Background: A hot new topic in medical treatment is the use of mesenchymal stem cells (MSC) in therapy. The low frequency of this subpopulation of stem cells in bone marrow (BM) necessitates their in vitro expansion prior to clinical use. We evaluated the effect of long term culture on the senescence of these cells.

Despite updating knowledge and a growing number of medications for multiple sclerosis (MS), no definite treatment is available yet for patients suffering from progressive forms of the disease. Autologous bone marrow derived mesenchymal stem cell (BM-MSC) transplantation is a promising method proposed as a therapy for MS. Although the safety of these cells has been confirmed in hematological, cardiac and inflammatory diseases, its efficacy in MS treatment is still under study. Patients with progressive MS (expanded disability status scale score: 4.0 –6.50) unresponsive to conventional treatments were recruited for this study. Twenty-five patients [f/m: 19/6, mean age: 34.7±7] received a single intrathecal injection of ex-vivo expanded MSCs (mean dose: 29.5×106 cells). We observed their therapeutic response for 12 months. Associated short-term adverse events of injection consisted of transient low-grade fever, nausea /vomiting, weakness in the lower limbs and headache. No major delayed adverse effect was reported. 3 patients left the study for personal reasons. The mean (SD) expanded disability status scale (EDSS) score of 22 patients changed from 6.1 (0.6) to 6.3 (0.4). Clinical course of the disease (measured by EDSS) improved in 4, deteriorated in 6 and had no change in 12 patients. In MRI evaluation, 15 patients showed no change, whereas 6 patients showed new T2 or gadolinium enhanced lesions (1 lost to follow-up). It seems that MSC therapy can improve/stabilize the course of the disease in progressive MS in the first year after injection with no serious adverse effects. Repeating the study with a larger sample size, booster injections and longer follow-up using a controlled study design is advised.

This study suggests that injection of MSC can be a suitable method, especially for secondary-progressive patients. It seems that reinjection of these stem cells can be safe and sustaining it positively increases the effects of this therapeutic approach.

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Background: Mesenchymal stem cell therapy has been used in multiple sclerosis (MS) in order to modulate the course of the disease in previous studies. One of the major concerns in such cases is long term safety or efficacy of this type of therapy. Objectives: This study was conducted to report the clinical status of five patients with secondary progressive multiple sclerosis and one patient with neuromyelitis optica, five years after an autologous intrathecal mesenchymal stem cell (MSC) injection. Patients and Methods: The patients (three male, three female) had a progressive course nonresponsive to the conventional immunomodulatory treatments with Expanded Disability Status Scale (EDSS) score of 3.5 to 6. They received the MCSs after discontinuing other treatments. They were examined annually to assess the disease activity and possible complications. Results: Two patients had no change in their EDSS scores. One was diagnosed to have Devic's disease decreased one score in the EDSS, but experienced four relapses during these five years. Three patients had an increase in EDSS scores by 1-2 scores after five years. Two experienced relapses after injection. There was no significant adverse reaction, infection, or neoplasm during this period of follow up. Conclusions: Intrathecal mesenchymal stem cell therapy for MS is generally safe and did not result in any adverse reaction like malignancy for a relatively long period of time. At least half of the patients had no change in their EDSS and the remaining patients had a delay in disease progress.