Modulating the Immune System with Mesenchymal Stem Cells: Looking Beyond Bone Marrow

Modulating the Immune System with Mesenchymal Stem Cells: Looking Beyond Bone Marrow

Mesenchymal stem cells have two unique and powerful properties that make them the focus of intense scientific research. First, mesenchymal stem cells can escape recognition by the immune system. In other words, when mesenchymal stem cells are infused into the body, the immune system does not recognize them as foreign and does not react to them. If the immune system did respond to the stem cells, it would cause an aggressive and potentially deadly allergic or immunologic response. Second, mesenchymal stem cells have the power to inhibit the immune system. This means mesenchymal stem cells could be used to treat immunological and autoimmune diseases such as Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis, and Crohn’s Disease, among others. In essence, mesenchymal stem cells can affect the immune system without triggering an inflammatory response making them an ideal treatment for these diseases.

For some time, mesenchymal stem cells extracted from bone marrow were thought to be the only type of mesenchymal stem cells capable of beneficially affecting the immune system. This fact is not necessarily bad, but it does mean that mesenchymal stem cell donors must undergo a bone marrow procedure, which can be painful and expensive. It would be far better if doctors could use mesenchymal stem cells taken from easier-to-get tissues such as fat (adipose), umbilical cord blood, or Wharton’s jelly (umbilical cord tissue). Most people have adequate amounts of fat just under the skin, and umbilical cord blood and tissue are thrown away as medical waste every day.

Fortunately for patients, Dr. Yoo and colleagues showed that mesenchymal stem cells taken from fat tissue, umbilical cord blood, and Wharton’s jelly exhibit the same immunomodulatory properties as mesenchymal stem cells taken from bone marrow. The researchers showed that these types of mesenchymal stem cells were able to suppress T-cell proliferation as effectively as those cells taken from bone marrow. T-cell proliferation, it should be pointed out, is a key step in autoimmune inflammation that occurs in diseases such as rheumatoid arthritis and others.

In short, mesenchymal stem cells taken from easier-to-get tissues were just as effective at suppressing inflammation (in vitro) as those taken from bone marrow. These results will need to be confirmed in clinical studies; however, this approach will be much more convenient and less expensive for patients and donors if they can use mesenchymal stem cells taken from fat or umbilical cord rather than bone marrow and yet reap the same benefits.

 

Reference: Yoo KH et al. (2009). Comparison of immunomodulatory properties of mesenchymal stem cells derived from adult human tissues. Cell Immunology. 2009;259(2):150-6.

Cannabinoids (CBD) Help Patients with Hard to Treat Muscle Spasticity From Multiple Sclerosis

Cannabinoids (CBD) Help Patients with Hard to Treat Muscle Spasticity From Multiple Sclerosis

Four out of five people with multiple sclerosis experience muscle spasticity. Muscle spasticity causes increased muscle tone, uncontrollable muscle contractions, and spasms. Like severe muscle cramps, muscle spasticity can be quite painful and is one of the most troubling symptoms of multiple sclerosis. Despite being so common and so troublesome, multiple sclerosis patients with muscle spasticity have few effective treatments options. In many cases, the muscle spasticity continues even after treatment with drugs such as baclofen or tizanidine. Not only are these drugs largely ineffective, in many cases they cause substantial side effects.

Marijuana has long been known to exert a muscle relaxing (anti-spasmodic) effect. As medical marijuana is becoming legal in more jurisdictions, researchers are now carefully studying the effects of the substances within marijuana. One important example is a study conducted by Spanish researchers. In 2010, Spanish drug authorities approved the use of an oral spray that contains a combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), two active substances found in marijuana (Cannabis sativa). Spanish authorities approved the use of this drug for multiple sclerosis patients with moderate to severe muscle spasticity who did not benefit from other antispasmodic drugs.

Dr. Lorente Fernández and other Spanish researchers were interested in learning whether this combination of THC and CBD was able to help multiple sclerosis patients with severe muscle spasticity. The scientists found that the combination of substances found in medical marijuana was effective in 80% of patients they examined. What is striking about this finding is that every patient included in this study had failed to find relief from other medical treatments of spasticity. In other words, they had difficulty in treating muscle spasticity. When viewed in those terms, an 80% effectiveness rate is extremely impressive.

Some patients withdrew from treatment because they felt that THC/CBD did not help them within the first 30 days of starting treatment or some experienced dizziness or weakness.

