Bone Marrow Therapy and Lupus

As the home of the stem cells that produce blood and immune system cells, bone marrow is a complicated tissue for people with lupus.

Bones are vital, hardworking parts of the body – they protect organs, provide structure, and enable all forms of movement, large or small. People with lupus often have issues with these important structures.Systemic lupus erythematosus (SLE,) has the capacity to affect any organ in the body, but it is most well-known for its affects on the joints, the lubricated, soft areas of cartilage in between different bones that allow limbs to bend and move. SLE attacks the joints, causing them to become inflamed, swollen, and damaged, locking up the limbs and making it difficult and painful to move. When the joints are attacked, the bones are often not spared, and the ends of the bones can often be directly damaged by lupus.Lupus medications, such as glucocorticoids, are notorious for causing bone loss. Osteoporosis is the general catch-all term for bone that has either been thinned and weakened or has been encouraged by disease to grow in ways that make it weaker – thicker bone in the wrong places can be just as structurally unsound as less bone! However, people with lupus usually experience bone loss and more fragile bones. Lupus itself causes pain and fatigue, which leads to inactivity, a contributor to osteoporosis. You can read more about fatigue here. Because the weakened bone from osteoporosis might make it risky to do certain activities, this creates a vicious cycle of inactivity, which can make all lupus symptoms worse – including the weakened bones!So, lupus does have an effect on the bones, but what about the bone marrow inside many of the larger bones of the body? And how is this bone marrow important for people with lupus?

Lupus and Bone Marrow

Bone marrow is a soft, spongy tissue found inside some of the bones of the body, including the ribs, vertebrae, sternum, and pelvis. It can also be found in the long bones (femur and humerus,) and shoulder blades, and the skull. Because marrow is semisolid, it serves many purposes in the bone itself, including absorbing some of the shock of an impact. However, its primary purpose is as the home of certain types of stem cells. The cells found in yellow marrow produce connective tissues such as fat, cartilage, muscle and bone. Red marrow has what are known as hematopoietic stem cells, which produce blood and immune cells including white blood cells and leukocytes. You can read more about the immune system here. It is the red marrow and its stem cells that are the most notable for people with lupus. Lupus is a disease with many potential triggers and causes within the body. However, because bone marrow and the stem cells within them produce important cells for the immune system and lupus is an autoimmune disease, abnormalities in the bone marrow are sometimes thought to be one of these potential causes. In studies, hematopoietic stem cells, also known as mesenchymal stem cells, may be abnormal in some people with lupus. You can read more about mesenchymal stem cells and the therapies that use them, here. So, would a bone marrow transplant fix lupus?

What is a Bone Marrow Transplant?

A bone marrow transplant is an attempt to replace hematopoietic stem cells that aren't doing their job properly, either by collecting stem cells from your own body or from a bone marrow donor. These cells are then delivered to your bloodstream in a process called infusion, where they eventually take up residence in bone marrow and produce healthy blood cells, called engraftment. Bone marrow transplants are very potent treatments that have a good success rate at improving quality of life for people with certain types of blood cancers, metabolic issues, anemias and immunological deficiencies.Gathering donor cells for bone marrow transplants is relatively easy. Marrow cells can be harvested by giving a medicine to the donor that causes the stem cells to reproduce rapidly and increase their presence in the blood stream. The blood is then drawn and filtered, and the stem cells are cultured until they are ready to be used. They can also be collected with a needle placed into the bone, usually the hip or sternum. The donor is anesthetized and usually does not feel any pain from the procedure. Bone marrow transplants are usually given after “conditioning” - low doses of intense medical treatments such as chemotherapy that kill off some of the existing bone marrow. This leaves a vacancy for the donated bone marrow to move in and take its place. This can be dangerous, as the immune system is weakened during this time and the therapies often have unpleasant side effects.After the transplant, complications can occur, especially when given by a donor, and they can also fail. The main thing to watch out for during recovery from a bone marrow transplant is infection, because the immune system is often weakened to allow the body to accept the transplant without attacking it.

Bone Marrow Transplants and Lupus

Bone marrow transplants have been used to treat leukemia, lymphomas, anemia, some solid tumor cancers, and immune deficiency disorders since 1968. T-cells which are a type of immune cell called a lymphocyte produced in the thymus, seek out and destroy viruses, bacteria, and tumors in the body. When they malfunction, they are key to autoimmune diseases like lupus. Bone marrow transplants could help 'reset' the T-cells and replace them with normal functioning cells, so it’s not surprising that they are considered a possibility for treating people with lupus.So, does it work?It’s still early days for the therapy. In a case where a patient was treated for non-Hodgkin's lymphoma, their SLE also went into remission for three years. Autoimmune disease did return, but the symptoms were different, implying that it was a different disease altogether. Bone marrow transplants definitely improve the production of B-cells and seem to help modulate the immune system's regulation and production of T-, B- and other immune cells.

A Lupus Warrior’s Takeaway

In other words, bone marrow transplants, though potentially effective, are not a commonly used strategy for treating lupus. Because of the conditioning that has to happen and the risk of complications, it certainly would not be the first idea that a treatment team would pursue, and it may not be right for many people with lupus.So, what can you do to take care of the bone marrow that you have?You can keep your bone marrow as healthy as possible by eating plenty of protein-rich foods, as well as having good sources of vitamin B12 and B9, and iron. Fish are very rich in all of these, but a balanced diet will easily provide sources of these nutrients. Regular physical activity is important for maintaining good bone, circulatory system, and muscle health, so it also will help the bone marrow. Keeping bone marrow healthy makes it more likely to produce functional blood and immune cells in the correct amounts, but these strategies also improve overall health and can help ease the symptoms of lupus over time, so they are well worth it anyway.You can read about some good, lightweight (but effective) exercises for people with lupus here!