b'Medicine & ResearchPPuuttttiinnggSSppoottlliigghhttoonnStemCCeellllTTrraannssppllaannttffoorrMMSSStemI siittrreeaaddyyfforrprio primmeettiimmee??IsBy Dr. Andrew M. Tarr and Dr. Ben Thrower There are two major kinds of stem cellas they essentially do not have a functioning transplant being evaluated for the treatment ofhumoral immune system. They are required multiple sclerosis: autologous hematopoieticto remain in the hospital in an isolation room stem cell transplant, which is being used forfor several weeks and to remain isolated at individuals that are having either very frequenthome for several more weeks after discharge relapses or evidence of new inammatoryto prevent infection while the new immune lesions on MRI; and mesenchymal stem cellsystem establishes itself. There have been transplant, which is being actively researchedseveral studies that have demonstrated that forthetreatmentofinammatorydisease,aHSCT is an effective treatment with long-lasting progressive neurodegenerative disease, or both.protection for people with highly active MS, Rebooting the immune system in some patients preventing relapse for at In aHSCT, the goal is to reboot the immuneleast 10 years.system by replacing the faulty immune systemBecause of the signicant upfront risk and with fresh immune cells to prevent futurethe benet mostly in preventing inammatory autoimmune attack against the myelin of thedisease, aHSCT is currently only recommended brain, spine, and optic nerves that togetherfor younger patients who have had MS for make up the central nervous system. This isless than 10 years and for whom other highly achievedinseveralstages.First,theboneeffective disease-modifying therapies have marrow is stimulated to produce and releasebeen unsuccessful in controlling their disease. many new blood cells (called stem cellWhere aHSCT will ultimately end up in the expansion). Next, these are then collected andselectionofMStreatmentsremainstobe stored in the laboratory (called stem cellseen.Itisthesubjectofacurrentmajor collection). With these safely stored in the lab,phase 3 clinical trial named Best Available the bone marrow is depleted or suppressedTherapy Versus Autologous Hematopoietic using a combination of different intravenousStem Cell Transplant for Multiple Sclerosis medications (called conditioning). Finally,(BEAT-MS) which is currently enrolling thecellsthatwerecollectedearlierarepatients at 19 sites across 13 states and soon transplanted back to the same patient by IVin London. with the goal of generating a new immuneRepair and regenerationsystem (engraftment). In mesenchymal stem cell transplant, the During the conditioning and engraftmentgoals are reducing inammation to help prevent phases, the patient is at risk of serious infectionrelapses, and promoting repair and regeneration msfocusmagazine.org 10'