What is Multiple Sclerosis?
Multiple Sclerosis (MS) is caused by the immune system malfunctioning and attacking the insulating myelin sheaths, surrounding the nerve fibers in the spinal cord and the brain by mistake. It causes problems with speech, vision, balance and movement. Over the years, the disease can turn into a progressive form. Scientists estimate there are about 2.3 million people with Multiple Sclerosis. There may be periods of recovery and remission. Even when the cause is not completely clear, the underlying mechanism is the damage to the myelin cells by an underlying destructive process by the malfunctioning immune system. This results in patho-physiological short-circuiting of electrical signals along nerves. Some of the factors can be genetics or environmental. The disease can be diagnosed after the patient has presented with neurological symptoms alluding to the condition.
What are the treatment options?
Treatment options over the years have varied from adrenocorticotropic hormone, decades ago to more specific drugs and even chemotherapy- similar to the treatment of leukemia. However, because this potent treatment causes collateral ablation (destruction) of vital stem cells in the bone marrow that produce the blood series of cells, Autologous Haematopoietic Stem Cell Transplant (AHSCT) is given to the patients to restore the blood- producing cells and avert fatal anemia. Hence, chemotherapy needs only be used with the more advanced forms of the disease and in those who didn’t respond to other medications. People with certain forms of cancer, namely blood dyscrasias, were treated with a similar approach. This approach gave good results at the beginning because the treatment resets the immune system, but it is not known for how long the benefits lasted. More recently, the less drastic modality of adipose-derived stem cell (ADSC) deployment has been offered by our center and others in the USA and aboard with encouraging results.
“Frozen” symptoms of the disease
A few studies have shown that the ablative procedure with stem cell rescue may “freeze” the disease up to 5 years. The therapy carries significant risks since it is aggressive chemotherapy that affects all cells of the body to varying extents. It deactivates the immune system for a short time so the patient may be at risk of infection as well as other complication as per any chemotherapy.
The ADSC treatment, on the other hand, is much simpler and has virtually little by way of side-effects, inconvenience, and complications. The outcomes, especially long-term, are less known and predictable than the ablative method because it is a newer method and the numbers of patients treated are fewer to date. However, its appeal lies in its virtually absent side effects and complications and perceived benefits in a large proportion of afflicted patients.
Destroying or resetting of the immune cells?
Chemotherapy destroys the immune cells that are responsible for the attack on the myelin sheaths of the nervous system. By virtue of immune and marrow cells being more sensitive to destructive drugs, patients are treated with them and then rescued by hemopoietic stem cell infusion. The ADSCs appear to help “re-boot” or immuno-modulate the immune system, causing it to stop treating self as the “enemy.”
Higher dose of chemotherapy
Giving the higher doses associated with chemotherapy kills the immune cells as well as the stem cells of the bone marrow. Thus the need for unaffected stem cells returned or transplanted into the body, which causes a “reset” of the immune system. Eighty percent of the patients, who received chemotherapy survived without any disability, relapse of the Multiple Sclerosis symptoms or formation of new brain lesions.
The remaining 20% experienced side effects with the high dose of immune suppression, like gastrointestinal problems, infections, and hair loss, which were significant. Following rescue with transplantation of stem cells, the patients didn’t receive any medications or drugs, and yet they remained in remission 3 years later. A few patients may experience shorter remissions and may require immunosuppressive drugs for a longer period of time.
In the ADSC modality, if and when symptoms recur a booster, of second procedure to infuse new ADSCs often helps to prolong remission. This has become easier with the advent if the “Cells-on-Ice” program, in which stem cells are stored and expanded to give repeated doses over time.
Worsening symptoms of Multiple Sclerosis
In a study, 3 in 4 (73% of the people) had symptoms that worsened in 5 years after chemotherapy treatment. The younger patients with less progressive forms of the disease respond better to the therapy, although the majority of patients had a progressive form of Multiple Sclerosis. It seems that the best chance to treat MS revolves around transplantation of stem cells until such a time when we can figure out how to reset the immune system more simply.
Those patients with relapsing Multiple Sclerosis had some small improvements of their symptoms. The disability with MS can be assessed on a scale known as Expanded Disability Status Scale, where 0 represents that the patient has no disability, 7 being the patient is bound to a wheelchair and 10 – death. At the beginning of the study, the patients had an average of 6.5 on the scale.
These patients had an improvement of 0.76, one year after receiving the treatment, and those with progressive MS, 0.14 improvements.
Patients with relapsing Multiple Sclerosis
A large group of “conservative” physicians claim that many of the treatment modalities that yield positive results need validation by having controlled studies with a placebo arm etc. They suspect that a lot of the positive results are a placebo effect! To counter that, advocates of chemotherapy and rescue with stem cell therapy, and ADSC deployment contend that it is difficult to deny those who are suffering serious symptoms and disability treatment that may be beneficial, and uses them as the control arm of the study. Another factor that militates against such a study is the fact that earlier cases respond better to stem cell therapy that do more advanced cases in the later stages of the disease. Denying a patient much-needed treatment may be unethical, especially when it is associated with hardly any downside of any added risk or complication!
Most doctors believe these procedures are promising, but since it would not be easy to conduct controlled trials with a placebo group (patients who did not receive treatment), the issue with not be settled for decades to come. However, all are in complete agreement that the medical community needs more effective, consistent and reliable treatments for this crippling, progressive disease.
At the Gulf Coast Stem Cell and Regenerative Medicine Center, we are actively engaged in research programs, managing a wide range of varied disorders, including orthopedic, degenerative, neurological and autoimmune. For more information about the diseases and disorders that we currently address and study, please call (866) 885-4823. There is also a lot more information on our website: www.gulfcoaststemcell.com