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In conversation: Neurologist Dr Ahmad Tauqeer on the real potential of stem cell therapy treatment for Multiple Sclerosis

Asykin Ismail, 25 Jan 2017
Multiple Sclerosis (MS) is a debilitating disease, in which nerve damage affects communications between the brain and body. It is a lifelong condition that can sometimes cause serious disability, although it can manifest as much milder symptoms instead too.

In MS, the immune system attacks the layer that surrounds and protects the nerves, called the myelin sheath. This damages and scars the sheath, and potentially the underlying nerves, which mean messages travelling along the nerves, become slowed or disrupted.

“People with MS may experience a wide range of symptoms, depending on which part of the brain or spinal cord is affected, including blurred vision, pain, numbness, extreme fatigue, loss of movement and speech problems. MS is most likely caused by an interaction of several factors related to individual immunity, the environment, past infections (viral or bacterial) and genetic predispositions,” explained Dr Ahmad.

There are four different types of MS (Relapsing-Remitting, Primary-Progressive, Secondary-Progressive, and Progressive-Relapsing) that call for different treatments at varying points in the progression of the disease.

Exploring stem cells

As all patients with MS are aware, current available treatments unfortunately are not targeted at curing the disease or repairing the damage that it does. Today’s crop of disease modifying drugs (DMDs) mostly aim to quiet the disease, thereby improving the quality of life for many of the patients taking them, especially those suffering from relapsing remitting MS.

But for a true cure, other measures are clearly required.

Dr Ahmad noted that stem cells could represent the revolution that patients both desire and require, and that experts are already using them to understand the normal development of brain tissue. For some, this is in hopes of translating this into learning precisely what goes wrong in MS. Stem cells are also enormously useful for testing new drugs and treatments and for learning more about the body’s natural repair mechanisms.

“Stem cell therapy is a treatment that uses or targets stem cells, which are the types of cells that differentiate into many different specialised cells in our bodies. The treatment works by resetting patients’ immune systems using their own stem cells,” said Dr Ahmad.

He went on to describe that there are five different types of stem cells, as follows:

• HSCs (haematopoietic stem cells)
These are adult stem cells found in bone marrow and blood. HSCs are capable of producing all of the cells that make up the blood and the immune system.

• MSCs (mesenchymal stem cells)
These are adult stem cells found in several places in the body, including the bone marrow, skin and fat tissue. They produce cells which help other stem cells function properly.

• NSCs (neural stem cells)
These are specialised stem cells responsible for repairing nerve-insulating myelin in the brain. These can be derived from other types of stem cells such as mesenchymal cells.

• hESCs (human embryonic stem cells)
These are stem cells derived from donated embryos. They can naturally produce every type of cell in the body.

• iPSCs (induced pluripotent stem cells)
These are engineered from adult cells to produce many types of cells.

From these though, much focus is currently placed on the first, HSCs, for therapeutic purposes.

A breakthrough therapy?

One approach uses stem cells to provide the patient with a brand-new immune system, which will not turn against a patient’s own body. This is known as hematopoietic stem cell transplant, or HSCT, and has been used on patients in trial settings for almost two decades.

To date, Dr Ahmad asserted that HSCT is the only scientifically proven treatment that stops underlying disease progression in MS, mainly benefitting the relapsing-remitting (RRMS) sub-type. It restores normal immune self-tolerance and produces lasting curative symptomatic improvement for the majority of MS patients. Over 2,000 patients have been treated worldwide, and the number continues to rise daily.

“HSCT involves ablating (destroying) a patient’s existing immune system through the use of powerful chemotherapy drugs, and then intravenously infusing a patient’s own stem cells back into their body,” said Dr Ahmad.

Once infused back into a patient’s body, the stem cells go about reconstituting their immune cells, effectively providing them with a brand-new immune system.

In practice, this type of therapy has proven to be quite effective, particularly among patients with aggressive relapsing remitting diseases who display a high amount of inflammation in their central nervous systems, as are evidenced by enhancing lesions seen on MRI imaging.

“There is also no ethical dilemma as the treatment uses adult stem cells extracted from the patient’s own blood, and no embryonic stem cells are involved,” he added.

Based on the evaluation of patients who have undergone HSCT, Dr Ahmad elaborated that HSCT was associated with an improvement in physical abilities, cognitive function, quality of life, and reduction in the volume of brain lesions as noted using magnetic resonance imaging (MRI).

Though HSCT is still considered an experimental treatment for MS, it is already being provided by many centres. Variable results have been seen from different centres. Some patients report a progression-free survival rate of up to 90.9 percent, and a clinical relapse-free survival of 86.3 percent. A common observation among the different studies, however, is that the sooner it is undertaken, the better the outcomes.

“This treatment does offer hope, but it’s also an aggressive procedure that comes with substantial risks and requires specialist aftercare. If anyone is considering HSCT, it is best for them to consult a neurologist,” advised Dr Ahmad.

Dr Ahmad also cautioned that while HSCT holds much promise for putting the brakes on very aggressive relapsing remitting MS, it unfortunately has little to offer those with progressive disease, and does nothing to directly repair the damage done to the central nervous system by MS.

He remarked that the primary goal of HSCT is to reboot a patient’s immune system and that HSCT does nothing to directly address the damage that has already been caused by the disease, but rather seeks to disrupt the disease process.

Living with MS

Receiving an MS diagnosis can be a difficult experience, leaving patients uncertain about how to cope in the future. Understanding one’s diagnosis and seeking support from healthcare professionals will provide the patient with the necessary information about their diagnosis and available treatment options and methods.

“MS patients should be more active, either on their own or with a physiotherapist. Their homes should be safe and easy to get around in order to minimise falls. They should also avoid getting overheated as an increased body temperature can temporarily make their symptoms worse,” said Dr Ahmad.

He also added that reaching out to loved ones for support through emotional, mental, and physical care will help patients to maintain their treatment in the long run.

About Dr Mohammed Tauqeer Ahmad

Dr Mohammed Tauqeer Ahmad is a Neurologist from the Raffles Neuroscience Centre, Raffles Hospital. He graduated from the Aligarh Muslim University in India in 1997, and obtained his MRCP from Royal College of Physician (UK), M Med (Int Med) from NUS in 2006 as well as Fellowship of the Royal College of Physicians (Edinburgh) in 2012. His other qualifications are MD (General Medicine), MRCPS (Glasgow) and FAMS (Neurology).

Prior to joining Raffles Hospital, he was a consultant in the Department of Neurology at the National Neuroscience Institute (SGH campus). He completed his basic and advanced specialist training at SGH. He was previously a Clinical Tutor at the Yong Loo Lin School of Medicine, and currently, a adjunct assistant professor at Duke NUS. He is actively involved in both postgraduate and undergraduate medical training, as well as teaching of allied healthcare workers and the public.

Dr Ahmad is a member of numerous local committees and reviewer for several peer-reviewed journals related to neurology. His special interests are in general neurology, stroke, epilepsy and neuroimmunology.

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