Autologous mesenchymal stem cells for secondary prog. MS

Discuss stem cells, adult and embryonic, and their therapeutic potential for MS here.

Autologous mesenchymal stem cells for secondary prog. MS

Postby SammyJo » Tue Jan 17, 2012 11:58 am

This pilot study on 10 patients is from University of Cambridge, it echos the positive results from the Bristol University study on 6 patients. This study used bone-marrow-derived cells, not adipose. No immune system ablation was used. Results from 10 months after the infusion.

Title: Autologous mesenchymal stem cells for the treatment of secondary progressive multiple sclerosis: an open-label phase 2a proof-of-concept study.

summry: This small but significant proof-of-concept study from the UK reports initial results following the intravenous administration of mesenchymal stem cells to ten people with secondary progressive MS. A dosing regimen based on body weight was used and no serious adverse events where reported following administration, though three people experienced mild, self limiting side effects.

The authors used paraclinical assessments of the visual pathway as clinical outcome measures and as a surrogate marker of wider disease. The results seem to suggest some structural, functional and physiological improvement after treatment in some visual endpoints which might be suggestive of neuroprotection.

source: Lancet Neurol. 2012 Jan 9. [Epub ahead of print]

study weblink: http://www.ncbi.nlm.nih.gov/pubmed/22236384
RRMS '95 SPMS '02 | CCSVI 10/09 | Adult stem cells 2012 | http://www.patientsforstemcells.org/
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby ApVish » Tue Jan 17, 2012 12:14 pm

Glad to see more information on mesenchymal stem cell trials. It would be awesome if they stop further disability progression/attacks. But 10 months might just be too short a time frame.

Hoping for more positive news on the stem cells front.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby georgegoss » Tue Jan 17, 2012 9:35 pm

I agree 100% with ApVish. I'm glad to see this specific work being furthered along.

I looked up more details of this specific study on the clinical trials website. . . .

http://www.clinicaltrials.gov/ct2/show/ ... 200&rank=1

I was glad to see that this study work involved colony expansion work of the MSC's to a re-infused population of around 2 million cells per kg of body weight. This appears as to now becoming a standard, same as Prof. Slavin offers at CTCI Isreal as I outline on this page:

http://themscure.blogspot.com/2011/06/g ... -have.html

Just a side note. . . this work appears to also validate the statement that the unmanipulated MSC therapy as offered by many clinics around the world (the main one being Medistem / Stem Cell Institute in Panama) as being nothing but snake oil stealing people's money for an ineffective treatment.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby SammyJo » Wed Jan 25, 2012 2:36 pm

Thanks for your feedback George! You have been such a pioneer with HSCT - congratulations on your 2 year anniversary!

I've had CCSVI 4x over the past 2 years, the progression has stopped and I can do minimal exercise to recoup nerve function but it is slow, hense my interest in MCS from adipose tissue. I don't think I could handle anything more aggressive at this point. Most of the MS-MCS stories I've followed tend to show improvement at first, which fades after a year or so. I am hoping that restoring better circulation as the first step, will extend the benefits from MSC. I'm also searching for others who have done CCSVI followed by MSC.
Last edited by SammyJo on Thu Feb 02, 2012 9:02 am, edited 1 time in total.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby georgegoss » Wed Jan 25, 2012 4:01 pm

SammyJo wrote:Thanks for your feedback George! You have been such a pioneer with HSCT - congratulations on your 2 year anniversary!

I've had CCSVI 4x over the past 2 years, the progression has stopped and I can do minimal exercise to recoup nerve function but it is slow, hense my interest in MCS from adipose tissue. I don't think I could handle anything more aggressive at this point. Most of the MS-MCS stories I've followed tend to show improvement at first, which fades after a year or so. I am hoping that restoring better circulation as the first step, will extend the benefits from MSC. I'm also searching for others who have done CCSVI followed by MSC.

