Mesenchymal stem cell therapy unable to rescue the vision from advanced Behcet's disease retinal vasculitis: report of three patients

Objective Retinal vasculitis (RV) is the most aggressive lesion of ocular manifestations of Behcet's disease, seen in 32.1% of patients. Although visual acuity (VA) improves with early and aggressive treatment, in the long run it is seen in only 48% of patients. Mesenchymal stem cell (MSC) transplantation (MSCT) can theoretically reverse the RV process. Patients and Methods Three patients with advanced RV and very low VA were selected. Eyes selected for MSCT were legally blind (no useful vision) with severe retinal damage due to vasculitis, resistant to combinations of monthly pulse-cyclophosphamide (1000mg)+azathioprine 2-3mg/kg/day+prednisolone 0.5mg/kg/day. After patient signed written consent, 30mL of bone marrow were taken and cultured for MSC growth. After having enough MSCs in culture (4-5weeks) and taking into consideration all safety measures, cells were injected in one eye of each patient (approximately 1.8million MSCs). VA was measured. Disease Activity Index (DAI) was calculated for anterior uveitis (AU), posterior uveitis (PU) and RV. Results Visual acuity was light perception (LP) for two patients and finger count (FC) for the third. Follow-up at 1, 6 and 12months were respectively LP/LP/FC at 0.5m, no-light perception (NLP)/LP/LP, NLP/LP/NLP. Discussion Results showed a total failure of the procedure, essentially due to the late and advanced state of vasculitis. However, the autoimmune/inflammatory reaction was greatly controlled by the procedure. Conclusion Earlier cases have to be selected for further trials.