Autologous Mesenchymal Stem Cell Therapy in Progressive Multiple Sclerosis: An Open Label Study

Mandana      Mohyeddin Bonab; Mohammad      Ali Sahraian; Aida      Aghsaie; Sanaz      Ahmadi Karvigh; Seyed      Massoud Hosseinian; Behrouz      Nikbin; Jamshid      Lotfi; Saeideh      Khorramnia; Mohammad      Reza Motamed; Mansoureh      Togha; Mohammad      Hossien Harirchian; Nahid      Beladi Moghadam; Katayoun      Alikhani; Samira      Yadegari; Sirous      Jafarian; Mohammad      Reza Gheini

Abstract

Despite updating knowledge and a growing number of medications for multiple sclerosis (MS), no definite treatment is available yet for patients suffering from progressive forms of the disease. Autologous bone marrow derived mesenchymal stem cell (BM-MSC) transplantation is a promising method proposed as a therapy for MS. Although the safety of these cells has been confirmed in hematological, cardiac and inflammatory diseases, its efficacy in MS treatment is still under study.

Patients with progressive MS (expanded disability status scale score: 4.0 –6.50) unresponsive to conventional treatments were recruited for this study.

Twenty-five patients [f/m: 19/6, mean age: 34.7±7] received a single intrathecal injection of ex-vivo expanded MSCs (mean dose: 29.5×106 cells). We observed their therapeutic response for 12 months. Associated short-term adverse events of injection consisted of transient low-grade fever, nausea /vomiting, weakness in the lower limbs and headache. No major delayed adverse effect was reported. 3 patients left the study for personal reasons. The mean (SD) expanded disability status scale (EDSS) score of 22 patients changed from 6.1 (0.6) to 6.3 (0.4). Clinical course of the disease (measured by EDSS) improved in 4, deteriorated in 6 and had no change in 12 patients. In MRI evaluation, 15 patients showed no change, whereas 6 patients showed new T2 or gadolinium enhanced lesions (1 lost to follow-up).

It seems that MSC therapy can improve/stabilize the course of the disease in progressive MS in the first year after injection with no serious adverse effects. Repeating the study with a larger sample size, booster injections and longer follow-up using a controlled study design is advised.

Keywords: Mesenchymal stem cell, multiple sclerosis, progressive MS, BM-MSC, central nervous system, inflammatory diseases, Multiple Sclerosis Functional Composite, clinico-radiologic paradox