The future of MS research and stem cells
On 6 September 2006, the MS Trust hosted an event that brought together leading figures in MS in the UK to discuss the state of research into the condition and the role of stem cell therapies in future treatments.
Research is of vital interest to everyone affected by MS. The headline grabbing but unproven stem cell treatments that have been available commercially have threatened to distract attention from the exciting advances in research that are happening in the UK and around the world.
This evening was part of the MS Trust's commitment to promoting, reliable, evidence based information about research.
Professor Alan Thompson
Alan Thompson is Professor of Clinical Neurology and Neuro-rehabilitation at the Institute of Neurology, Queen Square, London. He is one of the foremost experts on neuro-rehabilitation.
Professor Thompson introduced the speakers and also chaired the discussion that followed the talks.
Professor Alastair Compston
Alastair Compston is head of the Department of Clinical Neurosciences at the University of Cambridge and heads the Brain Repair Centre in Cambridge. His research focuses on the clinical science of human demyelinating disease.
MS Research - theories and areas for progress
Professor Compston reviewed the development of MS research from the mid nineteenth century, explaining the factors that are thought to contribute to the onset of MS and the processes that the condition causes within the body. Understanding how these factors interact gives researchers clues as to areas in which to focus research. Professor Compston reviewed the state of research into the cause of MS, the mechanism of the disease, areas of interest in genetic research and the study of infections that might trigger the condition.
Professor Neil Scolding
Neil Scolding is Burden Professor and Director of the Institute of Clinical Neurosciences at Frenchay Hospital, University of Bristol. He has a clinical and research interest in the biology of multiple sclerosis and in particular in attempting to develop treatments designed to repair the brain and spinal cord in patients with disability from MS.
Stem cells - the current evidence and issues around such treatments
Stem cell research offers the potential for exciting developments in many areas of medicine, including in the treatment of MS. However, it is not an area without problems. Professor Scolding discussed the ethical issues associated with embryonic stem cell research and the medical hurdles that need to be overcome in producing safe and reliable treatments from adult stem cells. He also discussed the problems associated with press coverage of unproven treatments and how people with MS should explore the issues behind the headlines before seeking treatment. Professor Scolding also described how treatment with stem cells might be beneficial to people with MS and how the work that he and other researchers are doing now may eventually lead to treatments for people with MS.
Download Professor Scolding's talk
With thanks to the MS Society
Questions and answers
Following the talks, Professor Thompson chaired a session of questions from the floor
Having mentioned stem cell treatments on offer in Rotterdam, the subject of recent coverage by the BBC, Professor Scolding was asked his opinion of the therapies being offered commercially by a clinic in Bruges. Whilst not familiar with the work of this clinic, he questioned the motivation of companies that would treat people in this manner with no consultation with their GP or neurologist and would offer no follow up treatment or monitoring. The fact that large sums are charged for these treatments he felt was exploitative. Another audience member questioned why it had taken the BBC to uncover the failings in the safety and integrity of services offered in Rotterdam and why the Department of Health had not intervened earlier. Whilst feeling this was a question better aimed at the Department of Health, the panel showed some sympathy with the question.
The best source of stem cells was raised by several people in the audience. Professor Scolding commented that although this was not essential, ideally stem cells should come from the person receiving treatment. The storage of umbilical stem cells at the birth of a child is speculative at the moment as there is no way to use the cells at present. Umbilical cells are immunologically inert and, if treatment were available, would be appropriate for use in either mother or child, as the cells would not be recognised as 'foreign' by the body.
Professor Compston was asked about the possibility of scar free healing of nerves - the scarred or sclerotic areas of nerves contributing to disruption of nerve messages. Theoretically, the best time to repair damage that leads to scarring is during periods of inflammation, when the myelin is under attack from the immune system. The potential dual role of stem cells as both anti-inflammatory agents and as repairers of areas of damage suggests they might be ideal for this. However, he was cautious about this approach as any repair from one period of inflammation may be destroyed in subsequent attacks, and timing treatment would be difficult. Repairing existing areas of scarring is not thought possible.
Related to this topic, Professor Compston was asked if axons could be replaced. Axons are the parts of nerve cells, covered in myelin, that carry messages to other nerve cells and which are damaged and/or destroyed by MS. He reported that whilst stem cells can be turned into nerve cells, connecting them together is the difficulty.
A questioner raised the problem of treatments for people with primary progressive MS and the feeling that this group is excluded from the main focus of research. Professor Compston explained how people with this form of MS have more nerve degeneration from the beginning and less inflammation, which means that existing therapies have not been shown to be helpful. He acknowledged that in this respect, they are a 'disenfranchised group'. Professor Thompson pointed out that there is research into treatments for progressive forms of MS and mentioned the trials of lamotrigine and the CUPID trial that is looking at the protection cannabis might provide to nerves.
Professor Scolding was asked about the work of Dr Geoffrey Raisman. Dr Raisman is working in the field of repairing spinal cord damage, from injury rather than MS, using cells from the back of the nose. Although it is not clear whether these cells are strictly stem cells, their ability to regenerate as other types of cells makes this another area of possible benefit in the long-term.
Some questions looked at the causes of MS. One person asked if a blow to the head immediately prior to her diagnosis had caused her MS, but Professor Compston rejected this, suggesting that this was just coincidence. Another question picked up on his discussion of infection with the Epstein Barr virus, the cause of glandular fever, as a possible trigger for MS. He reiterated that infection in the late teens is associated with a higher risk of developing MS, but that infection earlier than this is not. Whilst appreciating the scientific logic of a comment that infecting people with Epstein Barr virus before the critical period might reduce the instances of MS, he felt that this wasn't an appropriate approach when only a small proportion of the population is genetically susceptible to developing MS.
A question about early treatment of MS brought guarded approval from Professor Compston. Research suggests that early, aggressive treatment that prevents inflammation from exposing axons to damage reduces the subsequent effects of MS. However, he acknowledged that aggressive treatments for people with few or no symptoms might not be appropriate, particularly as the nature of MS means that some would remain relatively symptom free regardless of treatment.
The effect of NHS cuts on research developments was raised. Professor Scolding pointed out that any treatments resulting from current research were likely to be expensive, and when the focus moves from research budgets to the NHS's operational budget, there could be problems. Professor Compston was more optimistic that the determination to advance research and produce new and better treatments would continue.
Asked about timescales before some of the areas discussed became available to people with MS, Professor Compston refused to be precise although he pointed out that doctors want to give their patients hope that science is finding solutions to their problems. He did however draw attention to the fact that the next few years will see advances in the various areas of research mentioned in his talk and that these would bring new treatments much closer.