Is Stem Cell Transplantation A New Cure For Multiple Sclerosis?

This disease then causes a breakdown in communication between the brain and the body. One can use the analogy of the nervous pathways in the body resembling highways littered with potholes. 

How does multiple sclerosis come about?

There are 3 ways in which myelin covering the nerve cells are damaged. These include the formation of plaques on the affected tissue in the central nervous system, inflammation of this tissue and breakdown of the myelin sheaths of neurons.

MS is also thought to be an auto-immune condition where there's interaction of the patient's genetics and certain environmental factors. These have been hypothesized to include issues such as tobacco smoke exposure, exposure to certain solvents, increased stressors or previous infections with mumps/rubella/measles and other viruses. 

What are the signs and symptoms?

The signs and symptoms of MS depends on where in the central nervous system the disease is causing damage. Therefore, the clinical presentation in these patients can vary tremendously.

These signs and symptoms can then include the following:

• Paraesthesia, which is a decrease in or loss of sensation in the limbs and can include the sensation of "pins and needles".
• An increase in reflexes in the limbs.
• Muscle spasms.
• Ataxia, which is difficulties with balance and coordination. The cerebellum will be affected here.
• Problems with swallowing and speech.
• Eye related issues such as nystagmus, double vision (diplopia) or optic neuritis.
• Fatigue.
• Acute or chronic pain.
• Bladder and/or bowel related problems such as chronic diarrhoea, constipation or incontinence.
• Emotional issues and mood disorders such as depression.

There are signs though which seem to be characteristic of MS and they are the following:

• Uhthoff's phenomenon is when there is a worsening of symptoms when the patient is exposed to higher than normally experienced temperatures.
• Lhermitte's sign is characterized by an electrical-like sensation that runs down the back when the patient bends their neck.

Diagnosing MS

The most commonly used way to diagnose MS is through the McDonald criteria. This criteria focuses on clinical findings, laboratory results and radiological evidence of lesions being found in different areas and at different times.

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Diagnosing MS can be difficult in the initial stages of the disease. The neurological signs and symptoms which it produces though would warrant a referral to neurologist. They would then further examine the patient and ask for imaging investigations such as CT and MRI scans to be performed. The findings here include the presence of plaques on brain tissue. Cerebrospinal fluid analysis may show signs of chronic inflammation involving the central nervous system. This finding gives merit to the possible diagnosis of MS when the clinical picture and radiological findings point to the same disease.

The Relevance Of Stem Cell Research In Multiple Sclerosis

Management of multiple sclerosis

Unfortunately, there is no cure for MS but there are treatments available which help to reduce disabilities caused by the disease as well as to reduce symptoms and signs caused by acute attacks. These acute attacks seem to respond well to high doses of intravenous steroid therapy.

Relapsing-remitting MS (RRMS) is being treated by disease-modifying agents, such as interferon beta-1a and 1b, and are effective in reducing the number of attacks the patient has. Regarding progressive multiple sclerosis, only mitoxantrone had shown any effect in reducing relapse rates and slowing down the disease's progression.

Stem cell therapy

A study was done on 151 patients who underwent haematopoietic stem cell transplantation (HSCT). They were subjected to low-doses of chemotherapeutic medication which suppressed their immune-systems and they were then given stem cells via an infusion. The stem cells, which were harvested from the patients themselves, helped to reboot their immune systems in order to stop producing auto-antibodies which would target central nervous system tissue.

The patients were then followed up with questionnaires regarding their signs and symptoms and with imaging investigations. Two years after this transplant was done, it was found that 50% of the patients involved had showed major improvement in their disability. Of the patients who were followed up 4 years after the transplant was done, more than 80% of them had not experienced relapses of the disease.

The cost of this treatment is very expensive though, reaching the mid-hundred thousand dollar range, but with that been said one has to consider that it is a once off treatment. With the disease-modifying agents costing up to $5000 per month, and remembering that they need to be taken indefinitely otherwise the patient will relapse, HSCT therapy will pay itself off at around 18 months time.  

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It's important to take note that HSCT therapy is not an effective treatment for managing progressive multiple sclerosis. It's also important to remember that if the patient is doing well and functioning on a normal level for them, then they should rather stay on the first-line therapy that they're using. If the patient is experiencing 2 or more relapses a year despite those treatments, then the patients and their doctors should consider stem cell transplantation.

Conclusion

Stem cell transplant therapy is currently only available to patients undergoing clinical trials. The therapy is also available to patients on a compassionate basis, ie. those who have a poor prognosis and who are terminally ill .