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  • Ajay Macherla

Evaluation of Stem Cell Therapies in the Treatment of Multiple Sclerosis


Abstract

Multiple sclerosis (MS) is a chronic autoimmune disorder that is influenced by immune, environmental, and genetic associations. These etiological factors contribute to demyelination and inflammation of the CNS, leading to the formation of plaques and lesions, as well as the elimination of oligodendrocytes. Symptoms of MS include depression, fatigue, numbness, weaknesses, dizziness, vertigo, pains, itching, gait, vision problems, bladder problems, and bowel problems. The McDonald Criteria, which has been revised many times since its inception in 2001, is a leading diagnostic tool for diagnosing MS. The criteria uses CNS inflammation and demyelination as evidence for the diagnosis, as well as DIS and DIT in later revisions. However, MRI scans and CSF analysis can be leveraged to diagnose MS as well. MS is the most frequent demyelinating disease that is concentrated in North American and European populations, and less in African and East Asian populations.


Stem cells are unique undifferentiated species that can differentiate to produce a variety of cells and can divide indefinitely to form large amounts of the final differentiated cell. These stem cells are leveraged in stem cell therapies to influence a differentiation in potent cell types that can alleviate the effects of MS. However, it must be noted that they do not permanently cure MS. ASC stem cell therapy involves using human adipose stem cells (ASCs), derived from adipose tissue, to treat MS. These cells can differentiate into myelin-producing cells, which will repair the demyelination that occurs in the CNS. aHSCT stem cell therapy incorporates aHSCT stem cells, immunoablation, and chemotherapies to reprogram and regenerate the immune system. This prevents the autoimmune attacks characteristic of MS.


Evaluating both therapies based on efficacy, safety, and financial burden, it was determined that ASC stem cell therapy was the preferable treatment option for physicians to continue in clinical trials and refine in order to effectively alleviate the symptoms of MS in patients. This was due to the efficacy of the treatment in the majority of MS patient populations, relative safety in comparison to aHSCT and other related stem cell therapies, and the affordable cost.


 

Introduction

Multiple sclerosis (MS) is a chronic autoimmune disorder that has consequences in the central nervous system (CNS). An overview of the disease will be presented in a four-stage framework: etiology, pathology, symptoms, and diagnosis. An in-depth examination of each stage will be presented subsequently.


Etiology:

Although an exact cause has not been widely accepted, MS is an autoimmune disorder where the immune system attacks the myelin that covers nerve fibers. Damaged areas are referred to as plaques or lesions. Aetiological research of MS has also suggested environmental risk factors of MS, including vitamin D deficiency, exposure to the Epstein Barr virus, and smoking, although a causal relationship has yet to be established (O’Gorman et al., 2012).


Pathology:

Plaques in the myelin sheath of nerve fibers can lead to disruptions in neural communication between the brain and the body. The central nervous system (CNS) is also impacted severely, leading to neurological symptoms. Inflammation and axonal injury are also associated with demyelination. Plaques can also be found in white matter around the ventricles, optic nerves and tracts, and long tracts and subpial regions of the spinal cord and brainstem (Huang et al., 2017).


Symptoms:

Symptoms of MS can include vision loss, fatigue, damaged coordination, muscle weakening, ataxia, sensory loss, and paralysis. Results vary based on the site of demyelination in the CNS. An exacerbated prognosis may be associated with the age of the MS victim and the number of relapses in the early stages of the disease (Ghasemi et al., 2017). There have been four stages of MS defined: relapsing/remitting (RRMS), secondary progressive (SPMS), primary progressive (PPMS), and progressive relapsing (PRMS). Stages are characterized by gradual neural deterioration and functional declines (Loma and Heyman, 2011).


Diagnosis:

To diagnose MS, a revised McDonald criteria test has been proposed using cerebrospinal fluid-specific oligoclonal bands. It must be noted that further research is required to fully validate and generalise this criteria to a diverse human population. Other diagnosis methods used in the medical community include magnetic resonance imaging (MRI) scanning of brain and spinal cord and functional assays of the nervous system (Huang et al., 2017).


Although there is no cure to MS, multiple solutions to alleviate symptoms have been presented through the incorporation of stem cells (SCs). SCs are characterized by two qualities:

  1. Undifferentiated, indicating that they can differentiate into several human cell types and repair damaged tissue.

  2. Can divide constantly to produce large quantities of cells (Biehl and Russel, 2009).


In this investigation, three stem cell therapies for treating MS will be presented: adipose-derived stem cell (ASC) therapy, mesenchymal stem cells (MSC) therapy, and autologous hematopoietic stem cell transplants (aHSCT). Each treatment involves the acquisition of ASC, MSC, and aHSCT respectively in order to produce myelin-producing cells that repairs the damaged myelin in the myelin sheath. Through a literature review research design, this paper aims to examine these three treatment options, identify strengths and weaknesses, and reason a viable treatment for the medical community to execute.

 



Evaluation of Stem Cell Therapies for Multiple Sclerosis
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