Stem cell transplants: Where do we go from here?

Stem cell transplants have shown some promise for treating MS. However, there are many unanswered questions. Here are some of the issues and questions for future research.

Early treatment
Usually we think of inflammation as a bad thing for people with MS. Inflammation can lead to nerve damage. However, some evidence also suggests that inflammation may actually help protect the nerves too. Early in the disease, inflammation leads to damage, and it is here that stem cell transplants may be the most beneficial. However, because they are still experimental, they have only been tested in people with more advanced and severe disease, usually in those with secondary progressive MS. So we don't know how well they will work in early disease, where they may do the most good.

A long-lasting cure?
Another research question with autologous (using the person's own cells) stem cell transplants is whether the benefits in treating MS will really be a long-lasting cure or will offer only short-lived relief of symptoms. Because the transplants are using the person's own cells and putting them back into the same environment, there is a chance that whatever caused the MS will eventually come back to attack the new cells as well. Longer-term studies will help answer this question.

Other areas of study
Researchers will also be looking for ways to reduce the mortality (death) rate from stem cell transplants. The morbidity and mortality related to the treatment have been decreasing as there is more experience with it. The current mortality rate is estimated at 1.3%.  

Studies in mice have shown that transplanted brain stem cells can turn into cells that add new myelin coverings to nerve cells. Could this work in people with MS? More human studies are needed to find out.

Future studies will also examine the safest and most effective treatments to wipe out the immune system before the transplant, how to reduce the risk of infections and other transplant complications, and which MS patients are most likely to benefit from a transplant.

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