Last summer we blogged about a team at The Ottawa Hospital that had proved a stem cell/chemo combo treatment could halt the progression of multiple sclerosis (MS) and — in some cases — help patients recover from the autoimmune disease.…
Last summer we blogged about a team at The Ottawa Hospital that had proved a stem cell/chemo combo treatment could halt the progression of multiple sclerosis (MS) and — in some cases — help patients recover from the autoimmune disease.
Now comes news from the United Kingdom that further substantiates the work of Drs. Harry Atkins and Mark Freedman in showing that using bone marrow stem cell transplants to rebuild an MS patient’s immune system can prevent the disease from worsening and dramatically improve mobility and freedom from pain for some.
The Atkins-Freedman study, published in the prestigious Lancet journal, focused on two dozen patients treated over a decade. The UK study, published last week in JAMA Neurology, reviewed 281 patients tracked over five years. Led by Dr. Paolo Muraro of Imperial College London, the study found the treatment prevented symptoms of severe disease from worsening for five years for almost half of the patients treated. Drs. Atkins and Freedman co-authored the UK study and results from their work were included in the review.
Among patients with relapsing MS, nearly three in four saw no worsening of their symptoms five years after treatment, while younger patients with less severe forms of the disease were more likely respond to the therapy. Most of the patients, though, had progressive MS, which is more severe. Among them, one in three experienced no worsening of symptoms, according to a report by Imperial College.
MS occurs when a person’s immune system misfires and begins attacking nerves in the brain and spinal cord. Currently, there is no treatment for sever, progressive MS.
In essence, the new approach, which is called autologous hematopoietic stem cell transplantation, involves extracting the patient’s own bone marrow stem cells and fortifying them, then destroying their immune system through chemotherapy. The stem cells are then transplanted back into the patient to rebuild the immune system — ideally without the disease.
The stem cell/chemo treatment is not for everyone who has MS — young people with more robust stem cells tend to respond better than older patients — and it comes with risks. Eight patients died following the treatment.
Dr. Muraro said the risks must be weighed against the benefits: “We previously knew this treatment reboots or resets the immune system – and that it carried risks – but we didn’t know how long the benefits lasted. In this study, which is the largest long-term follow-up study of this procedure, we’ve shown we can ‘freeze’ a patient’s disease – and stop it from becoming worse, for up to five years.”
In this blog and in our Fall/Winter newsletter we told the story of Dan Muscat, the St. Thomas, Ontario jeweler who has seen remarkable reductions in the symptoms of his scleroderma — a painful and deadly disease that turns the skin of its victims into cement-like hardness and then petrifies their internal organs.…
In this blog and in our Fall/Winter newsletter we told the story of Dan Muscat, the St. Thomas, Ontario jeweler who has seen remarkable reductions in the symptoms of his scleroderma — a painful and deadly disease that turns the skin of its victims into cement-like hardness and then petrifies their internal organs.
Over the summer, Dan underwent an experimental stem cell therapy at The Ottawa Hospital under the care of Dr. Harry Atkins, who has done outstanding work in treating patients with other autoimmune diseases such as multiple sclerosis, Stiff Person’s Syndrome and Crohn’s disease using a combination chemotherapy/stem cell approach.
Avis Favaro reported on Dan’s “180-degree” turnaround on CTV National News last night, telling Dan’s powerful story. You can watch it here.
After the initial report, the CTV website provides a four-minute interview with Dan that goes into greater detail, along with interviews with Dr. Atkins and James Price, President and CEO of the Canadian Stem Cell Foundation, who says “Dan’s story is an exciting one for the field.”
As Ms Favaro says at the end of her report, Dan continues to get improve and is now able to walk three kilometres on a treadmill. While the extreme treatment isn’t for all scleroderma patients — it comes with potentially fatal risks — it offers new hope where none existed before.
