Saturday, November 23, 2002 - 7:00:00 AM
By Ann Lukits
The Kingston Whig-Standard
A leading Canadian neurologist who is experimenting with stem cell transplants to cure multiple sclerosis says the technique appears to be halting – and possibly reversing – the disease.
Dr. Mark Freedman said there is no sign of multiple sclerosis in the first six patients enrolled in a $4-million multi-centre study investigating the effectiveness of bone marrow transplants in stopping the disease.
There is also early evidence that the transplants are contributing to a “regeneration” of myelin, the substance that surrounds and protects the central nervous system but can be damaged permanently in people with MS.
“We’re very hopeful that if that continues we’re seeing something we’ve never seen before with MS,” Freedman told The Whig-Standard.
Freedman is one of three principal investigators in a groundbreaking six-year research study to determine whether transplanting bone marrow stem cells in people with MS can stop the disease. If the stem cell implants fail to halt the disease, researchers hope to discover what triggers multiple sclerosis and when.
A neurologist at the University of Ottawa, Freedman will be in Kingston today to discuss the bone marrow transplantation study and other current MS research at a public education forum sponsored by the Kingston Chapter of the Multiple Sclerosis Society of Canada.
Freedman said in an interview that the idea of using stem cells on people with MS started with the search for an agent to boost the immune system of severely disabled patients who had undergone heavy doses of chemotherapy.
In such cases, he said, implanting stem cells was seen as a kind of “rescue therapy,” a way of giving people back their cell systems.
“Only subsequent to the whole business did the notion come out that the cells themselves may have some ability to repair [damaged myelin],” Freedman said. “If that’s the case, then we’ve got a dual mode of therapy.”
Led by Freedman, Dr. Harold Atkins, a bone marrow transplant physician at the University of Ottawa, and Dr. Roland Martin of the U.S. National Institutes of Health, the study will involve 36 people diagnosed with rapidly progressing multiple sclerosis who are likely to become severely disabled.
Of the 36 patients, approximately 24 will receive bone marrow transplantation while the others will serve as a control group.
Range of symptoms
Multiple sclerosis is a progressive disease that causes a range of symptoms including numbness, tingling, paralysis and incontinence. Although the cause is unknown, MS is thought to be an autoimmune disease in which the body’s defence systems attacks the myelin, causing scarring and damage to the underlying nerve fibres.
Freedman said that the goal of the bone marrow transplantation study is to wipe out the old immune system in MS patients “because it doesn’t work or it doesn’t work very well” and replace it with a new one.
Following transplantation, participants will be monitored closely for signs that the disease has either disappeared, regressed or returned. As part of that monitoring, patients will undergo complex immune system tests that may pinpoint specific genes that contribute to a genetic susceptibility.
“If we can completely replace the immune system,” explained Freeman,
“and there’s a brand new one and the disease starts up again, are we really
dealing with an acquired autoimmune disease or with problematic patients
who will develop the disease no matter what?
“Here’s an opportunity to prove that.”
Participants in the study will be hospital inpatients for several weeks in one of three treatment centres in Ottawa, Toronto or Montreal. Before receiving treatment, patients will undergo an operation to remove bone marrow from their pelvis. (The marrow will be frozen and reserved in case it is needed to restore the immune system if the treatment fails.)
Participants will also be given a chemotherapy drug that causes the
bone marrow to grow more white blood cells. About two weeks after receiving
the drug, a portion of the white blood cells will be collected and purified
to remove any trace of the old system before being frozen and reserved.
At this point, three drugs will be administered to destroy the existing immune system. Then the purified stem cells will be thawed and given back to each individual in a procedure similar to a blood transfusion.
The role of stem cells in the treatment of Parkinson’s disease, diabetes, stroke and breast cancer is currently being studied in a number of other Canadian research centres.
Freedman said the multiple sclerosis study is specifically recruiting patients “who have not yet been so disabled as to have no other recourse but to take this procedure. If you walk with more than a cane you’re out.”
Although no one from Kingston is enrolled in the study, Freedman said there is nothing to stop physicians from referring people to Ottawa for screening.
Freedman’s presentation takes place this morning in the Correctional
Staff College gymnasium on Union Street. The forum will conclude at 12:30
p.m. There is no charge to attend.
© Copyright 2002 The Kingston Whig-Standard