Could Stem Cells Slow Down Disability Progression in MS Patients?

<blockquote> <h3>Fast Facts</h3> <ul> <li>Approximately 2.8 million people live with multiple sclerosis (MS) worldwide </li> <li>There are four types of MS including secondary progressive MS (SPMS), a more advanced stage of disease in which symptoms worsen over time. </li> <li>Two-thirds of people with relapsing-remitting MS (RRMS) progress to SPMS </li> <li>Treatment for SPMS is focused on symptom management and slowing down disease progression as there is no cure</li> </ul> </blockquote> <p>A team of Italian researchers has found that people with active secondary progressive MS (SPMS) who received a stem cell treatment developed disability more slowly than those taking anti-inflammatory disease-modifying therapies (DMTs), a class of drugs that impact the underlying disease.</p> <p>Previously, hematopoietic stem cells (HSCs: blood cells that form in the bone marrow) were shown to delay disability when transplanted to patients with relapsing-remitting MS (RRMS). Until recently, little research had been done on autologous HSC transplants (AHSCT) in SPMS, which involve taking healthy cells from your own body to replace the diseased ones.</p> <figure> <figure> <figure><img alt="Stem cell therapy for multiple sclerosis | Source: https://www.amaskincare.com/about/alice-pien-md-medical-director/ Alice Pien, MD" src="https://cdn.storymd.com/optimized/YqGmKKh1ol/thumbnail.jpg" /> <figcaption>Stem cell therapy for multiple sclerosis. <em>Source: Alice Pien, MD</em></figcaption> </figure> </figure> </figure> <p>Most MS patients start with an RRMS diagnosis, which entails flare-ups followed by calmer seas. Many people with RRMS progress into having SPMS, a condition where instead of experiencing big swings in symptoms, you have a slow and steady decline. Current treatments for SPMS offer modest benefits at best, leaving room for improvement.</p> <h2>About multiple sclerosis</h2> <p>MS is a chronic central nervous system disease that is unpredictable; the effects and progression vary from person to person. As it takes hold, patients often notice blurred or double vision, impairment of color perception, strange feelings, pain and numbness, prickling, and pins and needles. </p> <p>Described as “a silent disaster unfolding” by one patient, MS is a disease in which your own body’s immune system attacks myelin, the fatty insulation that coats neurons of the brain and spinal cord. Myelin protects nerve cells and expedites the electrical jolts moving from one neuron to the next, jumping across synaptic gaps via rapid bursts of chemicals. </p> <figure> <figure> <figure> <figure><img alt="Myelin sheaths | Source: TheVisualMD" src="https://cdn.storymd.com/optimized/Rdar7vuXql/thumbnail.jpg" /> <figcaption>Myelin sheaths. <em>Source: TheVisualMD</em></figcaption> </figure> </figure> </figure> </figure> <p>Minus the myelin, signaling between brain and body becomes a confusing mess or disappears entirely. For the patient, this communication breakdown is noticeable through oddities in your toes and fingers and glitching and twitching.</p> <p>General symptoms include:</p> <ul> <li>Weak muscles</li> <li>Coordination loss</li> <li>Partial or total paralysis</li> <li>Speech troubles</li> <li>Cognitive issues, e.g., memory, attention, and concentration</li> </ul> <p>We don’t have a formalized test for MS; instead, we monitor for MS attacks, two of which must happen at least a month apart, and there must be more than one area of damage to the central nervous system myelin in order to justify a diagnosis. It isn’t clear what causes MS to manifest in the first place, though it may be a combination of genetic and environmental factors.</p> <figure> <figure><img alt="Symptoms and Findings in Multiple Sclerosis | Source: Guido4/Wikimedia" src="https://cdn.storymd.com/optimized/8ok7BEC4o7/thumbnail.png" /> <figcaption>Symptoms and Findings in Multiple Sclerosis. <em>Source: Guido4/Wikimedia</em></figcaption> </figure> </figure> <h3>What are stem cells?</h3> <p>The key word with stem cells is potential: they have the ability to transform into all sorts of cell types in the body, from blood to brain tissue. They are neutral until given a designation as to what they are to turn into, and they act as a repair system for damaged tissue. There is a great deal of hype in the medical world about stem cells’ potential to deliver breakthrough therapies for all sorts of disabling conditions as well as cancer.</p> <p>As it stands, there are only a handful of FDA-approved stem cell treatments; it’s a relatively new area, and we’re still learning how to master the science behind it. Despite this, there are many private clinics out there advertising unapproved stem cell treatments for a litany of disorders, so it’s important to be wary.</p> <h2>Treatment not only delayed but improved disability symptoms </h2> <p>The study is a retrospective analysis involving 79 patients with active SPMS who received the stem cell transplants and 1,975 people from Italy’s MS registry who were treated using drugs. The two cohorts were matched for variables like sex, age, and level of disability. </p> <p>In the paper, the researchers describe their analysis of over 10 years of data on the two groups. Disability was measured using the 10-point expanded disability status scale (EDSS). The median score at the beginning of the study was 6.5, defined as requiring a cane or brace on both sides to walk 20m without rest.</p> <p>In terms of who became worse off over the study period, a clear point of separation was noted at the five-year mark: 62% of those who received AHSCTs did not experience worsening disability compared to 46% of those on the medications. 19% of the AHSCT group witnessed sustained improvements at this point, whereas it was only 4% for the control group. </p> <p>By 10 years, the EDSS score for the stem cell group had decreased by an average of 0.01 points per year, meaning that their disability had improved. For the medications group, their score increased by 0.16 points per year, meaning things got worse.</p> <p>“A proportion of patients with AHSCT had improvement in their disability scores, which further strengthens the argument that AHSCT is effective in secondary-progressive multiple sclerosis,” commented Daniel Ontaneda of Cleveland Clinic’s Mellen Center for Multiple Sclerosis in Ohio. </p> <p>“However, all this data has to be taken with caution, as it is observational, and not produced in the gold standard context of a randomized clinical trial. Although the authors made attempts to ensure the groups were comparable, some residual confounding factors may still be present,” he added.</p> <p>Encouraging as the findings are, further research is needed in larger groups to confirm the results. It’s also not clear if the AHSCT therapy would help with SPMS that is not active, i.e., not expressing signs of inflammatory disease activity.</p> <p>Lead author Matilda Inglese commented to the media that, spurred on by these findings, the team are going ahead with a randomized controlled clinical trial in Italy. The goal of this study will be to investigate the use of HSCTs against highly active RRMS, as compared to the best available conventional treatments.</p> <h2>More on Multiple Sclerosis</h2><ul><li><a href="https://soulivity.storymd.com/journal/oja88enu4w-multiple-sclerosis" target="_blank">Multiple Sclerosis (MS): Causes, Symptoms, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/oja887z04w-stem-cell-basics" target="_blank">What Are Stem Cells and What Do They Do?</a></li><li><a href="https://soulivity.storymd.com/journal/wvbd385u7m-myelin" target="_blank">Myelin and Its Role in the Nervous System</a></li></ul>