This 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
problem 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 barrier.
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.
The 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 targets.
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.
And a 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.
The 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