Muscle spasticity is one of the most common, most troubling, and most difficult to treat symptoms of multiple sclerosis. While traditional medical treatments often fail, the substances in medical marijuana may offer hope. This study illustrates that 4 out of 5 multiple sclerosis patients with difficult to treat muscle spasticity achieved relief from a combination of THC and CBD, substances found in medical marijuana.

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Reference: Lorente Fernández et al. (2014). Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. Neurologia. 2014 Jun;29(5):257-60.

Mesenchymal Stromal Cells Shown to be Safe in Multiple Sclerosis

Mesenchymal Stromal Cells Shown to be Safe in Multiple Sclerosis

Of all conditions that affect the central nervous system, Multiple Sclerosis (MS) is the most common in young adults. The severity of multiple sclerosis varies considerably and can affect almost every organ system in the body affecting eyesight, bowel function, bladder function, and sexual function. Multiple sclerosis may cause cognitive problems, depression, seizures, fatigue, and pain. Most people with multiple sclerosis will have a relapsing-remitting course, which means they will have periods of relative health punctuated by flare-ups of the condition. About one out of ten people with the condition will have primary progressive multiple sclerosis, which means once the disease occurs it almost constantly causes symptoms and progresses over time.

Multiple sclerosis appears to be an inflammatory condition that affects the covering around nerves. During acute flareups/exacerbations, physicians usually prescribe a powerful steroid medication such as methylprednisolone to combat the inflammation. Patients with multiple sclerosis generally always require some sort of treatment to help manage their immune system. No fewer than 15 immune modulating treatments have been used to treat multiple sclerosis, none of which provides a cure. As such, researchers are seeking new and innovative ways to treat this potentially debilitating condition.

Researchers at the Tisch Multiple Sclerosis Research Center of New York chose to focus their research efforts on a particular type of stem cell, namely bone marrow-derived mesenchymal stromal cells. The researchers harvested these cells from the patients themselves (autologous stem cells). Then, in their laboratory, scientists used various means to prompt the cells to become neural progenitors. A neural progenitor cell is a cell that can become any of the three main types of brain cells: neurons, astrocytes, or oligodendrocytes. Incidentally, oligodendrocytes are believed to be most affected in multiple sclerosis.

Harris and co-authors at the Tisch Center enrolled six patients with progressive multiple sclerosis. These six patients had failed to find relief from other conventional multiple sclerosis treatments. The researchers provided between 2 to 5 infusions of neural progenitor cells into the spinal fluid. The multiple sclerosis patients treated with the cells tolerated the treatment very well. No serious adverse events occurred, nor were there any safety concerns during treatment. Impressively, four of the six patients—for whom no other multiple sclerosis treatment worked—had a measurable clinical improvement after stem cell treatment.

Based on the results of this clinical study, the scientists concluded that neural progenitor cells created from autologous mesenchymal stromal cells were safe to use in patients with primary progressive multiple sclerosis. Moreover, the beneficial effect witnessed in two-thirds of treated patients suggests that these cells may be able to help patients with even the most severe and difficult-to-treat forms of multiple sclerosis. Of course, additional testing is required before this treatment becomes commonplace, but the results of this first-in-human clinical study are extremely encouraging.

 

Reference: Harris et al. (2016). Clinical safety of intrathecal administration of mesenchymal stromal cell-derived neural progenitors in multiple sclerosis. Cytotherapy. 2016 Dec;18(12):1476-1482.

Hemp Extract Reduces Muscle Spasticity in Patients with Multiple Sclerosis

Hemp Extract Reduces Muscle Spasticity in Patients with Multiple Sclerosis

Multiple sclerosis (MS) is a debilitating neurological condition. MS causes nerve cells to become dysfunctional. The symptoms of multiple sclerosis vary from person to person and over time; however, one of the most common symptoms of MS is muscle spasticity. More than 80% of patients with MS have some degree of muscle spasticity.

Muscle spasticity causes increased muscle tone. Affected muscles contract even though the person is not trying to contract them. Patients may also experience uncontrollable muscle jerking and spasms. These muscle contractions can be quite painful and interfere with daily activities. In fact, about one in 20 multiple sclerosis patients with muscle spasticity are completely disabled because of it.

It can be difficult to treat muscle spasticity in patients with multiple sclerosis. Physicians may prescribe baclofen, tizanidine, or dantrolene for muscle spasticity; however, these treatments are only mildly effective and may cause troubling or serious side effects. Baclofen may cause muscle weakness, tizanidine may cause severe dry mouth, and dantrolene is toxic to the liver, for example. Researchers are continuously looking for ways to help multiple sclerosis patients to reduce muscle spasticity.

