Stem cell transplantation: a clear horizon for therapy of Multiple Sclerosis
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Mehdi Ataee Karizmeh ,1,* AmirAli Moodi Ghalibaf,2 Nilufar Ashouri,3 Faezeh Farhomay Sani,4
1. Birjand University of Medical Sciences
2. Mashhad University of Medical Sciences
3. Mashhad University of Medical Sciences
4. Mashhad University of Medical Sciences
- Introduction: Multiple sclerosis (MS) is an autoimmune-based demyelinating disorder of the brain and spinal cord, which finally made an axonal loss and eternal neurological disability. Epidemiologically, MS is the most common demyelinating disease, with a prevalence that varies extremely, from a high rate of prevalence in North America and Europe (>100/100,000 inhabitants) to a low level in Eastern Asia and south of the Sahara in Africa (2/100,000 population). Although recent proof suggests that MS relapses are created by environmental and exogenous triggers like the infectious agent and genetic background, its very complex pathogenesis is not completely understood. Therefore, the utility of current immunosuppression-based therapies of MS is too low. Cell-based therapies have provided a new chance for the prevention and treatment of different neurodegenerative diseases like MS. In this review, we discuss the current datum, methods, and limitations of stem cell-based therapies for the treatment of patients with MS.
- Methods: A comprehensive search was performed in electronic databases PubMed, Scopus, Science Direct, UpToDate, and Web of science with the keywords “Stem Cell” and “Multiple Sclerosis” from 2012 to 2020. Original articles that mentioned the therapeutic effects of stem cells on MS were included in the study.
- Results: Currently, existing treatments for MS help ameliorate the patient’s overall quality of life and reduce long-term disability by preventing the recurrence and severity of MS attacks, however, so far there is no cure for this disease. In recent years, stem cells derived from a variety of sources have been used in clinical trials as transplant agents to break down and alter the faulty chemical process or damaged tissue. The foremost common kind of stem cells used in the treatment of MS is mesenchymal stem cells (MSCs) found within the bone marrow because of their harmlessness and straightforward extraction ways. In addition to mesenchymal cells, there are other types of stem cells that can be used for the treatment of MS. Autologous hematopoietic stem cell transplantation (HSCT) is another method that can be considered as a therapeutic option. The goal of HSCT is to remove stem cells and modulating the patient’s immune system to attain long-run remission of MS. Umbilical cord (UC) stem cells are also an effective treatment for MS due to their high ability to differentiate into diverse tissue. However, a cell bank is required to reserve and sustain these cells. Adipose tissue stem cells (ASCs) are one of the best types of stem cells that can be used in the treatment of MS. Firstly, the sequestering of the fat tissue is straightforward and might be provided from various organs of the body. Secondly, the density of stem cells per unit of area in fat tissues is high and during sampling, a large number of stem cells can be obtained. Thirdly, the cost of stem cell transplantation from fat tissue is negligible. Meantime, adipose MSCs, like the adult stem cell group, are looks safe to use. These benefits make the ASCs an acceptable candidate for the treatment of MS. Neuronal stem cells can also be a source of well-differentiated cells that can be quickly altered by damaged neuronal cells. However, this methodology requires a high number of aborted fetuses that create it terribly arduous for preparing needed cell stem cells.
- Conclusion: Studies have shown that cell therapy significantly improves the quality of life, neurological disability, and functional scores. In general, HSCT and MSC transplantation in MS patients have been well-tolerated, but several potential acute and chronic adverse effects should be considered. Infusion-related toxicity and infection are serious risks of stem cell therapy, and additive immunosuppressive treatment increases the risk of infection after transplantation. Ectopic tissue formation and malignant transformation of stem cells are theoretical concerns, although it has not been reported in MSC therapy studies, yet. Well-designed randomized controlled studies that systematically evaluate the efficacies and safety of cell replacement therapy compared to other relevant treatments are needed to clarify treatment benefits.
- Keywords: Stem cell, Multiple Sclerosis, Stem cell therapy
