00380930552240 (باللغة العربية)
00380930552240 (باللغة العربية)
Observed were 13 cases with remitting–relapsing multiple sclerosis, among them 5 female patients and 8 male patients. Age of patients varied from 19 to 28, mean age being 25.3±2.47 years. Duration of the diagnosed multiple sclerosis varied form 8 months to 3.5 years (mean 2.13±0.26 years). Duration of remission in this group lasted from 2 months to 1 year, usually being 3-6 months. Since the onset, we observed worsening of symptoms and residual effects from attack to attack in most patients (10 individuals).
Clinical symptoms in MS patients were evaluated using the 4-score scale: 0 – absence of sign; 1 – mild sign; 2 – moderate sign; 3 – severe sign; 4 – extremely severe sign. The Table 1 presents the mean score in patients demonstrating a certain sign and the number of such patients (N). The symptoms were evaluated during the remission.
By the beginning of the fetal stem cell treatment, this group of patients most frequently demonstrated pyramidal, sensory and visual disturbances of different degree (Table 1).
Table 1. Clinical Profile of Patients with Remitting-Relapsing MS (n=13)
|Symptom||N||Symptom intensity, score (0–4)|
|After treatment, years|
|elevation of deep reflexes||6||3||3–2||2||2–1||2–1|
|diminished superficial abdominal reflexes||6||3–2||2||2||2–1||2–1|
|pathological extensor plantar reflexes||5||2||2||2||2–1||2–1|
|Weakness in the extremities||6||2||2–1||1||1||1|
|slowed information processing||4||2||2–1||2–1||1||1|
|Dizziness and vomiting||3||2||1||1||0||0|
After the stem cell treatment, this group of patients demonstrated gradual reduction in clinical manifestations of the focal lesions of the central nervous system. Significant positive dynamics was noticed in such symptoms as nystagmus, convergence disturbance, spasticity, coordination disorders, depression and cognitive dysfunction. Usually, these disturbances resolved within the first year of our follow up after the treatment.
Other disturbances were more resistant, their manifestations persisted during several years, and their reduction was not so clear. These are such manifestations as dysarthria, dysphagia, pathological reflexes and ataxia. These differences must be due to different degree and location of the damage in the central nervous system.
Stem cell treatment significantly improved mental state of MS patients, and we believe this effect is due not only to neurological improvement that gave the patients a hope for recovery after the continuous inefficient routine treatment but also due to the positive effect of fetal stem cells on the emotional sphere.
During the observation period (2 to 5 years) no exacerbations were noticed in this group of patients, although most of them suffered them regularly before the treatment. No disease progression as well as progression-related increased disability was observed either.
MRI results demonstrated the decrease of foci volume in the mean by 31%, decrease in number of foci following the gadolinium contrast by 48%, and reduction of the specific density of the foci in T2-regime. This evidences for the significant improvement of demyelinisation processes in the central nervous system.
Immunological test results (in 8 patients of the group) before the beginning of the fetal stem cell treatment showed depression of T-cell immunity – evident decrease of average number of CD3+lymphocytes (by 20.1%), CD8+lymphocytes (by 15.4%), increase of immunoregulatory index (by 15.3%), and activation of humoral immunity (elevation in lymphocyte count with CD19+ phenotype (in the mean by 38.1%), and class G immunoglobulins by 32.7% (p<0.05). Other indices didn’t have significant deviations from the reference rate (Table 2).
After fetal stem cell treatment, the average level of lymphocytes with CD3+ phenotype has reliably increased in comparison with the initial level, although it was still lower than normal by 9.0% (p<0.05). In 6 months after the treatment, this index increased in the mean by 5.7% and statistically didn’t differ from the norm.
T-helpers (CD4+) demonstrated mild and unreliable tendency for elevation. Within 6 months, their number gradually increased on average by 7.7%.
The number of T-suppressors (CD8+lymphocytes) in one month after the treatment increased and statistically didn’t differ from the norm, and in 6 months after the treatment their level elevated again (in the mean by 20.5%) and achieved the initial level.
Immunoregulatory index reflected definite shifts of the cell immunity and increased with the elevation of the CD8+lymphocyte level. In one month after the treatment, the average immunoregulatory index was 1.74±0.05, i.e. it decreased by 7.6%, and in 6 months after the treatment it remained stable.
The decrease in CD19+ lymphocyte level that was initially increased was noticed in one month after the treatment (by 17.2%). In 6 months, the average level of CD19+ lymphocytes was reported to decrease more, in the mean by 21.7% (p<0.05), in comparison with the initial level.
Class G immunoglobulins level also gradually decreased, and in one month after the treatment it reduced by 12.0%, and in 6 months – by 19.3%.
Thus, we can conclude that fetal stem cell treatment has a significant immunomodulatory effect on the immune system of MS patients. Our study confirmed the elevation of the lowered indices of the cell immunity and decrease of the elevated indices of the humoral immunity (CD19+lymphocytes and IgG) in one month after the fetal stem cell treatment, and this tendency persisted within the period of our study (6 months).
Table 2. Immunity Indices in Patients with Remitting-Relapsing Multiple Sclerosis (n=8)
||Before transpl.||After treatment|
|In 1 month||In 6 months|
Note: * - validity coefficient in comparison with the reference rate p<0,05; # - validity coefficient in comparison with the rate before the treatment p<0,05.