For anyone who has heard the radio, seen the news, read the newspaper, or read many websites, stem cell research in MS has taken a step forward, with the launch of projects from the MS Society and the UK Stem Cell foundation
As one of the recipients of the awards, I was rather shocked by the news and the level of confusion created by the charity websites and particularly the media. The first I heard of it was from a phone call from a Dutch MSer, followed by a few emails from MSers and then the sight of the BBC News web site, to find out that we were now undertaking a clinical trial in optic neuritis in MS using stem cells from aborted foetuses.
Whilst ignoring the risk of excommunication from the church, I apologize for the false hopes created by the media. I spent much of the day dealing with this and getting websites to change their stories. The stories reported are so far from the truth it is shocking, so now I give you the real story which is to explore the therapeutic effect of adult, neural stem cells in mice.
This project uses the skills of two stem cell experts (UK and Italian) who have pioneered the use of stem cell therapy in mouse and rat models of disease in the eye and the brain. They have already developed the technology for production of human stem cells. This will be combined with our skills in experimental MS models where we can generate damage and then eliminate further autoimmune disease such that we have a platform to monitor repair.
We have selected to examine the effect of stem cell transplantation on optic neuritis, which is inflammation of the optic nerve. This is a common symptom of MS but because of the relative ease of accessibility to the optic nerve. Furthermore the visual system is an ideal target for monitoring neurorepair strategies as we have the tools to do this already.
We will look at the reparative properties of neural stem cells derived from adult animals and determine their capacity to produce repair via the generation of nerves and glial cells that produce myelin sheaths or repair either from the transplanted cells or via stimulation of endogenous stem cells already present in and around lesions. This will be following delivery to the lesions or the blood stream
However, the most notable, positive-effect of stem cell transplantation to date has been modulation of the inflammatory response that drives relapsing attacks. However, simply controlling the immune-response is not enough to control progressive disease in MS. Furthermore, there are a number of potent immunosuppressive drugs such as Gilenya that could achieve this outcome. Therefore, it is imperative that we can show that stem cell therapy can deliver added benefit over simple suppression of the immune system. This added benefit has not yet been shown.
Once we can show this added benefit we can work out how it is caused, but importantly we should be more ready to perform clinical trials to determine whether this works in MS.
However, I suspected you are more interested in the actual clinical trial being led by Dr Paolo Muraro at Imperial College London. Based on that found on various websites this appears to be a trial involving up to 13 people. Their stem cells will be grown in tisue culture then injected back into their blood stream. This will occur in Edinburgh and London, as part of a international effort to examine bone marrow, mesenchymal stem cell transplantation in 150-200 people with MS. This willl be occurring in Italy, USA and Canada. I have no details of the people to be recruited although I am sure you MSers have found out already.
Mesenchymal stem cells have potential to divide in to a variety of different cell types, however to date it must be said that in models of MS there is no good evidence that these cells enter the brain and differentiate into neural cells, in constrast to some evidence with neural stem cells. To date their influence appears to be at the level of inhibition of immune responses. As mentioned above, this may be achievable by available drugs an may not be good enough to inhibit progressive MS.
Time will tell but at least we have started to investigate this.