From the Guidelines
Stem cell transplant can be a highly effective treatment for rejuvenating nerves in patients with multiple sclerosis and neuromyelitis optica spectrum disorder, as evidenced by the latest recommendations from ECTRIMS and EBMT 1. The use of autologous haematopoietic stem cell transplantation (AHSCT) has been shown to stop inflammation in the brain, suppress clinical and MRI-detected disease activity, and stabilize or even improve function in relapsing–remitting MS 1. Key considerations for patient selection, treatment protocol, and management of rehabilitation, fertility, and vaccinations are crucial for optimal outcomes. Some of the benefits of AHSCT include:
- Suppression of clinical and MRI-detected MS disease activity
- Stabilization or improvement of function in relapsing–remitting MS
- Potential for long-term monitoring of adverse events and neurological outcomes However, the safety profile of AHSCT involves higher acute risk than many approved disease-modifying therapies (DMTs) for MS, and the optimal placement of AHSCT in the therapeutic algorithm for MS remains uncertain 1. In terms of specific patient populations, AHSCT has been used to treat adults with MS or NMOSD, but its use in the pediatric setting requires further investigation and separate recommendations 1.
From the Research
Stem Cell Transplantation for Nerve Rejuvenation
- Stem cell transplantation has been explored as a potential therapeutic approach for nerve rejuvenation, with studies suggesting its effectiveness in alleviating neuropathic pain 2 and enhancing nerve regeneration 3, 4.
- The transplantation of stem cells, such as mesenchymal stem cells and adipose-derived stromal cells, has been shown to promote nerve regeneration by providing neurotrophic support and signaling cues for regenerating axons 3.
- Induced pluripotent stem cell-derived Schwann cells have also been investigated for their potential to enhance nerve regeneration, offering a patient-specific autologous source of Schwann cells 3, 5.
- Stem cell transplantation has been proposed as a strategy to extend the time window for nerve reconstruction, allowing for the preservation of target muscles and enhancing functional recovery 5.
Mechanisms of Action
- Stem cells have been shown to differentiate into Schwann-like cells, which can recruit macrophages for removal of cellular debris and secrete neurotrophic factors to promote axonal growth and remyelination 4.
- The transplantation of spinal motor neurons derived from human induced pluripotent stem cells has been demonstrated to survive, functionally innervate, and preserve target muscles in rodent models 5.
- The use of stem cell-seeded nerve guides has been explored as a means to enhance nerve regeneration across "gaps" in neural repair, with potential applications in reconstructive transplantation 3.
Current Options and Opportunities
- Various types of stem cell sources are being investigated for their application to peripheral nerve regeneration, including mesenchymal stem cells, adipose-derived stromal cells, and induced pluripotent stem cells 4, 6.
- The combination of stem cell therapy and peripheral nerve transfer has been proposed as a potential therapeutic approach for peripheral nerve injury, offering a synergistic effect on nerve regeneration 6.