Stem Cell Therapy Safe in ALS Patients, Review Finds; Evaluating Effectiveness is Next

Stem Cell Therapy Safe in ALS Patients, Review Finds; Evaluating Effectiveness is Next

Stem cell therapy seems to be safe in patients with amyotrophic lateral sclerosis (ALS) and clinical trials evaluating its effectiveness are on the way, according to a review study.

The review, “Stem cell transplantation for amyotrophic lateral sclerosis,” was published in the journal Current Opinion in Neurology.

Over the past years, there has been much excitement and hope around the therapeutic potential of stem cells in a variety of neurodegenerative diseases, including ALS.

Stem cells have the remarkable potential to develop into many different cell types in the body and to replicate rapidly. These properties highlight their potential to replace cells that are lost or to provide protective, immunomodulatory (that regulate immune responses), and survival signals to the remaining cells.

Currently, no stem cell treatment, in which stem cells are transplanted into the patient, has been approved for ALS, and the evaluation of its safety and effectiveness is only in its first steps. “In the case of amyotrophic lateral sclerosis (ALS), there are no approved stem cell treatments and there are only a few legitimate clinical trials of stem cells to date,” the authors wrote.

Researchers at the Cedars-Sinai Medical Center, in Los Angeles, and the Emory University School of Medicine, in Atlanta, reviewed current knowledge and recent efforts to develop and evaluate stem cell therapies for ALS.

Because the reconstruction of complete motor nerve circuits in adult patients is very complex, current stem cell approaches in ALS aim to use them to improve the function of motor nerve cells and prolong their survival.

This is done through the regulation of immune responses, secretion of important molecules, and/or production of brain cells that support motor nerve cells.

The authors noted that the best source of stem cells (bone marrow-derived mesenchymal stem cells or immune cells, or fetal-derived nerve stem cells) and the best delivery method — directly into the brain, cerebrospinal fluid (the fluid that bathes the spinal cord and brain), muscle, or blood — is still unclear.

Mesenchymal stem cells have the potential to differentiate into cells that produce key factors for the healthy function and survival of nerve cells or signals that regulate immune responses, such as inflammation.

Four recent Phase 1 or 2 clinical trials have mainly evaluated the safety, but also some preliminary measures of effectiveness, of transplanting the patient’s own mesenchymal stem cells intrathecally (directly into the cerebrospinal fluid).

The results showed this approach appears to be safe and well-tolerated — although associated with temporary infusion reactions — and to temporarily increase the levels of key factors for nerve cells’ survival and anti-inflammatory molecules.

However, since these studies were small and not placebo-controlled, the effectiveness of this approach remains unproven.

Next phase of research

Nevertheless, the dosing and safety knowledge gathered so far is sufficient to promote the development of randomized placebo-controlled Phase 3 trials.

One such Phase 3 study is underway (NCT03280056) and will evaluate the safety and effectiveness of BrainStorm Cell Therapeutics’ therapy candidate NurOwn, every two months in ALS patients, compared to placebo. The trial is recruiting up to 200 participants at six U.S. sites. BrainStorm plans to complete the study by July 2019.

A couple of Phase 1 clinical studies evaluating the safety of transplanting the patient’s own bone marrow- or blood-derived immune cells intrathecally (into the spine) or directly into the blood also highlight that this may be a safe approach, but its effectiveness remains to be clarified.

Fetal-derived nerve stem cells, such as neural progenitor cells — cells with the potential to generate nerve cells and their supporting cells — are another potential source of therapeutic stem cells in ALS.

Their use aims to replace interneurons (nerve cells that connect sensory and motor nerve cells), release potent growth factors, and reduce toxic inflammation.

Phase 1 and 2 clinical trials also have demonstrated the safety of delivering neural progenitor cells into the spinal cord of ALS patients, and Phase 3 studies to evaluate the effectiveness of this approach are currently being planned.

Additionally, induced pluripotent stem cells (iPSCs), or stem cells derived from tissues of adult patients, have the advantage to allow researchers to generate iPSCs-derived neural progenitors from the patient and avoid ethical concerns with fetal or embryonic tissues.

