
Canadian doctors reverse severe MS using stem cells - yurisagalov
http://www.vox.com/2016/6/9/11898512/multiple-sclerosis-stem-cell-chemo
======
wildmXranat
I live in Canada. I just listened to one of the participants talk about the
experience on the radio and I found it just incredible.

In her own words, "She could not feel her body from the neck down. After the
long and gruel ordeal procedure, she began to get sensation back. Things like
hot and cold water began to be discernible. She no longer needed to hold both
railings when walking down stairs in her home, needing a cane to get the mail,
etc ..."

She said that it gave her her life back. She said that in short time, she
began to get bored with doing the regular, tired routine and actually got a
part-time job.

I mean, all that sounds phenomenal.

~~~
cpncrunch
It does sound phenomenal, but bear in mind there was no placebo control, so we
don't know how much of the effect was due to the placebo effect.

Generally the placebo effect will vary depending on the type of intervention.
A very novel and invasive intervention like this will have a high placebo
effect. Remember Liberation Therapy?

Given that psychological treatment alone can reduce the fatigue in MS to below
that of healthy controls (van Kessel 2008), it's likely that the placebo
effect plays a large role. (The placebo effect will also affect pain, weakness
and numbness, as the part of the brain that produces fatigue - the anterior
cingulate cortex and insular cortex - also produces those symptoms).

~~~
zxv
Hang on a minute.

Placebo effect does not explain regaining sensation, nor regaining ability
walking.

~~~
refurb
Sure it can. Sensation is a subjective measure by the patient themselves. If
the patient takes a drug then you ask if sensation improves, they could
certainly say "it feels like it's improving".

And with regards to ability to walk, fatigue is often a major complaint in MS.
If the patient takes a drug, "feels better", they may have more energy and do
better on a walk test.

There are measure where a placebo effect is unlikely, such as blood tests of
biomarkers or physical processes that are easily measurable without having to
ask the patient (e.g. plaque buildup on arterial walls).

~~~
King-Aaron
I think you're vastly and grossly underestimating how multiple sclerosis
impacts your nervous system if you think that a placebo effect making you
"feel better" will give you the ability to walk again.

It's actually a little stunning, reading your position on this.

~~~
refurb
It's not my position, it's the FDA's position. Take a look at some of the
FDA's comments on other disabling diseases like Duchenne's muscular dystrophy.
An improve in an ability to walk (6 minute walk test, 6MWT) is view with
skepticism by clinicians.

------
tempestn
Sounds like another good reason to consider banking stem cells, as described
here:
[https://news.ycombinator.com/item?id=11830407](https://news.ycombinator.com/item?id=11830407)

In this case the article describes using chemotherapy to stimulate generation
of stem cells, then scrubbing them of the disease before reintroducing. I have
no expertise in this field, but I would think having a bank of healthy stem
cells would have simplified the procedure and perhaps improved the likelihood
of positive outcomes.

@markkat if you're reading this, do you have any comment?

~~~
markkat
>I would think having a bank of healthy stem cells would have simplified the
procedure and perhaps improved the likelihood of positive outcomes.

It is possible, assuming that the banked cells were drawn before progression
to a disease state. Here, they used the patient's own cells, which they
treated before reintroduction, which strongly suggests there is a state to
which they can be reverted. It's reasonable then to assume that at the very
least, previously banked cells could be similarly treated before
reintroduction, which might be a better starting point.

As speculated in the article, those patients that did not respond might have
progressed too far for the treatment to work. If so, cells banked years before
might be advantageous. Of course, that may not be reason why those patients
didn't respond. Much of MS still remains a mystery.

Still, these results are very exciting, and add to the growing evidence that
bone marrow stem cells have real clinical potential.

I'll ask our Chief Science Officer, Dr. Ben Buller, to discuss this trial in
our blog: [http://foreverlabs.co/blog](http://foreverlabs.co/blog) He has
published work using bone MSCs to reverse demyelination, which occurs in MS.
I'm sure he'll have some good perspective.

------
Hondor
That all happened 15 years ago. The article mentions that it's available at
some hospitals, so that suggests it was ultimately successful and it's now
part of regular medicine. I suppose it's still only for 5% of cases and only
as a last resort and still most patients aren't having any reversal of their
disease. There doesn't sound like much hope for it to expand to cure MS in
general given how long it's been with apparently no further progress.

~~~
bhouston
> still most patients aren't having any reversal of their disease

From the article, "70 percent saw the progression of their disease halted or
reversed"

70% change of no further progression or even reversal? Those are good odds.

~~~
Hondor
I was just stating the outcome in a more negative way. Most had no reversal
but also most didn't get worse either. Because half of that 70% were in the
"halted" category which might not be much use if you're already at a late
stage of the disease and you were only eligible for this treatment because you
were almost dead.

------
BurningFrog
This is the tech support approach to the immune system:

Try turning it off and on again.

~~~
YeGoblynQueenne
A corollary of which is that the immune system runs on MS Windows.

