A stem cell treatment for secondary progressive MS has undergone phase II clinical trials in England.

This is good news because most of the treatments on the market help Relapsing Remitting Multiple Sclerosis, but few new treatments are available for Progressive MS.

What is “Secondary Progressive”  MS?

Remember the main MS types, and their symptoms [1]. The source here is the good Julie Stachowiak  MS  blog at about.com

  • Relapsing-Remitting  (RRMS):    Unpredictable attacks (relapses) followed by periods of relative remission with no new signs of disease activity
  • Secondary Progressive (SPMS) :     Neurologic decline without acute relapses: A sign that one is evolving from RRMS to SPMS is that the baseline drugs[ CRABT]  work less well (Copaxone, Rebif, Avonex, Betaseron and Tysabri); Disability has progressed. This group is fairly large : about 50 % of RRMS evolves into SPMS within age 40.
  • Progressive Relapsing (PRMS) :     Steady neurologic decline and superimposed attacks.
  • Primary Progressive  (PPMS) :    Decline from the beginning without attacks; problems walking, which gradually get worse; slowly worsening tremor; problems with balance.
Since the “CRABT”  and other immunomodulator, disease modifying  drugs, work less well against Secondary Progressive MS, what is often prescribed?

Wikipedia, in [1], singles out the following meds:

  • Mitoxantrone (might have cardiac risk for long term use)
  • Tysabri (Natalizumab)
  • Some Interferons might work for some people.

Recent research  in stem cell therapy has brought some new venues  for Secondary and Primary Progressive MS. The hope, as in all stem cell therapy, is based on regeneration mechanisms that the stem cells initiate. Diseased tissue would make way for healthy one.

The stem cells infused or injected are of two types:

 1)  Autologous Mesenchymal Stem Cells (AMSC) :  Mesenchymal stem cells (MSCs) are found in multiple human adult tissues including Bone marrow, Joints (synovial tissues), and Fat  adipose tissues. (Wikipedia). They are  multipotent stem cells that can differentiate into a variety of cell types, including: bone cells, cartilage cells, and  fat cells.

Note: Autologous means the stem cells are taken from the patient’s own body, bypassing, among others,  the embryonic stem cell ethical issues.
The Lancet, an authoritative British medical journal, published a small scale human study (20 MS patients) [2]. The MS symptoms tracked were affecting  vision.  They noted improvement after treatment in visual acuity, however,   “…[They]  did not identify any significant effects on colour vision, visual fields, macular volume, retinal nerve fiber layer thickness..”
So it seems that the progress was there, but limited.
This probably is why  the study concludes cautiously that “… the study was suggestive of neuroprotection…”

Bone Marrow Harvesting (Wikipedia Commons)

Usually, direct injection or placement of cells into a site in need of repair may be the preferred method of treatment, as vascular delivery (infusion) can suffer from a “pulmonary first pass effect” where intravenous injected cells are sequestered in the lungs (Wikipedia). That might present additional challenges for MS.

2)  Autologous Hematopoietic Stem Cells (AHSC) :  They are  also  multipotent stem cells, and they  give rise to all  blood cell types.  A phase II study was conducted about infusion of these stem cells on MS patients [ 3].  The results were encouraging: “Relapses dramatically decrease and inflammatory MRI activity is almost completely suppressed...” Yes, they are still talking about improvement in relapses, which does not demonstrate directly progress in SPMS. Progresssive Relapsing (PRMS) , maybe?

 The Biology of Blood and Marrow Transplantation [4] summarized the status of this kind of research in 2010. Even though a lot of hope is riding on Hematopoietic stem cells transplantation, [4] ‘s summary describes  AHSC as still very much in the  research stage.
Note that Hematopoietic Stem Cells Transplants, although complex and risky, have been a treatment for a many diseases from leukemia to anemia to immuno-deficiencies, usually when everything else fails.
At this time, It seems that AHSC is ahead of AMSC for RRMS.  For SPMS, the field is more open. On the other hand RRMS is in general less severe than SPMS, so the need to go to the stem cell research procedure for RRMS is less clear
To be sure, the treatment also has studies that end in failure, like this German study on the autologous hematopoietic stem cells [ 5].

Warnings of caution have also been issued [6] for  Mesenchymal Stem Cells Transplants.  Of concern are stem cell migrating to wrong parts of the brain, and forming masses, or “… More disturbing, the mesenchymal stem cells seemed to play out their natural biology in the brain – making connective tissue, such as cartilage, in response to inflammatory cues…”

Hmmm…

So, Progressive MSers, hang in there,

We will let you know when we hear something….

Hope this helps, and talk to your Doctor

Sources:

  1. About.com ; Julie Stachowiak
  2. The Lancet ; “Autologous mesenchymal stem cells for the treatment of secondary progressive multiple sclerosis: an open-label phase 2, a proof-of-concept study” ; Jan 2012
  3. The Lancet ; “Autologous haematopoietic-stem-cell transplantation for multiple sclerosis.” ; Jan. 2005
  4. Biology of Blood and Marrow Transplantation ; “Hematopoietic stem cell transplantation for multiple sclerosis: collaboration of the CIBMTR and EBMT to facilitate international clinical studies.” ; Aug 2010
  5. Brain; Oxford journals ; “Autologous haematopoietic stem cell transplantation fails to stop demyelination and neurodegeneration in multiple sclerosis” ; Feb. 2007
  6. Beaker;  Sanford-Burnham ; “A Word of Caution on Mesenchymal Stem Cells” ; March 2011

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