Most MS Patients Who Got Stem Cell Transplants Still in Remission Years Later

http://www.healthline.com/health-news/ms-patients-who-received-stem-cell-transplants-still-in-remission-010715

by adventured • 12 years ago

122 25 12 years ago

lotharbot• 12 years ago

The therapy in question is what's called "autologous" transplantation, which means it's the patient's own stem cells. They receive an injection that boosts stem cell production in their blood, those cells are harvested, the patient undergoes a chemotherapy/immunosuppression treatment, and then their stem cells are infused back into their blood.

http://www.halt-ms.org/forpatients.html

GauntletWizard• 12 years ago

I've been wondering how many of our issues related to aging and cancer are simply due to our own body fighting itself as many generations of cells slowly diverge by transcription errors. I'd love to see, and maybe it will be a viable test in a few years, what we can achieve by simply having the body 'rebuild' itself with a supply of fresh, identical stem cells.

waps3• 12 years ago

It is known for quite some time that while there are diseases caused by transcription errors, the only reason the occurence of those diseases increases with age is that the immune system becomes worse over time.

There are strong indications that aging, and dying, is an entirely programmed-in part of our genetic structure. We age and die, not because of DNA copy errors, but because DNA sabotages itself and the cell it's in over time. There are, of course, ageless cells. The most obvious example being procreation-related cells, but there's many different kinds (for instance, muscle cells have very different aging clocks).

Multiple "death clocks" have been identified, telomeres being the most famous, that measure number of cell divisions, others measure the amount of energy expended by the cell, genetic quality, and presumably a few other things. Exceed the limits on any one of them, and the cell commits suicide. But if you're close to the limit, the cells will "senescence", which means they'll be less active and less worried about making mistakes. But this is an active, controlled process, not an accidental result of gene degradation. All of your cells contain logic somewhat like this :

  do_something() {
    if (rand() > age/150) {
      don't do it
    }
    if (rand() > age/300) {
      kill the cell off
    }
    actually do it
  }

The huge question now is : why is that logic there ? Presumably, there's a good reason (there always is for things in DNA). What, exactly, goes wrong when cells (and therefore people) are allowed to age without consequences ? Likely, we'll find the answer when we learn how to reset the clocks on a large scale in someone's body.

Also there are plenty of animals and plants, smaller ones, that don't age. Which has the surprising consequences that death (caused by old age at least) has an origin. There must be a point in history where evolution decided we'd grow old and die.

There's a very interesting book about this subject :

http://www.amazon.com/Sex-Origins-Death-William-Clark/dp/019...

reasonattlm3• 12 years ago

Stem cell therapies can really only fix one part of aging. They do nothing for build up of metabolic waste products, for example, which are direct causes of a range of issues.

There is an assumption in the research community that, yes, stochastic DNA damage and epigenetic drift in tissues has to be important in aging in ways other than cancer, but there isn't any good experiment to demonstrate that this is in fact the case. If anything the available evidence points in the opposite direction, such as mice loaded with a large multiple of the normal level of point mutations that don't appear to suffer any consequences as a result.

When you look at what kills the most people, cardiovascular disease, it all appears to be fairly directly linked to a combination of degredation of elasticity in blood vessel walls (cross-links in the extracellular matrix, a metabolic waste product issue), damaged lipids in blood vessel walls spawning self-reinforcing damage generators (mitochondrial DNA damage, inflammation), and things of that ilk, which lead to hypertension and runaway bad feedback loops in blood pressure and the body's response to same, and then catastrophic failures or blockages in blood vessels. Stem cells and their declining activity are something of a secondary issue in the background, and don't really figure in the important path through this pathology. If your skin and blood vessel walls are loaded up with cross-links that the body cannot break down and increasingly inelastic as a result then it doesn't matter how youthful your stem cells are, you are still on the path to death.

reasonattlm3• 12 years ago

Yes, this is very much a treatment of killing off immune cells and sneaking in a set of replacements before the body generates its own. So that way the replacements are the ones you want, not the ones you'd otherwise get.

In autoimmunity the problem is that the immune system is misconfigured in some way - so culling existing immune cells and replacing with fresh ones stands a good chance of getting rid of the cell-based misconfiguration. That is true whether or not the misconfiguration is understood; it is a good shortcut past lack of knowledge.

This has worked for other autoimmune diseases, but is sufficiently drastic that the research community has abandoned it in favor of even marginally effective treatments for conditions where those exist. For example there were promising results in the burn-and-rebuild approach for rheumatoid arthritis a way back, but then biologics arrived offering control and less pain for some patients, and that line of research died out.

It will probably return with the advent of more targeted therapies that are not as harsh as chemotherapy, ways to selectively destroy only immune cells with specified surface chemistry. This sort of thing is underway in the cancer research community, and the technologies produced will have very broad application: safe and painless removal of immune cells, fat cells, senescent cells - anything we don't want and can be distinguished. This is a big deal but still in the works; the issue isn't destroying the cells, but rather coming up with sufficiently discriminating targeting systems.

DrStalker• 12 years ago

Sounds like the immune system version of "turn it off and back on again."

ekianjo• 12 years ago

It has shown some efficacy as well in severe forms of RA: http://www.jrheum.org/content/31/3/482.short while it may not be conclusive yet.

thrownaway2424• 12 years ago

I guess we're supposed to intuit this somehow, but what's the rate of remission for the control side?

cpncrunch• 12 years ago

There's no mention of any control group in the article at all.

joeyspn• 12 years ago

I love to see this kind of medical breakthroughs in the front page... It amazes me to see how far/fast we are advancing in Life Sciences. Stem cells w/o any doubt hold the key to powerful life enhancing treatments, probably we belong to the last generation who'll rarely surpass the 100 years mark...

melling• 12 years ago

Not really. Research is painfully slow. It takes decades. We really need to find other ways to innovate.

kragen2• 12 years ago

Do we have a good estimate of how high the risk of death from cancer is from this therapy? Still, it'll be hard to beat a 91% chance of curing your MS. Advanced MS is a horrible disease.

adventured• 12 years ago

I would have to guess that the risk is primarily concentrated to the span of a week or two, prior to the immune system getting back up to a minimally required level to suppress cancer.

I wonder if the chemotherapy doesn't act to kill or suppress some of the cancer risk until the immune system reboots.

kragen2• 12 years ago

I'm not talking about a risk of cancer from immunosuppression, but about the well-established long-term risk of cancer due to any stem cell therapy.

kohanz• 12 years ago

Bexfield’s insurance company, Presbyterian Health Plan, declined to cover the hefty cost of $198,000 for the stem cell transplant. He was forced to cash in his savings and turn to family in order to help pay for the treatment.

Only months after his denial, Presbyterian added coverage for stem cell transplants to their plans. Bexfield thought that meant his procedure would be paid for after all. But there was a hitch. Bexfield was told the insurance company would only cover stem cell transplants from donors — a much riskier procedure — not those done using the patient’s own cells.

Bexfield waged an epic battle against the insurance company that lasted several years and consisted of countless emails, YouTube videos, and even help from David Segal, aka “The Haggler” from the New York Times. In the end, Presbyterian reimbursed his $198,000 original payment for the procedure and paid $204,000 in interest.

Wow, the good guy wins. Was not expecting that ending!

stefantalpalaru• 12 years ago

It looks more like a pyrrhic victory if he had to waste the little time he had left on fighting his insurer.

xmstr• 12 years ago

This is great news! I would be interested to know if they ever intend to expand the trials out to other autoimmune muscle related diseases, for example myositis and its variants.

Most MS Patients Who Got Stem Cell Transplants Still in Remission Years Later

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