~~~
dclowd9901
Given its baffling nature, I'd say that's a pretty apt comparison.

------
jawns
Just in case anyone is wondering -- though at this point, isn't it your first
guess? -- the stem cells used in this therapy were adult stem cells, meaning
they were collected from her own body, as opposed to embryonic stem cells.

I mention it here because the article doesn't give that info until about half-
way down.

~~~
Teever
I don't understand why you felt it necessary to mention this. I think it's
half-way down in the article because it's not really the most important aspect
of the conversation.

I think the fact that MS has been cured in some people for the first time is
far more relevant than the source of the stemcells used to cure MS.

~~~
KevanM
Depends how you feel about stem cell research.

~~~
dave_sullivan
I feel like it's been held back for a decade or two by, mostly, the religious
right, and I wonder how many people's lives are worse off as a result.

~~~
wtbob
I wonder how many more lives would have been ended had federal dollars funded
research using embryonic stem cells.

~~~
dave_sullivan
The religious right (US-version):

Life begins at conception and every life is special.

Also for: guns, more prisons, war on drugs, war on terror, global warming does
not exist, borderline racist social policies, george bush jr., "doesn't trust
science", lack of financial success can only be the result of personal
failings (and choices), and no taxes because "who needs roads" and "I did it
all myself".

Not saying you (PP) share any of those, but why is it that the supposed
humanitarian group when it comes to embryos tends to treat actual living
members of society so poorly?

Meanwhile, the bleeding heart liberals are all baby killers (or at least,
there's a rather large distinction between embryos and babies, in their
opinion).

Serious question, isn't that a weird dichotomy?

~~~
lizardskull
A group who actively works to convince others they are victims is treating
others poorly.

------
xor_null
Quite interesting. But something i don't understand, MS causes immune cells to
attack the myelin cells. Depending on the severe of the attack the myelin
cells are completly destroyed or even the nerv cells themselves are destroyed.
Recreating the immun cells would prevent the immun cells from attacking the
myelin cells, but what happens to the tissues which are already destroyed? As
far as i know, the body is not able to repair all kind of destroyed nerv cells
/ myelin cells on his own. So how can this treatment help to repair/recover
already destroyed tissue?

------
hvs
A similar (smaller) study was done back in 2003 with Crohn's disease. The
results were similar.

[http://www.nature.com/bmt/journal/v32/n1s/full/1703945a.html](http://www.nature.com/bmt/journal/v32/n1s/full/1703945a.html)

A more recent, better controlled study found very little difference between
traditional treatment, though.

[http://www.news-medical.net/news/20151218/Stem-cell-
therapy-...](http://www.news-medical.net/news/20151218/Stem-cell-therapy-not-
significantly-better-than-conventional-treatment-for-Crohns-disease.aspx)

------
kakoni
Related; Type 1 diabetes being also auto-immune disease. There have been now
atleast 2 groups that have succesfully done "cure" using same kind of immune
system reboot strategy.

few interesting links;

[1]
[http://cureresearch4type1diabetes.blogspot.fi/2008/12/burts-...](http://cureresearch4type1diabetes.blogspot.fi/2008/12/burts-
brazilian-research.html)

and

[2]
[http://cureresearch4type1diabetes.blogspot.fi/2010/11/snarsk...](http://cureresearch4type1diabetes.blogspot.fi/2010/11/snarski-
confirms-burts-phase-i-results.html)

------
jeroen
> And there are questions about the very long-term effects. It’s not clear
> what the next 10, 20, or 50 years look like for patients like Molson.

Does that even matter? Molson would probably be dead right now if it weren't
for the treatment, not to mention an enormous increase in quality of life.
Even if the treatment kills her in 10 years, she will have had 25 years of a
proper life, versus a few more years of lying in bed.

Of course long term effects are interesting to study and see if there is room
for improvement, but I don't see them impact the validity of the treatment.

------
djaychela
There was a comment on this on BBC breakfast yesterday, with an MS specialist
saying that it was promising, but not up to the hype that people were making
over it? He said it was an Avenue to explore further, and looked to be a good
technique, but there was a long way to go - he quoted the stats from the
study, and certainly seemed to be familiar with it and the methodology used.
Can't find a link to it (it was an interview rather than a feature), alas.

------
indymike
My Dad had MS and died earlier this year of pneumonia. MS is a horrible
disease in every way. It's debilitating, humiliating, and painful.

Hopefully this study can be repeated. So many studies using whatever is the
trendy science of the day end up failing. This study looks hopeful and could
be life changing in the best way possible. But it's not the first study that
has started with an amazing result.

