Wednesday, 7 January 2015

There are stem cells and stem cells

The media have us thinking that stem cells are the answer to MS.
This maybe the case but we have to ask what is the question?

To many MSers stem cells are going to repair the damage from MS. To some this means to some re-growth of nerves to others repair of the damaged myelin or both.

But to many MSers they are not thinking that this means repair of the immune system. However, this is what Haematoietic stem cell transplantation (HSCT) is.

This is the most extreme form of immunosuppression and carries significant risks and is therefore generally only offered to people failing other treatments.

The idea is to produced blood stem cells and drugs are used for this. 

You the kill off the individuals immune system with drugs and so destroy the MS causing cells.

Then you transplant the stem cells and they create new white blood cells and the aim is that when they replace a new immune system that no longer causes MS. They do not aim to make new myelin or grow nerves .

16 comments:

  1. Do the "significant risks" exceed the risk of using Lemtrada or Tysabri (On JCV+ at 2 years lets say) when done at a good reputable center with proper follow up ? I don't think so

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    1. in the post just before christmas there were two deaths out of twenty four. yes late deaths after treatment but deaths all the same. couple this with a twenty fi e percent failure rate. I will clarify this with the fact that these people had failed alot of current ms treatments and so someone who is less aggressive may do better.I think the procedure death rate is about 1% but each centre lower tha. a few years ago.

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    2. at reputable centers it is probably lower then 1% using the non -myeloablative protocol , I guess we will get a better picture when the MIST trial concludes

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  2. I had one son who developed leukaemia and underwent a bone marrow transplant and one son who has MS and has had alemtuzumab. The alemtuzumab protocol is much easier than the total ablation of the immune system needed for a bm transplant or HSCT . My son with MS was able to use public transport the week after his alemtuzumab infusion- he still had an active immune system. My son with leukaemia was treated at a top London teaching hospital. He was ok throughout his transplant protocol, but in a previous ablation of his immune system (it's the way they treat leukaemia) he got sepsis and nearly died, even though he was kept in isolation for the time his immune system was down, he was careful about what he ate and drank, and he had one to one nursing.
    I think the confusion arises when you talk about stem cell treatment as opposed to HSCT. I think the STREAMS clinical trial is looking at this and giving MSers back their own MSC's, but I don't think it requires ablation of the immune system(I don't know)

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  3. I was treated with HSCT by Dr. Richard Burt at Chicago Northwestern University. I will be reporting my one-year results in February on my blog msvictoryhsct.blog.com

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    1. Wayne, thanks for the info on your HSCT, could you give a short history of your MS ( symptoms, timeline, therapies, etc.). Congratulations on your success and all the best.

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  4. I think the confusion is in calling HSCT a stem cell procedure,. HSCT is a chemotherapy procedure, The use of stem cells is not proposed to have any therapeutic effect on MS. They are used only to support repopulation of the immune system which has been wiped out by the chemo (usually in combination with a monoclonal antibody).

    Worth noting that there are two types of HSCT; myeloablative, and non-myeloablative. Myeloablative ablates the blood-forming tissue of the bone marrow as well as they lymphocytes, so the immune system would not repopulate without stem cell rescue and the patient would likely die. Non-myeloblative uses a less intense chemotherapy protocol which leaves the majority of this blood-forming marrow tissue in tact, so the immune system would naturally recover in time, even without stem cell rescue - but stem cells are used to speed this process up and reduce the period of time a person is at risk from neutropenia (i.e. having essentially no immune system). There is no clear data on which protocol is more effective in the treatment of MS at this time. Myelo is certainly more lymphoablative, but is also slightly more dangerous and has a longer recovery time due to the more intense chemotherapy protocol. Non-myelo has a very low fatality rate (<0.5%), and a substantially similar progression free survival rate at 3 years. Moscow have done around 400 non-myelo HSCT procedures on MS patients over the last 8-10 years and have zero fatalities. I believe Chicago Northwestern (running the MIST trial, non-myelo) have similar results.

    For me, actual "stem cell therapy" should only really be used to refer to MSC/NPC stem cell therapies, where the stem cells themselves are responsible for the therapeutic effect on MS.

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  5. "Then you transplant the stem cells and they create new white blood cells and the aim is that when they replace a new immune system that no longer causes MS. They do not aim to make new myelin or grow nerves ." MD, by re-setting the immune system with a new population of lymphocytes isn't the inflammatory environment diminished allowing for endogenous repair in the CNS? The use of natalizumab and fingolimod to restrict T-cell migration and now alemtuzumab to supress mature lymphocytes are only steps away from HSCT. It seems to be a question of how far down the stem cell lineage pathway one needs to go before benefits are seen.

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    1. Yep I agree with you, if you stop the inflammatory response then the natural repair mechanisms will kick in

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  6. I thought the risk with HSCT had about a 2% mortality rate? It would be interesting to find out how many MSers would opt for this treatment if they were offered it. I expect it may be higher than the medical profession would estimate. There are worse fates then death and you have to balance the risks. The results of HSCT look excellent if you catch MS early. As a young adult I'd take my chance.

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  7. I would be interested to know if there is any info/data out there on HSCT being used/tried with SP and PP MS - if there is it would no doubt be coming from those countries which are a little less bound up in regulations ruling everything to the n-th degree. Does anyone know of any data, and has anyone with progressive MS had HSCT? If so, do they think it has worked for them?

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    1. Russian study published July 15: - again around 80% move into recovery rate - notes the progressive people not doing quite as well as the relapsing remitting people, so looks like they've treated both from the abstract, requires purchase of the full paper I have not done.
      http://www.ncbi.nlm.nih.gov/pubmed/25711670

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  8. Dear Matt
    Please do not be offended if you do not see your comments not appearing.

    However, by adding links and giving names, then we will need to spend hours viewing (e.g. a link to 60minutes) and vetting the content that you are wanting people to watch.

    Whilst this may be very helpful, it can also be an advertisement for clinics. As you appear to be a health tourist yourself. We want to avoid advertising clinics especially if they are charging a fee for service. I hope you can appreciated this as this is how CCSVI got started.

    Importantly we need to deal with real data and not anecdotes. There is evidence that HSCT less effective in more advanced progressive MS (http://www.ncbi.nlm.nih.gov/pubmed/12842989). The imaging data shows that HSCT is associated with brain shrinkage....is this loss an artefact as swelling is being reduced and so creates the appearance of shrinkage, however some of the conditioning agents can be toxic
    http://www.ncbi.nlm.nih.gov/pubmed/21194151

    p.s. Haem is British English Spelling Heme is Amercian English Spelling.

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  9. It would be helpful to get a view from a haematologist in respect of treating MS in this way.

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    1. neurodocG and ProfG have both worked in haematology I believe. Bone Marrow transplants wont phase a haematologist.its their job.
      But what is the question you want to ask

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