By Drs. David Niesel and Norbert Herzog
An international trial was recently published revealing the outcomes for 145 patients with relapsing-remitting multiple sclerosis who received blood stem cell transplantation. Excitingly, these stem cell transplants were associated with substantial improvements in neurological symptoms and other clinical outcomes of MS. While these are preliminary findings they are nonetheless exciting. MS is a disease in which a person's own immune system attacks the myelin sheath that covers nerves. This reduces the ability of nerves in your brain to efficiently communicate with your muscles. Myelin is a wrapping made of lipids or fats and proteins that serve to insulate and protect nerves much like the plastic covering of electrical wires. Myelin also serves to greatly increase the speed by which nerves signals are transmitted. Myelin is present in both the central nervous system and the peripheral nervous system. In MS, only the myelin in the CNS is affected. The damage in MS can also lead to damage of the nerves, eventually leading to scarring and issues with nerve conduction. If this process is not stopped it can lead to permanent neurodegeneration.
Symptoms of MS vary for each individual and over time. Symptoms can include fatigue, numbness or tingling, weakness, dizziness, pain, difficulties walking, spasticity, vision and bladder problems among many others. These primary symptoms can advance to more severe secondary and tertiary symptoms. This is an incurable disease that can leave a person unable to walk and perform other routine tasks.
Current treatments include strategies to manage relapses or attacks and the symptoms. So the thought was if the immune system in an MS patient could be re-booted to the state before it began to attack the myelin, then the symptoms of MS would disappear. This technology has been used for many years in the treatment of blood cancers. The treatment is called autologous hematopoietic stem cell transplant. The rogue immune system is first destroyed using chemotherapy. The immune system is then replaced using stem cells from the patient's own blood. These cells are very immature and have not yet learned to attack the myelin and therefore could still protect these patients from infections but no longer damage the myelin and stop and perhaps even reverse the effects of MS.
Indeed, several MS patients who received transplants have gone from being wheel chair bound to once again walking and regaining other functions of normal living. For some patients, the improvements have persisted for at least four years, another encouraging fact. Right now physicians categorize these recoveries from MS as dormant MS and it remains to be seen if they are permanent.
Of course, cost to benefit analysis cannot be ignored. The approximate $45,000 one-time cost of a transplant is about equal to the cost of care for some MS patients per year. That makes the math easy, if this works and is a cure, the cost is well worth it. Even if these transplants cannot be used to treat all forms of MS, at least some of MS patients have hope of a permanent solution to their symptoms.
Medical Discovery News is hosted by professors Norbert Herzog at Quinnipiac University, and David Niesel of the University of Texas Medical Branch. Learn more at www.medicaldiscoverynews.com.