Preclinical and clinical studies also have highlighted the importance of the location of stem cell delivery to treat ALS, as different locations throughout the spinal cord, or administration into the spinal cord vs muscle, have shown distinct results. So, additional studies are needed to clarify the best delivery location of stem cell therapy.

“With clinical trials recently demonstrating that stem cell transplantation can be safe and well tolerated in ALS, the field is positioned to complete pivotal controlled trials to determine efficacy,” the researchers wrote.

They also noted that the major challenge is to “design pivotal phase 3 trials that include appropriate controls to definitively demonstrate clinical value, but that simultaneously maintain cost effectiveness and do not place control subjects at undo risk without benefit.”

Marta Figueiredo holds a BSc in Biology and a MSc in Evolutionary and Developmental Biology from the University of Lisbon, Portugal. She is currently finishing her PhD in Biomedical Sciences at the University of Lisbon, where she focused her research on the role of several signalling pathways in thymus and parathyroid glands embryonic development.
Marta Figueiredo holds a BSc in Biology and a MSc in Evolutionary and Developmental Biology from the University of Lisbon, Portugal. She is currently finishing her PhD in Biomedical Sciences at the University of Lisbon, where she focused her research on the role of several signalling pathways in thymus and parathyroid glands embryonic development.
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  1. Margarita Caddell says:

    There needs to be more done to expedite this research. People are dying. Everything and anything should be offered to any individual that wants to try it. They are dying anyway and I know that my husband would be open to anything given the chance.

  2. Alexandria King says:

    Anyone who volunteers for stem cell research should be seriously considered. ALS doesn’t offer the time for drawn out clinical trials.
    If stem cells can be used to slow down degeneration of the motor neuron cells then by all means investigate that possibility.

    • Alexandria King says:

      A placebo is cruel for an ALS patient. My loved one does not want to participate in trails because of the placebos. Who wants to put all their hopes on a placebo.

    • John Berens says:

      Amen to that! It”s sinful to put people through that. It either work or it doesn’t. If they’re thorough, they can figure this out.

  3. Anjim Tabasum says:

    Time is slipping out of our hands. We the mnd patients have no choice after diagnosis but to wait for death unabatedly….please save us as early possible…

  4. Every ALS patient in the past 10 years that has reported to me to be undergoing stem cell treatment in various facilities around the world has improved but then their disease Progresses.
    Unless the infection Borrelia and co-infections are suppressed the bacteria will attack the new cells produced by the stem cells.

    • Julie McDonough says:

      Dr. Tedone, How can one truly rid themself of the infection Borrelia and other co-infections beyond antibiotic treatment while fighting ALS? Would like to have stem cell as an option for ALS, but am fighting a multitude of infections and toxins simultaneously.

  5. Delbert Mitchell says:

    I am a 73 year old male who has had ALS symptoms since 2009. I was diagnosed with ALS in 2014. I have been trying to get into any ALS trial for almost six years, but, the research hospitals are either too far away, or the clinicians conducting the trials tell me I’ve had the disease too long, or I’m too old. Who cares about age or how long you’ve had the disease. We ALS sufferers need some hope, and the ability to be included in new drug or stem cell testing. We are dying clinging to hope, but no one is listening, or it’s out of reach of the common man. I have an identical twin brother, and he shows no signs of ALS, and yet they will not consider him for a stem cell donor for me. Why? The obvious candidate for me is my twin who shares the same DNA, so why not use his healthy stem cells to be infused into me? I would hope that this be considered before my life slips away. Any research company, hospital, medical university, or pharmaceutical up to the challenge?

    • Chica says:

      Sir, you’ve had ALS for 10 years? My mother has too. She cant walk, or talk. She has no feeding tube, we blend all her food and spoon feed her. She has NO respirator, she breaths on her own. For the past 6 years, she requires 24 hour care. Only if you see her in her wheelchair you would ask her what is wrong, cause she looks GREAT. Not your typical patient.

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