Rebooting the Immune System
Can a ‘Reboot’ of the Immune System Stop MS?
Multiple sclerosis happens when the immune system goes haywire. By destroying the immune system then ‘reinstalling’ it, researchers are stopping the disease in its tracks.
By Dr. Sanjay Gupta
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Anton Feokhari’s symptoms began when he was in college. First, his right hand stopped doing what he wanted. Then, he developed problems with balance and vision. Walking became difficult. His bladder and his bowels acted up. Ten years after the first symptoms, he could no longer work. “It wasn’t looking good for me,” Feokhari says.
Because his MS was aggressive, Feokhari was a good candidate for a bold but risky experiment to try to stop MS in its tracks by “rebooting” the immune system, like you would a buggy computer.
MS is an auto-immune disease, meaning it arises when the immune system mistakenly attacks the body’s own tissues. In the case of MS, antibodies attack the protective sheath that surrounds the nerves.
We know that genetics play a part in MS, but only a part. If one identical twin has MS, in most cases the other twin does not. That means there must be an environmental trigger.
“We sort of took that and said, ‘Maybe if we wipe the slate clean and they didn’t have the same environmental challenges… then maybe they won’t have MS this time around,’” says Michael Racke, MD, a neurologist at the Ohio State University Wexner Medical Center and one of the researchers in the trial. “I am trying to make them their own identical twin who doesn’t have MS,” he says.
Of course, “wiping the slate clean” is not as easy as he makes it sound. They do it with a stem cell transplant, a procedure normally used in advanced cases of certain cancers.
No Walk in the Park
“The stem cell transplant is no walk in the park,” says Dr. Racke. Stem cells are the cells in the bone marrow that make new blood cells, including immune cells. In a transplant, the stem cells are first collected and stored. Then heavy doses of chemotherapy drugs are used to completely wipe out the immune cells in the blood and the stem cells in the bone marrow. The stored stem cells are then reinjected into the bloodstream. They migrate back to the bone marrow and begin to rebuild the immune system from scratch. Until they do, a patient is left without any protection from infection.
“The transplant was the hardest experience in my life,” Feokhari says. He got an infection that nearly killed him. “They say it was touch and go for a while. But however it happened, I turned the corner eventually and then I went from regretting doing the trial to being very happy I did it.”
Feokhari wasn’t cured, but he stopped getting worse. It is now five years since the transplant, and he has not had any return of active disease.
He has even seen some improvement. “My worst symptom was nerve pain and that improved greatly,” he says.
Racke says only 22 percent of patients in the trial had a return to active disease after three years. That is contrasted with 60 to 70 percent with other treatments. “To be able to see improvement in people who had just really bad MS is pretty amazing,” Racke says.
The trial is called Halt-MS, because that is what it aims to do. But balancing the risks of stem cell transplant against even these impressive results presents a challenge. “The treatment is potentially perhaps the most aggressive type of treatment that you can give for these people,” Racke says.
MS is rarely fatal, but stem cell transplants sometimes are. As researchers prepare for the next stage of these trials (Phase III), Racke says “that’s where the big discussion is going to be…. How aggressive should we be so that we get the most durable therapy, but also don’t have any mortality? I mean, we’ve all been taught, ‘Physician, first do no harm.’”
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