Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune disease of the central nervous system (CNS). Disease-modifying therapies (DMT) targeting inflammation have been shown to reduce disease activity in patients with relapsing–remitting MS (RRMS). The current therapeutic challenge is to find an effective treatment to halt disease progression and reverse established neural damage. Stem cell-based therapies have emerged to address this dilemma. Several types of stem cells have been considered for clinical use, such as autologous hematopoietic (aHSC), mesenchymal (MSC), neuronal (NSC), human embryonic (hESC), and induced pluripotent (iPSC) stem cells. There is convincing evidence that immunoablation followed by hematopoietic therapy (aHSCT) has a high efficacy for suppressing inflammatory MS activity and improving neurological disability in patients with RRMS. In addition, MSC therapy may be a safe and tolerable treatment, but its clinical value is still under evaluation. Various studies have shown early promising results with other cellular therapies for CNS repair and decreasing inflammation. In this review, we discuss the current knowledge and limitations of different stem cell-based therapies for the treatment of patients with MS.
Highlights
Multiple sclerosis is an autoimmune condition characterized by demyelination and the loss of central nervous system (CNS) neurons
We aim to describe the current knowledge and limitations regarding cell-based approaches for treating Multiple sclerosis (MS), and discuss the future considerations that are required to optimize the therapeutic parameters regarding treatment efficacy and safety
Immunoablative therapy followed by aHSC therapy to manage highly active and treatment-refractory MS has been investigated for the last two decades, following reports of the coincidental improvement of autoimmune disease symptoms in patients undergoing transplantation for hematological malignancies [13,14]
Summary
Multiple sclerosis is an autoimmune condition characterized by demyelination and the loss of CNS neurons. Active inflammation is most evident in early RRMS. A neurodegenerative process may contribute to disability accumulation during later secondary progressive MS (SPMS) [1]. Available disease-modifying therapies (DMT) for MS have been shown to reduce the number and severity of relapses. Despite the broad range of options, there is still a therapeutic challenge in finding an effective treatment to halt disease progression and to reverse established neural injuries [2,3]. A subgroup of MS patients and those with an aggressive subtype may continue to deteriorate despite the use of DMT [4,5]
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