Our understanding of Multiple Sclerosis (MS) as developed substantially over the last few decades. This has led to a number of treatment options for people living with MS. The defining approach has been to identify and develop drug therapies which suppress the immune system, in an effort to reduce the number of relapses, as well as halt the progression of the condition. But what if we could reverse the damage done? Could stem cells play a role in this endeavour?
Stem cells are cells which have the ability to divide and specialise into many different types of cells (muscle, bone, skin etc) and can self-renew to produce more stem cells. There is, and has been, much controversy in relation to stem cells – both in their use and their procurement, especially with regard to the use of ‘embryonic’ stems cells in medical research. Further to this, there are intermittent stories in relation to unlicensed stem cell procedures carried out with little regard for the safety of the patient or the effectiveness of the procedure.
With respect to adult stem cell research, those cells taken from an individual’s own body, or likely that of a consenting relative, ethical dilemmas are less controversial. In 1956, the first successful bone marrow transplant between a related donor and recipient was performed by Dr E. Donnall Thomas in New York. The patient, who had cancer, leukaemia, was given radiotherapy and then treated with stem cells, (healthy bone marrow from an identical twin). This was a stem cell therapy procedure in action, and since, has become accepted use in the treatment of leukaemia.
Stem cell research is one important area of interest in relation to the future treatment of multiple sclerosis. Only through evidence based research, can we develop a greater understanding of both multiple sclerosis and the ability to harness and utilise stem cells in an effort to treat and ultimately cure the condition. Many collaborators are working to this end.
The U.S. based non-profit research organisation, called the Myelin Repair Foundation (MRF) is focused on accelerating the discovery and development of myelin repair therapeutics for MS. With the support of the MRF, researchers at Case Western Reserve University in the U.S., lead by Dr. Robert Miller PhD., identified a pathway in which stem cell signals not only protected myelin, which is damaged by the immune reaction in MS, but also facilitated myelin repair.
From this research, Dr. Miller and his colleague, renowned researcher Arnold Caplan PhD., encouraged multiple sclerosis expert Dr. Jeffrey Cohen MD, Director of Experimental Therapeutics at Cleveland Clinic’s Mellen Center, to develop a phase I clinical trial, which won a $2.75 million, four-year grant from the U.S. Department of Defense and a $1 million grant from the National Institute of Health (NIH).
The trial involves harvesting a patient's stem cells, found in the bone marrow, culturing them in a laboratory, and then injecting them back into the patient in order to see whether the procedure is safe, if it decreases disease activity, and/or leads to improved repair. A total of 24 participants were to be enrolled, half with relapsing remitting MS and half with secondary progressive MS. As of April 2012, 12 of 24 participants had been enrolled.
Dr. Cohen said, “The hope is that mesenchymal stem cells (MSCs) will lessen ongoing damage caused by MS and promote repair. We're taking a cautious approach, carefully monitoring for any unexpected side effects, as we look to see if MSCs have the abilities that we anticipate."
Study participants will be monitored very closely for six months after they receive the MSC transplantation, to determine whether the procedure is safe and well tolerated. The research team will also monitor their disease status. Finally, in collaboration with investigators at the Montreal Neurological Institute, the immunologic effects of MSCs will be comprehensively assessed, both in culture and in the patients.
Dr. Cohen says no side effects or complications have been seen from the safety data so far. The date for final data collection is December 2014.
Further Links on Stem Cells and MS
The Trial Autologous MSC Transplantation in MS
Stem Cells and MS: Future Therapy