- Multiple sclerosis is an autoimmune disease that affects your central nervous system.
- There are many available treatments used today, but stem cells transplantations are not considered standard.
- Experts say some people with multiple sclerosis may benefit from stem cell transplantations, but there are risks involved.
High voltage electrical transmission cables are usually wrapped in a protective layer of insulation. If the insulation is removed, electrical problems can certainly be expected.
This is essentially how myelin functions in the human body. Nerve fibers are coated with a layer of insulation made of proteins and fats called a myelin sheath. This sheath protects nerve fibers and speeds up electrical activity.
Multiple sclerosis (MS) is an autoimmune disease that causes your body’s natural defense systems to mistakenly attack and destroy these myelin sheaths. Depending on the exact location and scope of this damage, it could manifest as a variety of neurological symptoms.
Stem cells transplantations are not a standard treatment for MS, but new research published in the Journal of Neurology, Neurosurgery & Psychiatry examines whether it might be an option worth exploring.
While some people with MS might benefit from this type of treatment, it’s not recommended for everyone. Let’s find out what experts had to say about the study.
According to Dr. Augusto Miravalle, the chief of the RUSH University Multiple Sclerosis Center in Chicago who was not involved in the study, part of what makes treating MS complicated is that researchers are still trying to determine what causes MS.
“The cause of MS is still unsolved, but recent research has provided valuable insight into certain genetic and epigenetic (environmental) factors that increase the risk of developing MS. How these genetic and environmental factors influence the risk of developing MS is not fully understood,” Dr. Miravalle told Medical News Today.
Complicating things further, the disease progression of MS can be different from one person to the next.
“Most patients (85%) develop a relapsing-remitting course of the disease, characterized by episodes of neurological symptoms followed by resolution or remission. A small proportion of patients develop sustained accumulation of disability from the early stages of the disease, a type of MS often described as primary progressive MS,” said Dr. Miravalle.
Other variations include secondary progressive MS and clinically isolated syndrome. Why any individual might develop one type of MS instead of another is still an open question.
“There is a lot left to learn about the ‘why’ behind MS,” Dr. Suma Shah, a neurologist at Duke Health in North Carolina who was not involved in the study, told Medical News Today.
The past several decades, however, have come with many treatment advances.
“Significant progress has been made in the treatment of relapsing-remitting MS (RRMS), particularly in the realm of disease modifying treatment options. Many of our recent high efficacy treatments offer far better opportunities at disease control than has previously been seen,” said Dr. Shah.
Stem cell transplants are used to treat a number of conditions ranging from blood disorders to certain types of cancer.
There are several types of stem cells and stem cell transplants. In this study, scientists examined autologous hematopoietic stem cell transplantations, or
Dr. Barbara Giesser, a neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in California who was not involved in the study, explained this process Medical News Today.
“In aHSCT, a sample of the blood forming (hematopoietic) cells are removed from the person’s bone marrow, and then the rest of the bone marrow is ablated with chemotherapy. The retained bone marrow is treated to remove any cells that are attacking the nervous system and then the treated marrow is infused back into the patient,” said Dr. Giesser.
“The overall goal is to renew or reboot the immune system into a friendlier state that will not attack the brain and spinal cord,” Dr. Michael Sy, a neurologist at UCI Health in California who was not involved in the study, told Medical News Today.
“Of note, these stem cells become a new immune system. They do not become new neural stems cells and do not directly regrown nerves or myelin,” said Dr. Sy.
“What is notable about this study is the high proportion of patients who had no evidence of disease activity, meaning no clinical attacks or worsening, and no new areas of damage seen on MRI at 5 and 10 years of follow-up, and the over 50 percent of patients who had improvement in disability,” said Dr. Giesser.
While these results are impressive, experts also warn that understanding these numbers must take a nuanced approach.
“Patients must be cautious of interpreting improvement, as the natural course of patients with RRMS is to improve after a relapse and they can continue to improve for months after a relapse,” Dr. Edith Graham, a multiple sclerosis and neuroimmunology specialist at Northwestern Medicine in Chicago who was not involved in the study, told Medical News Today.
Still, AHSCT could provide some benefits over existing treatments for RRMS.
“Current therapies require ongoing treatment that keep the immune system weaker and are very costly. AHSCT involves a larger initial risk and cost, but afterwards patients generally do not need and do not receive further treatment. Thus, they are not immunosuppressed on an ongoing basis and health systems may eventually see cost savings,” said Dr. Sy.
Dr. Nancy Sicotte, the chair of the Department of Neurology at Cedars-Sinai in Los Angeles who was not involved in the study, told Medical News Today that AHSCT is not for everyone.
“I want to emphasize that the people who benefit from this are not that common. They are people who have very, very active RRMS. It has been tried in people with primary or secondary progressive MS, and it did not appear to be beneficial, and it has risks associated with it,” said Dr. Sicotte.
Even though AHSCT might lead to improvements, it’s also not a cure.
“The benefit from the transplant doesn’t last forever in most cases. There will eventually be a return of some inflammatory activity. But it certainly seems to put the disease into remission,” Dr. Sicotte said.
Experts also said that the study itself, while useful, was far from definitive.
“The biggest limitation of this study is that there is no control group,” pointed out Dr. Graham.
“[Another limitation was] the short time for defining safety (only 3 months after transplant). This limits the ability to confidently speak to the long-term implications of AHSCT in this population,” said Dr. Shah.
Those long-term implications could be quite severe.
“This is an aggressive therapy, with the main potential risks being infection, or re-activation of latent viral infection. There might also be potential concerns about effects on fertility, depending upon the type of chemotherapy that is used,” said Dr. Giesser.
Studies with promising results have the potential to produce an emotional response from people who might benefit from the treatments.
“I would use the National MS Society website as a resource. When these studies come out it can create some confusion in the patient population,” recommended Dr. Sicotte.
“There are also places claiming to offer ‘stem cell treatments,’ some of them outside the United States, so there’s some medical tourism going on. It’s potentially expensive and could be dangerous, so we really like to guide people to reliable sources of information,” Dr. Sicotte added.
Other related studies are currently seeking to better understand the risks and benefits of AHSCT.
“There are already two randomized clinical trials under way comparing AHSCT to current best available therapy, one in the US and one in Europe. The results of those studies will hopefully show whether AHSCT truly is superior to current therapies and whether the benefits outweigh the risks,” said Dr. Sy.
“Today, AHSCT is becoming more widely used here in the US and insurance may cover the costs. If patients are interested, they should speak with their neurologist and obtain a referral to a center that offers this treatment,” Dr. Sy advised.
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