Stem Cell Transplantation in Multiple Sclerosis: Not Ready for Prime Time

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Another central nervous system repair technique that is often discussed and under research is stem cell transplantation. It’s clearly not the only one, and it may not turn out to be the most effective.

Stem cell research in multiple sclerosis (MS) is in its infancy. There are still questions that must be answered. First, what should be the source of the cells: fetal placental or hematogenous blood? Patricia K. Coyle, MD, describes how skin cells can be exposed to factors and create neuroprogenitor stem cells. Other questions include: What is the best dose? What is the frequency? What is the ideal administration in MS patients?

She explains that stem cells are basically pluripotent cells, which could replace neurons and the oligodendrocytes; however, both of those cell populations are lost in MS, which makes the concept stem cell transplantation interesting. Approaches are being refined and may result in an effective treatment to restore fixed damage, to repair fixed damage, and restore function in MS patients.

Fred Lublin, MD, describes hematopoietic stem cell transplantation as an aggressive MS therapy. He explains that a patient’s immune system is wiped out by chemotherapy and reconstituted with his or her own stem cells. A couple of recent studies suggest that the therapy may be better than chemotherapy alone, because higher doses can be given. He explains that there is a mortality associated with it, and he is disappointed that this physically challenging approach does not cure the disease. There are even some data suggesting that the brain continues to shrink over time and MS activity may return. Another approach, he notes, is mesenchymal cell transplantation, which attempts to enhance repair. This approach does not involve wiping out the patient’s bone marrow or the concomitant use of chemotherapy, and the early safety results are reasonable.