Disabled Traveler: Progress in Stem Cell Treatment of Secondary Progressive Multiple Sclerosis

_**A s****_t_em 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 came for progressive MS.

What is "Secondary Progressive" MS?

Remember the _**main MS types**_ (Wikipedia), and their symptoms [2]

* **_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 fro RRMS to SPMS is that the baseline drugs[ CRABT] work less well (Copaxone, Rebif, Avonex, Betaseron and Tysabri); Disability has progressed.

* **_Progressive Relapsing (PRMS)_** : Steady neurologic decline and superimposed attacks

* **_Primary Progressive (PPMS)_** : Decline from the beginning without attacks problems walking, which gradually gets 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 cardiac risk for long term use
* Tysabri (Natalizumab)
* Some Interferons might work for some people to a certain extent.

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.

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

_Note: Autologous means the stem cell are taken from the patients 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, or optic nerve magnetisation transfer ratio…"

_**So it seems that the progress was there, but limited.**_

This probably why the study concludes cautiously that "… the study was _suggestive_ of neuroprotection…"

[![][1]][2]

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 suffers 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**_: They also are multipotent _**stem cells that give rise to all the blood cell types**_. A phase II study about infusion of these stem cells on MS patients with visual impairements, [ 3], the results were modest , but encouraging: "…Autologous mesenchymal stem cells were safely given to patients with secondary progressive multiple sclerosis in our study. The evidence of structural, functional, and physiological improvement after treatment in some visual endpoints is suggestive of neuroprotection…"

The Lancet here too, reported a study in 2008 [3], and the Biology of Blood and Marrow Transplantation 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 a research very much in flux.

Note that Hematopoietic Stem Cells Transplant, although complex and risky, have been a treatment for a many diseases from leukemia to anemia to immuno-deficiencies, usually when everything else fails.

_**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 t**__**alk to your Doctor**_

Sources:

1. [About.com ; Julie Stachowiak][3]
2. [The Lancet][4] ; "Autologous mesenchymal stem cells for the treatment of secondary progressive multiple sclerosis: an open-label phase 2a proof-of-concept study" ; Jan 2012
3. [The Lancet ][5]; "Autologous haematopoietic-stem-cell transplantation for multiple sclerosis." ; Jan. 2005
4. [Biology of Blood and Marrow Transplantation ][6]; "Hematopoietic stem cell transplantation for multiple sclerosis: collaboration of the CIBMTR and EBMT to facilitate international clinical studies." ; Aug 2010
5. [Brain; Oxford journals ][7]; "Autologous haematopoietic stem cell transplantation fails to stop demyelination and neurodegeneration in multiple sclerosis" ; Feb. 2007
6. [Beaker; Sanford-Burnham ;][8] "A Word of Caution on Mesenchymal Stem Cells" ; March 2011

[![Email][9]][10][![Twitter][11]][12][![LinkedIn][13]][14][![Facebook][15]][16][Share/Bookmark][17]

URL: http://www.medinewsdigest.com/?p=3861

Sunday, February 12, 2012

Progress in Stem Cell Treatment of Secondary Progressive Multiple Sclerosis

No comments:

Post a Comment