Marlo asks David if stem cell treatment is going to be a reality for all MSers.
Stem cell research has been in the news a lot lately, is this something to consider for people with MS?
I think you’ve got to be aware of what you mean by stem cells, there are many different types of stem cells. So the stem cells that most people kind of want are the stem cells that turn into repair cells and repair the myelin. The ones that have been in the news recently are not stem cells that repair the myelin, they’re stem cells that repair the immune system, and so it’s a different type of stem cell. So it’s like a current disease modifying treatment, only it’s the most aggressive form of immune treatment, so what you do is you take drugs that kind of wipe out your immune system and then the stem cells you take are to replace your white blood cells, because if you don’t have them you can’t cope with infections, so that’s what the stem cells are there for.
So there’s two types: one is what they call non-myeloablative, so you don’t wipe out everything, and then the stem cells are just there to stop the kind of infection risk which you have. And then there’s a myeloablative where you remove your white cells and you actually create a whole new immune system. That is more risky in terms of the side effects that can occur, but it is potentially very effective. If you look at the data – there’s been some produced very recently – it’s the most effective treatment that there is, but it comes with significant risks and that’s why it’s kind of really restricted to people where most of the other drugs have failed, rather than being a generalised thing, because the risk can be, it can kill people if you don’t, can’t deal with the infection. So it tells us that the immune system’s important, so, you know, it supports everything we know about the current drugs, but you may be able to get just as good an effect with the current drug without having to go the whole hog of the stem cell. But as I say, the important thing is, it’s a different type of stem cell to what most people want, I think.
Are the stem cells coming from the person themselves, so it’s your own?
Yes. I think what we realise now is if you take a stem cell from a different person, it means you’re going to have to be on immunosuppressive drugs for your life, because eventually you will reject them. And that approach is used in cancer, but I think what we’re thinking about MS is that you would use your own cells. And for the kind of white cells you use kind of blood, so you liberate the stem cells from your bone marrow and then you harvest them and then you kind of culture them and then you re-inject them. For the stem cells that maybe make the myelin, that’s a different type of stem cell and you can make them from different sources, you just have to kind of educate them to become a nerve cell or a myelin cell. So there are ways of doing that and there are a number of groups around the world that are doing that, so it’s just a matter of time before they’re tested, but obviously it’s a slow process.
MS Reporter: Marlo
MS Expert: David Baker. He works in a lab researching the basic science of MS and works closely with the clinical team at the Barts and The London School of Medicine and Dentistry.