Also, it seems we are at the start of MCS treatment in the US, obviating the need to go to foreign clinics. I will start a new post on what I've been able to track down on Celltex in Texas.


Thanks Sammy.

As it stands now, no US facility can legally provide/administer colony-expanded MSC therapy outside of an FDA-approved clinical trial (as currently only performed by Cleveland Clinic / Case Western). The data is so far stacking up that only the colony-expanded MSC therapy (and not the minimially manipulated adipose fat tissue MSC therapy) appears to have a potentially beneficial effect. So at this point in time the only option of legally receiving such treatment outside of a trial is an overseas clinic, such as CTCI in israel. The rules may change someday in the US, but for now it's pretty black and white. Effective MSC treatment cannot be had in the US outside of a clinical trial at this time. But as stated before. . . . I'm glad it is available somewhere, such as in Israel with Prof. Slavin:

http://www.ctv.ca/CTVNews/Health/200811 ... nt_081116/

And the US-based trial work at Case Western:

http://www.youtube.com/watch?v=-S49VSZh ... r_embedded
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby SammyJo » Wed Jan 25, 2012 8:15 pm

I hope there will be more news soon for IRB approved trials for MSC stem cells.
Last edited by SammyJo on Thu Feb 02, 2012 9:04 am, edited 1 time in total.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby georgegoss » Wed Jan 25, 2012 9:53 pm

Thanks for educating me about this, Sammy. Clearly there is more to the story than I had first understood.

Although MSC culture expansion in the USA is clearly illegal by FDA rules & regulations, it looks like Perry's efforts to support and push a bill/law through the Texas state legislature and support a business endeavor clearly makes it legal under Texas state law. I don't know how this will eventually be reconciled between federal and state law, but in the end I hope Celltex will be able to provide this (culture expanded) MSC infusion therapy without breaking any laws and available to the public as a whole. (This situation appears to be similar to marijuana being illegal under US Federal law, but legal under specific circumstances for medical use under some states law, such as California.) I fully support this expanded MSC infusion treatment endeavor since 200M MSC's as you described over three infusions fulfills the basic researched efficicacy requirement of greater than 1-2M stem cells per Kg of body weight. I suspect in the end we'll see if this is challenged in Federal court by the FDA. But for now I'm glad to see the work continue. I personally would also consider this treatment for myself if the stated MSC expansion population is correct. And if so, the $25K pricetag might be a good value making the treatment well worth a try.

Good news summary of the legal/political situation (be sure to watch the video):

http://www.msnbc.msn.com/id/44291973/ns ... tors-firm/
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby Liberation » Sun Jan 29, 2012 5:31 am

Recently, I have been giving some thoughts to going through a stem cell treatment. I really admire you, George for your courage, and I feel the same way that HSCT has the most rationale behind it, but I have to admit that I am not brave enough to go through it at the moment. The high price tag and the fact that my native language is not English just make things even more difficult or me.

Therefore, recent news on MSC drew my attention to it as it seemed less invasive (no chemotherapy). However, I read some questions about tumor possibility and its effectiveness seems less specific. " MSCs display certain special properties such as immune privilege (survival in allogeneic environments) and active homing to distressed tissues via surface molecules such as CXCR4. They also preferentially home to tumor stroma,24 potentially inhibiting tumor immune surveillance. "

I also do not know what someone can expect from an MSC treatment. News about the results are quite vague. Could it be that there is more data in Korea and China in this field? It looks like RNL is really in the front line. I am just wondering if the lax regulation in China gave rise only to the scam operations or also opened the door to real scientists and sped up their research as they could do stem cell treatment without waiting for decades for regulatory approval to start a clinical trial.

What are the differences among the MSC treatments which have been recently announced? If a clinical trial started how much they can incorporate any new findings during the trials? It seems that stem cell treatment is developing rapidly and every day something new comes around.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby Liberation » Sat Feb 04, 2012 6:04 am

Anyone knows where someone can participate in a clinical trial with MSC stem cells in Europe? In last august there was an announceent that clinical trails will start in 6 months all over in Europe for 150 patients.

