Yale researchers have just performed an experimental surgery on a patient with multiple sclerosis (MS) in an attempt to repair damaged brain cells. MS is a progressive disease in which the body’s immune system attacks nerve fibers in the central nervous system and damages their myelin, the protective sheath surrounding the cells. When the myelin is damaged, the cells do not conduct the nerve impulses properly, which can affect many body functions. It will be six months before Timothy Vollmer, MD and his colleagues can determine whether the transplant surgery was successful. If so, the procedure could offer hope to people suffering with MS and those with other myelin disorders.
"The purpose of this experiment was to determine whether the procedure is safe and has enough promise to justify further research," said Dr. Vollmer, associate professor or neurology at Yale School of Medicine, in a Yale news release. The procedure is part of a Phase I clinical trial which is investigating whether cells in peripheral nerves can repair myelin-damaged cells in the brain or spinal cord. This is the first time this type of surgery has been performed on a human, and researchers are not certain that the transplanted cells will repair the damaged ones in the patient’s brain.
The idea to perform the nerve transplant came after animal studies showed that myelin in certain peripheral nerve cells (called Schwann cells) can replace de-myelinated cells in the brain and spinal cord (called oligodendrocytes) and re-myelinate the damaged cells. Dr. Vollmer and his colleagues want to see if the same procedure can restore the nerve fibers in a human brain and restore normal function.
To perform the two-day surgery, the researchers removed Schwann cells from the patient’s ankle. Using magnetic resonance imaging (MRI), they were able to guide a needle through the patient’s frontal lobe of the brain and inject the cells into an area that contained myelin-damaged cells. As of July 25, seven days after the surgery, the patient was said to be doing well. She will be monitored with neuroimaging and functional assessments. In six months, Dr. Vollmer and his colleagues will remove (biopsy) a small portion of the cells that were implanted into her brain to determine whether the cells survived and whether they produced myelin.
According to the National Multiple Sclerosis Society, no additional transplant procedures are planned until the researchers can assess the results from this first surgery. However, if successful, Dr. Vollmer and his colleagues would like to perform the procedure in a maximum of five patients to determine whether additional testing is warranted. If the surgery works and further studies produce similar results, the procedure could potentially help patients with MS and other myelin disorders, such as a group of hereditary diseases called leukodystrophies.
Multiple sclerosis (MS) is a chronic, often disabling autoimmune disease that affects the central nervous system. Symptoms of MS may be mild, such as numbness in the limbs, or severe such as paralysis or loss of vision. The progress, severity and specific symptoms of MS in any one person cannot yet be predicted.
While symptoms of MS vary significantly, examples of initial symptoms may include:
- Difficulty in walking
- Abnormal sensations such as numbness or a feeling of "pins and needles"
- Pain and loss of vision due to optic neuritis (inflammation of the optic nerve)
Examples of less common initial symptoms may include:
- Tremor
- Lack or loss of coordination
- Slurred speech or other speech disorders
- Sudden onset of paralysis, similar to a stroke
- A decline in cognitive function (the inability to think, reason, and remember)
In addition, a variety of secondary and tertiary symptoms can arise from the primary symptoms of MS. For example, bladder dysfunction can cause repeated urinary tract infections; paralysis can lead to bedsores, etc. While there is currently no cure for MS, many symptoms can be effectively managed and complications can often be avoided with regular care by a neurologist and other health providers.
Additional Resources and References
- The July 23, 2001 Yale News Release, "Groundbreaking Transplantation Surgery at Yale Attempts to Repair Central Nervous System in MS Patients," is available at http://www.yale.edu/opa/newsr/01-07-23-01.all.html
- The July 25, 2001 National Multiple Sclerosis Society bulletin, "First Surgical Transplants Attempted to Repair Myelin," is available at http://www.nationalmssociety.org/Research-2001Jul25.asp
- Visit the comprehensive Imaginis resource center on multiple sclerosis (MS) at http://www.imaginis.com/multiple-sclerosis/