------
reasonattlm
Publicity materials: [http://www.eurekalert.org/pub_releases/2016-06/tl-
tln060816....](http://www.eurekalert.org/pub_releases/2016-06/tl-
tln060816.php)

Paper:
[http://www.thelancet.com/journals/lancet/article/PIIS0140-67...](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736\(16\)30169-6/abstract)

The latest update for ongoing efforts to test destruction and recreation of
the immune system in patients suffering from the autoimmune disease multiple
sclerosis demonstrate that this approach is effectively a cure if the initial
destruction of immune cells is comprehensive enough. Researchers have been
able to suppress or kill much of the immune system and then repopulate it with
new cells for about as long as the modern stem cell therapy industry has been
underway, something like fifteen years or so. Methodologies have improved, but
the destructive side of this process remains unpleasant and risky, something
you wouldn't want to try if there was any good alternative. Yet if not for the
scientific and commercial success of immunosuppressant biologics such as
adalimumab, clearance and recreation of immune cell populations may well have
become the major thrust of research for other prevalent autoimmune conditions
such as rheumatoid arthritis. Destroying these immune cell populations
requires chemotherapy, however, and with avoiding chemotherapy as an incentive
for patients, and the ability to sell people drugs for life as an incentive
for the medical industry, biologics won. For conditions like rheumatoid
arthritis, the aim became control and minimization of symptoms rather than the
search for a cure. Only in much more damaging, harmful autoimmune conditions
like multiple sclerosis has this research into wiping and rebuilding the
immune system continued in any significant way.

It is worthy of note that while these trials were only enrolling a small
minority of patients, the approach could be used on every patient. That tends
to be the way trials work, picking a small subset. The driving factor for
keeping the numbers small is the onerous and risky chemotherapy process.

Beyond being able to pinpoint which tissues are suffering damage due to
inappropriately targeted immune cells, the underlying mechanisms of most
autoimmune conditions are very poorly understood. Multiple sclerosis, for
example, results from immune cells attacking the myelin sheathing essential
for proper nerve function. Collectively, the cells of the immune system
maintain a memory of what they intend to target, that much is evident, but the
structure and nature of that memory is both very complex and yet to be fully
mapped to the level of detail that would allow the many types of autoimmunity
to be clearly understood. That these autoimmune conditions are all very
different is evidenced from the unpredictable effectiveness of today's
immunosuppressant treatments - they work for some people, not so well for
others. Many autoimmune diseases may well turn out to be categories of several
similar conditions with different roots in different portions of the immune
system.

Destruction of the immune system offers a way around present ignorance: it is
an engineering approach to medicine. If immune cell populations can be removed
sufficiently comprehensively, then it doesn't really matter how they are
storing the bad data that produces autoimmunity. That data is gone, and won't
return when immune cells are restored through cell therapies. The cost of that
process today is chemotherapy, which is not to be taken lightly, as the
results presented here make clear. A mortality rate of one in twenty is enough
to give pause, even if you have multiple sclerosis. In the future, however,
much more selective cell destruction mechanisms will be developed, such as
some of those emerging from the cancer research community, approaches that
will make an immune reboot something that could be undertaken in a clinic with
no side-effects rather than in a hospital with all the associated damage of
chemotherapy. Autoimmune diseases are far from the only reason we'd want to
reboot our immune systems: as we age, the accumulated impact of infections
weighs heavily upon the immune system, and its limited capacity fills with
uselessly specialized cells rather than those capable of destroying new
threats. Failure of the immune response is a large part of age-related
frailty, leading to both chronic inflammation and vulnerability to infection,
and it is something that could be addressed in large part by an evolution of
this approach to autoimmune disease.

------
thatha7777
Does this teach us anything about the causes of MS, and potentially inform on
preventative measures?

------
lvs
A nice longterm study. However, the fact that they need to specify in the
title of this lay article that "this isn't hype" really says it all about
science "journalism."

~~~
ohthehugemanate
Also the fact that if you read the study, it IS hype. (fromory, because I'm
mobile) One study, of 24 people. The treatment is only for 5% of MS sufferers,
and it's 70% effective at stopping the progress of the disease. Only 3 of the
patients in the study had a reversal like the case they describe, so 12%. And
the treatment is incredibly rough on the body. One person in this study died
from treatment, but almost everyone else suffered at the high end of the
scale.

The not hype version would be "Potential treatment for 3% of MS patients in
extreme risk cases! It even reverses the disease for a lucky handful."

It is a bug advance, but... Well this is Vox, after all.

~~~
Houshalter
Well the title wasn't "MS universally cured". It's significant progress
towards a cure. And curing 3% of a disease that afflicts millions of people is
still tens of thousands of lives saved.

~~~
RobertoG
And, more interesting, I think, it confirms the theory of what cause the
illness. That was not so clear the last time I read about it.

That in itself is a big advancement.

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purpleidea
I believe this _might_ have been the study where 25%(?) of the patients were
killed by the treatment. As a result, this is only indicated for the very
severe RRMS (relapsing-remitting, not related to Stallman) cases.

I'm sure HN can correct me if I'm wrong, but the point to make is that this
isn't a cure.

~~~
sago
Maybe you can read the article and correct yourself?

1/24 patients died during the trial (no causal link was specified), and the
treatment was given to progressive MS patients (PPMS or SPMS).