Anyone knows what are the differences in efficiency and safety among the different MSC stem cell sources (like, fat, bone marrow, umbilical cord blood, etc.)?

I am a little bit confused what is the mechanism of MSC stem cells therapy. Are they supposed to repair the damage caused by MS or they are only neuroprotective?
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby georgegoss » Sat Feb 04, 2012 12:46 pm

Liberation wrote:Anyone knows where someone can participate in a clinical trial with MSC stem cells in Europe? In last august there was an announceent that clinical trails will start in 6 months all over in Europe for 150 patients.

Anyone knows what are the differences in efficiency and safety among the different MSC stem cell sources (like, fat, bone marrow, umbilical cord blood, etc.)?

I am a little bit confused what is the mechanism of MSC stem cells therapy. Are they supposed to repair the damage caused by MS or they are only neuroprotective?


All excellent questions, Lib. At this point the data is so sparse that all the questions regarding the underlying mechanisms of possible benefit are still unanswered. There have been a few basic phase I (safety & tolerability) studies, but they were very small patient populations and were designed to test safety, not efficacy. The next levels of phase II / III studies are designed to test efficacy, but have yet to start.

As of today, this study report out of Israel is the best compilation of scientific clinical data (which frankly, is not very conclusive):

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036569/

Here is an article describing the European study out of the UK you mention that will be treating 150 patients. But again, this early study is designed to primarily test safety, not efficacy. If you want to participate in this study, I would suggest to contact the Imperial College London:

Doctors begin major stem cell trial for MS patients

http://www.bbc.co.uk/news/health-14332206

Cleveland Clinic is also doing a phase I study:

http://www.healthcanal.com/drugs-approv ... y-for.html

And some Case Western researchers in a video report about this subject:

http://www.youtube.com/watch?v=0aE2fYP-0uk

Here is an article & video of a Canadian woman that received MSC infusion therapy at CTCI Israel that appears to have worked well for her specific case. But remember that this one case doesn't prove anything specific and does not directly translate to anyone else:

http://www.ctv.ca/CTVNews/Health/200811 ... nt_081116/

If you can't / don't get into the UK study, you can still pay to get the MSC treatment at CTCI in Israel:

CTCI homepage:

http://ctcicenter.com/

"In-vitro" (in the test tube) cellular observations have shown that MSC's secrete cytokines that are thought to operate as messenger molucules to encourage or direct other cells to effect repair of nerve tissue. There is also some preliminary evidence that MSC's (in sufficient population quantities) "might" have some immunomodulatory effect (duration unknown) to reduce autoreactivity underlying MS. However, there is virtually no "in-vivo" (in the body) data to show clinical benefit in a controlled or repeated manner. So right now scientists are "hoping" that what has been observed at the cellular level will translate to benefit in a higher level functional organism (human body). So this is why population studies and trials must be performed. Until then, all these very important questions remain unanswered and there is only individual anecdotal information, which in itself does not hold any predictive usefulness as a treatment for MS.

The only "real" conclusions that have been determined so far is that 1) The re-infused MSC's must be culture-expanded to create a sufficiently large population (1-2M MSC cells per kg of body weight) to create some clinical effect (which also clearly shows that clinics, i.e. Panama, that do not manipulate the MSC population is completely ineffective and is snake oil rip-ff), and 2) The re-infused autologous MSC's so far appear to be safe. But beyond this, there is no conclusive evidence that this treatment is responsible for improving people's health. Although, the data is definitely encouraging and seems to point in the right direction.

This is why I'm happy to see the work continue in a controlled manner. If the results progress along as everyone hopes, I also would consider this treatment.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby Liberation » Mon Feb 06, 2012 12:33 pm

Hi George,

thank you for your answer. It was really very useful. I am not so familiar with interpreting the results, so I am not sure how these results would translate into change in sy' ordinary life. Some questions that just popped into my mind when reading these articles:

Whether the efficacy could be improved by repeating the stem cell therapy? Could a much more impressive gain be achieved this way?

