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July 31, 2018

Multiple sclerosis (MS) is a disease of the brain and/or spinal cord and gets progressively debilitating over time. This disease can be seen in all age groups, being more prevalent in younger sections, women and more number of cases in northern latitudes. This disease is a peculiar one among neurological diseases as its mechanism is yet to be deduced completely! Multiple sclerosis is a chronic condition where nerves undergo a loss of myelin sheath: a coating that insulates the nerve cells and is required for the efficient working of nerve cells. The damage to nerve cells leads to disability, problems in balance and understanding, as well as negative impacts on quality of life. The most usual case is Relapsing-remitting multiple sclerosis (RRMS) where there are symptoms that appear between phases of recovery!

Current medication is based on modulation of the immune system to minimize the attack on the nerve cells to prevent relapse of the disease, but these medicines do not repair the damages to the nerve cells or prevent relapse of the disease. Another challenge with the treatment is the cost; a recent report states that the average estimated cost of MS treatment especially disease-modifying therapies ranks second after heart failure: US$60,000 annually! The use of immune suppressors such as corticosteroids protects the cells from the immune system but do not address the damage that causes deterioration of the nerves further! Moreover, although the patients undergo standard therapies for MS, a secondary progressive phase generally occurs in the majority of patients, which, unfortunately, none of the available therapies can tackle.

So, what do we do to address this? This is where we could look at the field of stem cells: diseases such as MS that involve degeneration of cells can be approached with cell therapy or the use of stem cells that can restore the myelin sheath of the nerve cells. Several types of stem cells have been tested such as neural stem cells (NSCs), hematopoietic stem cells (from bone marrow) or mesenchymal stem cells (MSCs) (that are adult cells isolated from marrow or umbilical cord). Several studies have highlighted the promise of stem cell therapy.

In a clinical human study in China in 2012, hematopoietic stem cells of patients were used in 25 patients and forty percent of the patients showed neurological improvement.

Another study published in 2016 used human embryonic stem cell (hESC) as injections twice over a week to one male and one female patient who had MS, and significant improvement in muscle strength, cognition, and stamina of the subjects was observed.

A recent study conducted in 2018 tested the use of umbilical cord MSC in the treatment of patients with MS. The study was carried out over one year where injections of the stem cells were given and results monitored. The study reported that one-month post-treatment effects were visible such as a change in dysfunction of bladder/ sexual problems as well as an improved life quality. Apart from minor fatigue and headaches, no other adverse effects were reported. Following a year of treatment close to 83% samples when examined by MRI (magnetic resonance imaging) showed lesions that were inactive!

While reports from research labs have shown such encouraging effects, stem cell therapy looks a viable option for the treatment of degenerative and crippling diseases such as MS. The use of clinical studies with larger numbers of patients can further strengthen and cast light on the role of this approach to target this disease.

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