Every now and then we still hear or read stories of miracle cures from stem cells – a man reported to have walked again when his severe spinal cord injury was treated with stem cells from his nose. Or dogs cured of their spinal disease with stem cell therapies.
We all know that newspapers need to sell copies, and that “scientists quietly optimistic of a small, incremental advance” makes a boring headline. So all of us try, when we see these things, to be at least a little cautious. But the plain fact is that, mostly, each of these stories does represent progress, a further step forward, sometimes small, sometimes large. They are good news.
So where do all these steps lead? What progress has there been, and how close are stem cell therapies to being routinely available and used in the clinic?
The short answer is: it’s complicated! And it’s complicated because MS is so complicated.
Three types of cell therapy
What has changed in recent years is that stem cell therapy in MS is now thought of in three quite different ways:
- as a cell replacement strategy, to restore damaged oligodendrocytes – the cells that make myelin – in the brain and spinal cord
- as a way of replacing the body’s immune system, in order to prevent future inflammation in the brain and spinal cord
- as a repair and protection strategy, using complex additional properties of some stem cells, both to limit nervous tissue damage and to promote its regeneration
These three approaches have different aims, and can use different types of stem cells. Partly because of this, many of us now prefer the term cell therapy to stem cell therapy. The strategies are at different stages of development, some nearer, some further from the clinic. But they are all important.
Turning research into treatment
The UK has a strong claim to be leading the world in all three of these approaches. But how and when do we turn research into treatments? Again, this differs for the three approaches.
Cell replacement strategies were probably the first to be thought of, but have faced the most difficult challenges in clinical development. There are challenges in:
- dentifying safe sources of cells and placing them safely in the areas where they’re most needed – inside the brain and the spinal cord
- and, in particular, being certain they carry no hazards, such as tumour formation
They therefore remain furthest from routine clinical use: there have not yet been any published clinical trials of this approach.
By contrast, bone marrow stem cell transplants to replace the body’s immune system are at an advanced stage. Taking advantage of the technical and clinical progress made by haematologist colleagues, clinicians in Europe, the US and the UK have completed large scale clinical trials in several hundreds of people with MS. While still hardly a routine treatment, we have an increasing understanding of the potential benefits – and the clinical risks – of this approach.
The third way of MS cell therapy, harnessing the protective and regenerative properties of stem cells, lies somewhere between these two in its development, with some small scale trials completed, and larger ones just getting underway.
Hope for people with progressive MS?
Our work in Bristol has largely concentrated on this third way. Some researchers use cells present in fatty tissue, others from other tissue, but we use cells from the bone marrow. Bone marrow stem cells are complex. We tend to concentrate mostly not on those bone marrow cells that generate the blood and immune systems, but on other, smaller populations of cells. We conduct laboratory research studying their properties, and clinical work. A few years ago we conducted one of the first trials in the world of this approach – a very small phase 1 trial to confirm their safety and the feasibility of this strategy.
Thanks to funding from the MS Trust, we are now conducting one of the first phase 2 trials using this approach, the ACTiMuS trial. Over the next few years we hope to begin to provide answers as to whether this will genuinely make a difference to people with MS.
Hope vs hype
While these treatments remain in their relatively early stages of clinical trial and development, it can be very tempting to imagine that the proof is already there (it isn’t), and that commercial outfits, advertising and selling ‘therapies’, usually in countries with a less robust regulatory system, are the answer (they aren’t).
Most forms of stem cell therapy in MS remain unproven: the hazards are not fully understood and some unscrupulous people are making a profit out of the hopes of people with MS.
Nevertheless cell therapy is one of the more promising areas of MS research and there is great work being done in this area in the UK. Whether you are interested in cell therapy or any other potential treatment for MS it’s important to make sure you consult reliable, evidence-based, information. See the box on the right for details about how you can make sure you consult MS information you can trust.
How can I tell good research from hype?
Although health stories always attract a great deal of media interest, not all of these reports are accurate accounts of what the studies have found. Some other reports may also sound convincing but they may just be opinion, or someone’s personal experience, presented as if they were facts that would apply to everyone.
The most important thing is to consult reliable, evidence-based information, for example, on the MS Trust website. If there has been a breakthough in a particular area of research, we will be reporting on it. If we haven’t reported on it, or have a different take on the research, then consider what is being said very carefully.
You can undertake your own analysis of a media story by asking yourself these questions:
- Does the article content contain evidence and data that match the claim in the headline?
- How many people did the research study include? Did it include a control group for comparisons too?
- Was the research in humans? This will give you a clue as to how advanced the research is. If the study was in petri dishes or animals, this means the treatments are much further away from being available in the clinic and may not even work in humans.
- Is it published in a scientific journal? Or is the article based on a presentation or an interview? Work published in journals goes through a rigorous review process from other experts in the area, in a presentation or interview the person can say whatever they like.
- Who is conducting the study? Is it research to help develop a treatment or does the study appear to be marketing? You should be very wary of any research or trial in which participants are expected to pay for their own treatment.
If you would like to know more about anything related to MS, contact the MS Trust information team and we can help you find out more. Call us on 0800 032 3839 or email email@example.com
This article is part of the March 2015 issue of Open Door, the MS Trust’s quarterly newsletter.