What differences can the different MSC sources (bone marrow, fat, etc.) result in efficacy and safty?

The story of the lady who plays golf was very impressive.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby georgegoss » Mon Feb 06, 2012 2:04 pm

Liberation wrote:Whether the efficacy could be improved by repeating the stem cell therapy? Could a much more impressive gain be achieved this way?


This has not been studied. But it seems to me that if a single MSC infusion turns out to be clinically beneficial then it is logical to think that multiple MSC infusions may offer additional benefit. However, this approach may also require some additional safety testing because there is a 'theoretical' possibility that infused MSC cells may lodge in the pulmonary tissues causing benign fibroblastic growths that could impair breathing function. If so, then lung surgery may be required to remove them. But this is still only a theoretical possibility since it has not yet shown to be a problem.

Liberation wrote:What differences can the different MSC sources (bone marrow, fat, etc.) result in efficacy and safty?


This is truly an excellent question. Mesenchymal Stem Cells reside in several descrete locations within the body (bone marrow, adipose tissue, cartilage and other connective tissues), and I also wonder what is the difference, function and capability of these MSC's in relation to each other. At the molecular level, these various-origin MSC's appear to be slightly or somewhat morphologically different, even though quite similar in function. Do all MSC origin-types behave the same, or differently in terms of clinical benefit for neurologic functioning? (It is known that marrow-derived MSC's replicate more effectively as compared to adipose MSC's, so clearly there is something different about them at some level.) In other words, is an MSC an MSC an MSC? I spoke with a PhD researcher at the Cleveland Clinic where they are doing the phase I trial with MSC's for MS (they use them from bone marrow because they can replicate them for colony expansion purposes more easily) and asked them this same question. The response is that they don't know. No one (yet) seems to know which source MSC might be better than the others, or if certain types have superior clinical performance, if at all. All part of the remaining mystery yet to be solved.

Liberation wrote:The story of the lady who plays golf was very impressive.


I was also very impressed with her recovery. Good to see. But was it due to the use of MSC infusion therapy, or just a propitious coincidence? No one knows the answer because a single individual's isolated case tells us almost nothing. This is why I am very happy to see these larger treatment population trials being conducted as only a controlled population study will provide the answers.
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby Liberation » Wed Feb 08, 2012 12:34 pm

Thanks George. I hope good things will come out of the clinical trials.

On the CTCI homepage, I could not find any info on the MSC; however, I inferred that they are doing such kind of treatment. They seem a reputable institution, so I would be interested in their experience.

It seems to me that MSC impact is twofold: "They found that MSCs produced a barrier that blocked the autoimmune response and the formation of scar tissue that would otherwise permanently halt signals from traveling along nerves. In addition, the cells produced molecules that enhanced regeneration of the damaged axon and the myelin surrounding it."

One thing that I could not make of anything is a comment from an article:
"Stem cells are drugs and possibly permanent ones. Yeah, they are extremely unusual drugs, but they are drugs. The FDA considers them drugs. Unlike other drugs, once a patient receives a stem cell drug, it will not necessarily simply go away like other drugs because a stem cell drug consists of living cells that often behave in unpredictable ways. What this means is if the stem cells are doing bad things your doctor has no way to stop it."
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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby packo » Fri Feb 10, 2012 10:32 am

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Re: Autologous mesenchymal stem cells for secondary prog. MS

Postby Liberation » Sat Feb 11, 2012 8:20 am

I am just wondering if the fact that adipose fat tissue has 300-500 fold number of healing mesenchymal stem cells compared to bone marrow would obviate the need for cell expansion?

I read in one of the articles that George posted that in case of BMMSCs, long-term culture alters the quality of MSCs, including morphological changes, attenuated expression of specific surface markers, reduced proliferative capacity, differentiation potential, and trophic activity.
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