ECTRIMS Congress 2013: A review/opinion paper published this week in The Lancet waxes enthusiastic about intravenously delivered mesenchymal stem cell therapies as a means to restore nerve function in multiple sclerosis patients. The timing is ironic.
paper appeared in the middle of the European Committee for Treatment
and Research in Multiple Sclerosis (ECTRIMS) meeting in Copenhagen, where there has been little evidence that such therapies are even contemplated.
ECTRIMS, if you didn't know, is the largest MS-focused medical meeting
in the world, with some 7,500 attendees this year, not counting exhibit
hall personnel. If stem cell-based remyelinating treatments were on the
clinical horizon, one would expect to see more hints than this. At
a press briefing held on the meeting's opening day, ECTRIMS's top
leadership acknowledged that efforts to find treatments for progressive
forms of MS are still struggling to gain traction. In fact, the
seems to be that this aspect of MS pathology is so poorly understood
that it's unclear where even to start looking for therapies. Asked why
treatments have been so long in coming, the officials just mumbled
something about difficulty in getting drugs across the blood-brain
Searching the program for "mesenchymal" yields
just six hits -- five posters on animal and in vitro studies and a
lecture addressing various therapies for secondary progressive MS that
(according to the abstract) mentions a stem cell therapy that showed
"promising results" in a previously published study.
MS community is rightly proud of the recent rush of new
disease-modifying therapies for relapsing MS that have become available
in the past 10 years. Starting with natalizumab (Tysabri), they resulted
from basic research that revealed mechanisms underlying the acute
inflammatory antimyelin attack. That, in turn, suggested specific drug
In the Lancet paper, four neuroscientists
affiliated with the University of Bristol in England and led by Neil
Scolding, FRCP, sought to show that, actually, a good deal is known
about chronic de- and re-myelination and that mesenchymal stem cells do
represent a plausible treatment strategy.
counterintuitive one at that. Mesenchymal stem cells come from bone
marrow and are not progenitors of myelinating oligodendrocytes.
Nevertheless, Scolding and colleagues wrote, these cells appear to be
involved in tissue repair throughout the body, in part by suppressing a
variety of pro-inflammatory and cytotoxic factors.
authors also found that, in addition to a handful of past trials of such
therapies in MS patients (with mixed results), more than a dozen are
currently ongoing or are about to start.
But they also
conceded that success from this approach is far from guaranteed. Rather
than focus on any single approach for a cell therapy -- or any other
single type of regenerative tactic, for that matter -- Scolding and
colleagues suggested that the more general processes of tissue repair,
if understood well enough, may offer a number of possible avenues to an
effective treatment for reversing MS nerve loss and disability.
It's already a proven strategy. READ MORE