Cannabinoids are the biologically active chemicals found in the cannabis plant. Cannabinoids have been used successfully for various medical purposes. For example, these agents have been used to treat nausea caused by chemotherapy and to stimulate appetite in patients with cancer. Patients with multiple sclerosis have reported that hemp extract helps relieve symptoms. Moreover, research studies have shown cannabinoids can protect nerve cells against damage. Based on these findings, researchers conducted a clinical trial to study the effect of cannabinoids on muscle spasticity in patients with multiple sclerosis.

A total of 630 patients with multiple sclerosis and muscle spasticity received the hemp extract or placebo for 15 weeks. The researchers then performed a number of objective tests to assess muscle spasticity. Patients who received the cannabinoids had fewer symptoms and less muscle spasticity at the end of the clinical trial compared to patients taking the placebo. The greatest benefit appeared after 40 weeks of treatment. Indeed, patients felt that cannabinoids helped manage their condition. Importantly, no major safety concerns were reported.

These clinical trial results suggest long term cannabinoids treatment is safe and may help people with Multiple Sclerosis control symptoms of muscle spasticity.

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Reference: Zajicek et al. (2005). Cannabinoids in multiple sclerosis (CAMS) study: safety and efficacy data for 12 months follow up.Journal of Neurology, Neurosurgery, and Psychiatry. 2005 Dec;76(12):1664-9.

5 Foods Multiple Sclerosis Patients Should Discuss With Their Doctors

5 Foods Multiple Sclerosis Patients Should Discuss With Their Doctors

The complex interplay between nutrition and health is still being researched by experts. In many cases, there are already established links between certain foods and undesirable health outcomes. For example, recent dietary guidelines recommend limiting added sugars to 10% of your daily calories or less, as they’re associated with an increased risk of heart disease. For individuals with chronic diseases, it’s perhaps even more important to consider the ways food can impact health.

For those with Multiple Sclerosis (MS), optimizing your diet means not only filling your plate with healthy foods, but also avoiding or limiting foods known to exacerbate symptoms. Research shows that in particular, patients with MS have been able to improve their quality of life by making specific tweaks to their diet. Discover which foods you should discuss with your doctor as a means of controlling your symptoms.

Fats

Saturated fats are commonly found in animal products, including red meat. These foods aren’t entirely void of nutritious qualities – after all, they can be rich sources of protein. Yet, their high concentration of saturated fats presents issues, as they could raise “bad” cholesterol levels. This is especially of concern for MS patients, who face a higher risk for heart problems than people without MS.

Trans fats, too, are considered dangerous. Sometimes labeled as “partially hydrogenated oils,” these fats are known to increase inflammation, particularly within the blood vessels. This, too, increases the risk of cardiovascular issues. Steer clear of packaged cookies, crackers, and dessert items, or at the very least, be sure to enjoy them sparingly.

Sugar

We mentioned briefly above that added sugars are notorious for their adverse health effects. Not only does excess sugar lead to weight gain, but it also produces an inflammatory effect which can intensify MS symptoms. Natural sugars, including those found in fruits, don’t have the same effect, so feel free to snack on those instead.

Sodium

Added salt presents a number of issues for MS patients. In general, higher sodium intake is associated with increased disease activity in MS, and has been found to increase likelihood of relapse and development of lesions. Sodium intake and blood pressure are also related, and because high blood pressure can decrease life expectancy in MS patients, added salt should be consumed at a minimum.

Dairy

Like meat, cow’s milk and other full-fat dairy products are high in saturated fats. Besides the fat content, however, specific proteins in the milk could cause trouble for people with MS. These agents could produce a reaction in multiple sclerosis sufferers, but research shows the link isn’t very strong. However, it may be worth replacing cow’s milk and other full-fat dairy products with alternatives to see if it alleviates your symptoms. Consider exploring options such as soy, almond, or even camel’s milk.

Gluten

Gluten is primarily a concern for people with celiac disease, which is characterized by an allergy to the protein found in rye, wheat, and barley. Consuming gluten can cause intestinal damage in people with the allergy. Because MS patients have a higher incidence of celiac disease than the general population, it may be useful to closely monitor your body’s reaction to consuming bread, cereal, pasta, and other foods with gluten. While there is currently no evidence suggesting avoidance of gluten can alleviate MS symptoms in patients who don’t have celiac disease, it never hurts to bring up any food-related concerns you may have with your physician.

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