis
Invasive Surgery: Effective in Relieving Chronic Pain?
Pain Catastrophizing: What Practitioners Need to Know
Pain Therapy Options for the Home
Regenerative Medicine
The Future of Pain Management: An Experts' Roundtable
Whole Body Vibration: Potential Benefits in the Management of Pain and Physical Function

Intravenous Stem Cell Administration for Ileitis

The author shares an N-of-1 retrospective case in which suspected Crohn’s disease is eased through regenerative cell therapy.
Pages 38-40

Chronic abdominal pain is a big problem in pain management. The treatment is difficult and largely unsuccessful because the intra-abdominal processes are poorly influenced by conventional methods. Ileitis, which is usually a manifestation of either infection or Crohn’s disease, can be especially troublesome. Pain associated with this condition may lead to disability and endless suffering. Medications, such as steroids and immunosuppressants, and surgical interventions have traditionally been used to help manage chronic ileitis; both approaches have been associated with their own complications.

Herein, the author shares an observed case of ileitis with associated abdominal pain that ceased after treatment with umbilical cord blood-derived (allogeneic) stem cells.

Allogeneic Stem Cells for Inflammation

When transplanted, the primary function of stem cells is to modify inflammation.1 Many components are involved in wound, heart, bone, nervous system, and other tissue healing. There are also multiple factors that suppress inflammation and mobilize cells to the site of action.2,3 Pain control associated with stem cell treatment may be accomplished in two ways; immediately, by blocking the initiation of the pain cascade and later, by decreasing inflammation.4,5 Further, pain has been shown to improve with tissue repair, improvement in metabolism, tissue oxygenation, and immune system boosting. These effects have been greatly studied in the neuropathic pain model6-8 and in gastroenterology.9 For instance:

  • Mesenchymal stem cell treatment for autoimmune diseases, specifically experimental intravascular administration, has been extensively reported.10-11
  • The European Commission has approved a stem cell therapy to treat complex perianal fistulas — one of the most disabling complications of Crohn’s disease.12
  • In the US, the Icahn School of Medicine at Mount Sinai is conducting an autologous stem cell transplant trial for Crohn’s Disease.13

Regardless of the etiology, stem cell transplants in inflammatory bowel disease are becoming a promising treatment modality,9,14-18 with umbilical cord-derived stem cells holding the greatest promise.19,20 The case described below illustrates the curative potential of allogeneic stem cell administration in acute ileitis (suspected Crohn’s Disease).

The Patient

A 32-year-old white, married male, presented to the clinic for a previously scheduled appointment in October 2017. The appointment was for the intravenous (IV) administration of live umbilical cord blood-derived stem cells and was not related to gastrointestinal (GI) diagnoses or complaints. Specifically, the patient wished to use stem cells to address his frequent chronic viral infections, fatigue, and general muscle pains as well as to help prevent future illnesses and to slow his aging process.

Although he had experienced occasional GI complaints and abdominal pain over the preceding several years, no specific pathology was ever identified or treated other than the occasional use of laxatives. In the day before this appointment, he developed acute onset abdominal pain in the right upper quadrant. His pain had spread to the right middle quadrant by the time he presented to the office for his stem cell transfusion.

When he arrived, his blood pressure was 108/70, heart rate: 80, respirations: 16. He graded his pain in the abdomen as a 5 out of 10 with acute onset as mentioned above. His weight was 138 pounds, and BMI was 19.24. At the time of appointment, he was sitting in a chair bent over due to pain; he complained of nausea and not feeling well. His physical exam was otherwise unremarkable except right-sided abdominal pain with abdominal rigidity and no peritoneal signs. His tongue was coated. Appendicitis was suspected, and a surgical consultation was ordered.

The decision was made to proceed with transfusion despite his symptoms for two main reasons: there are known reports of stem cells helping with inflammatory bowel conditions; and, as the cell delivery had been coordinated with patient availability, it would have been wasted if unused. Accordingly, umbilical cord blood-derived stem cells in the amount of 2 mL were delivered intravenously by a slow push over a period of 20 minutes.

After infusion, the patient proceeded to have an outside surgical consult regarding his acute GI complaint. At the surgical appointment, acute appendicitis was suspected. An abdominal CT scan was performed with oral and intravenous contrast. The scan indicated signs of ileitis, possibly Crohn’s disease, and no appendicitis (see Figures 1 and 2).

Figure 1. CT scan views on patient’s initial visit show signs of ileitis. (Author provided image)

Figure 2. CT scan views on patient’s initial visit show signs of ileitis. (Author provided image)

The patient received no medication, supplements, or other kinds of treatment for this complaint beyond the noted stem cell IV. The patient’s pain, nausea, and distress subsided within 2 hours of the transfusion. He remained asymptomatic and did not follow-up with the surgeon.

He received a second umbilical cord blood-derived stem cell administration one week after the initial infusion as it was scheduled as a customary two-treatment series.

Two weeks later after the initial transfusion, an abdominal CT scan was repeated upon primary care doctor order and showed no acute inflammatory processes, no evidence of enteritis or colitis (see Figures 3 and 4). The patient also underwent a subsequent colonoscopy three weeks later, ordered by primary care out of abundance of precaution and due to the patient’s half-sister suffering from Crohn’s disease. The colonoscopy proved entirely normal. The patient has remained asymptomatic for 14 months since the described episode.

Figure 3. CT scan views two weeks post stem cell infusion. (Author provided image)

Figure 4. CT scan views two weeks post stem cell infusion. (Author provided image)

Discussion

Acute onset diffuse ileitis may be a prelude to chronic abdominal pain associated with inflammatory or autoimmune gastrointestinal disease. A treatment modality, which could interrupt and potentially reverse this process would likely be welcomed by chronic abdominal pain sufferers and the idea of preventing pain-disease chronification is likely appealing to clinicians.

There is a risk of an unknown factor(s) influencing the outcome of any single case report. Studies of allogeneic umbilical cord cells are needed to investigate their benefit in treating abdominal pain of different etiology. 

Last updated on: April 12, 2019
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