Multipe Sclerosis - Treatment

Cell Therapy - updated: 10 November 2009

Cell therapy for autoimmune diseases

Arthritis Res Ther. 2007;9(2):206.

Dazzi F, van Laar JM, Cope A, Tyndall A.

Cell therapy, pioneered for the treatment of malignancies in the form of bone marrow transplantation, has subsequently been tested and successfully employed in autoimmune diseases. Autologous haemopoietic stem cell transplantation (HSCT) has become a curative option for conditions with very poor prognosis such as severe forms of scleroderma, multiple sclerosis, and lupus, in which targeted therapies have little or no effect. The refinement of the conditioning regimens has virtually eliminated transplant-related mortality, thus making HSCT a relatively safe choice. Although HSCT remains a nonspecific approach, the knowledge gained in this field has led to the identification of new avenues. In fact, it has become evident that the therapeutic efficacy of HSCT cannot merely be the consequence of a high-dose immuno-suppression, but rather the result of a resetting of the abnormal immune regulation underlying autoimmune conditions. The identification of professional and nonprofessional immunosuppressive cells and their biological properties is generating a huge interest for their clinical exploitation. Regulatory T cells, found abnormal in several autoimmune diseases, have been proposed as central to achieve long-term remissions. Mesenchymal stem cells of bone marrow origin have more recently been shown not only to be able to differentiate into multiple tissues, but also to exert a potent antiproliferative effect that results in the inhibition of immune responses and prolonged survival of haemopoietic stem cells. All of these potential resources clearly need to be investigated at the preclinical level but support a great deal of enthusiasm for cell therapy of autoimmune diseases.

Publication Types:

• Review

Stem cells in therapy of multiple sclerosis

Duodecim. 2009;125(9):965-73.

Narkilahti S, Hovatta O, Elovaara I.

In multiple sclerosis, inflammatory autoimmune response, degeneration of the central nervous system and axonal damage eventually lead to disability. The inflammatory reaction can be controlled with current medication, whereas the neuronal and myelin damage is practically uncontrollable. Cell therapies may provide a new means to prevent nerve cell destruction and promote the regeneration of brain tissue. Bone marrow stem cell transplantation has been used as an immune response modifying therapy in severe MS. Experimental evidence of corrective and protective effects on tissues by preneuronal cells differentiated from fetal and embryonal human stem cells has been obtained in an animal model.

Publication Types:

• Review

Regeneration and repair in multiple sclerosis: the role of cell transplantation

Neurosci Lett. 2009 Jun 12;456(3):101-6

Pluchino S, Zanotti L, Brini E, Ferrari S, Martino G.

Physiological (spontaneous) and reactive (reparative) regenerative processes are fundamental part of life and greatly differ among the different animals and tissues. While spontaneous regeneration naturally occurs upon cell attrition, reparative regeneration occurs as a consequence of tissue damage. Both spontaneous and reparative regeneration play an important role in maintaining the normal equilibrium of the central nervous system (CNS) as well as in promoting its repair upon injury. Cells play a critical role in reparative regeneration as regenerating structures (cells or tissues) depend on the proliferation without (de)differentiation of parenchymal cells surviving to the injury, proliferation of stem (progenitor) cells resident in the injured tissue, dedifferentiation of mature cells in the remaining tissue, or by the influx of stem cells originating outside the damaged tissue. Considering the central role of stem and progenitor cells in regeneration, a spur of experimental stem cell-based transplantation approaches for tissue (e.g. CNS) repair has been recently generated. This review will focus on the therapeutic efficacy of different sources of somatic stem cells - and in particular on those of neural origin - in promoting CNS repair in a chronic (auto)immune-mediated inflammatory disorder such as multiple sclerosis.

Publication Types:

• Review

Stem cell therapy in multiple sclerosis: a clinical update

Z Rheumatol. 2009 May;68(3):214-5, 217-9.

Schippling S, Martin R.

Promising results in an animal model of multiple sclerosis (MS; experimental autoimmune encephalomyelitis, EAE) have shown that immunosuppression followed by allogeneic bone marrow transplantation has the potential to significantly ameliorate the spontaneous course of the disease. Since 1995, emerging data on autologous hematopoietic stem cell transplantation (AHSCT) has supported a benefit also in patients with multiple sclerosis. To date, results on approximately 500 cases have been consecutively reported by the European Group for Blood and Marrow Transplantation (EBMT). These reports have not only proved a favourable outcome for many patients but also provided the rationale for the currently ongoing controlled trials on AHSCT in MS. At present, results from the ASTIMS study in particular, a multicenter active-controlled phase II study, are awaited. However, a number of critical issues remain unresolved. Furthermore, with upcoming new treatment compounds that to some extent act via lymphoablative properties, it remains essential to better select those patients who might profit most from stem cell therapy based on a justifiable benefit-to-risk ratio. Although transplant related mortality has dropped to 1%, mortality combined with concerns about long-term safety remain critical issues in a primarily non-life-threatening disease like MS.

Publication Types:

• Review

Stem cell transplantation in multiple sclerosis

Schippling S, Heesen C, Zander A, Martin R.

Following promising results in animal studies showing that immunosuppression and consecutive allogeneic bone marrow transplantation has the potential to significantly reduce autoimmunity, emerging data is supporting a benefit in patients with multiple sclerosis (MS) and other autoimmune disorders not responding to approved therapies. Until today, results on over 400 cases have been reported by the European Blood and Marrow Transplantation Group (EBMT), many of them with a favorable outcome. However, results of randomized, controlled clinical trials are missing. Furthermore, with upcoming new treatment compounds that to some extent act via lymphoablative properties, it remains essential to better select those patients who might profit most from stem cell therapy based on a justifiable benefit-to-risk ratio.

Publication Types:

• Review

Publication Types:

• Review