In the wake of the CTV story on Dan, The Ottawa Hospital has produced an online resource for people seeking more information about chemo/stem cell treatments for scleroderma and other autoimmune diseases like MS and Stiff Person’s Syndrome. You can find it here.
The Canadian MS Bone Marrow Transplant Research Study is a MS Society-funded project to re-grow the immune systems of patients with MS using stem cells.…
The Canadian MS Bone Marrow Transplant Research Study is a MS Society-funded project to re-grow the immune systems of patients with MS using stem cells. Led by Drs. Mark Freedman and Harold Atkins at the Ottawa Hospital Research Institute and University of Ottawa, the study began in August of 2000. Ten years later, more than half of the 26 patients enrolled have seen their symptoms stabilize and, in many cases, actually improve, unheard of results in the treatment of MS. Yet few people know about this research. As part of our month-long salute to MS and stem cells, we will speak with people involved in every aspect of this study: the doctors and researchers, patients and their families and the people behind the scenes. In these three videos, Dr. Harry Atkins gives an overview of stem cells and how they’re being used in this study. Videos courtesy of the Canada Science and Technology Museum.
Want to know more about last Thursday’s announcement that two Ottawa doctors have found a way to shut down aggressive MS?…
Want to know more about last Thursday’s announcement that two Ottawa doctors have found a way to shut down aggressive MS?
In case you missed it, Rita Celli, host of CBC’s Ontario Today, dedicated her entire hour-long program on Friday to discussing the report. Published in the Lancet, the paper details how Drs. Harry Atkins and Mark Freedman were able to halt the progression of the disease for the 24 patients in the study. Some patients, like Jennifer Molson, saw their MS symptoms disappear entirely over time. You can access the podcast here.
Ms. Celli features Dr. Freedman who explains how the treatment destroys the patient’s immune system through chemo and then rebuilds a new MS free one using their own previously harvested bone marrow stem cells. He also takes calls from listeners, some of whom tell their stories of life with MS.
The program also features clips of Ms. Molson explaining how the treatment freed her from life in a wheelchair, and Dr. Atkins declaring that “MS can be stopped in its tracks.”
The program provided a comprehensive look at the treatment, which is considered high risk (one patient died) and is only for those MS patients for whom nothing else is working.
Back in December 2013 we told the story of Tina Ceroni, an accomplished athlete and personal trainer who was diagnosed with Stiff Person Syndrome.…
Back in December 2013 we told the story of Tina Ceroni, an accomplished athlete and personal trainer who was diagnosed with Stiff Person Syndrome. The extremely rare neurological disorder triggered a series of episodic attacks during which her muscles would tighten mercilessly — putting her life at risk.
Tina underwent stem cell transplant treatment at Ottawa General Hospital under the care of Dr. Harry Atkins in April 2011. She is now back running and cycling and has resumed her career as a personal trainer.
Tina is scheduled to share her story, with help from Dr. Atkins, on CTV’s Canada AM tomorrow morning at 8:05. Catch it live or watch for a link to it to appear here soon.
The Canadian MS Bone Marrow Transplant Research Study is a MS Society-funded project to determine whether transplanting bone marrow stem cells in people with MS can stop the disease.…
The Canadian MS Bone Marrow Transplant Research Study is a MS Society-funded project to determine whether transplanting bone marrow stem cells in people with MS can stop the disease. Led by Drs. Mark Freedman and Harold Atkins at the Ottawa Hospital Research Institute and University of Ottawa, the study began in August of 2000. Ten years later, more than half of the 26 patients enrolled have seen their symptoms stabilize and, in many cases, actually improve, unheard of results in the treatment of MS. Yet few people know about this research. As part of our month-long focus on MS and stem cells, we will speak with people involved in every aspect of this study: the doctors and researchers, patients and their families and the people behind the scenes. Today, Cathy Nabuurs, a patient in the study, shares her MS stories.
A: I was diagnosed with MS in January of 2001 at the age of 28. I was beginning my career as a speech-language pathologist and had been married for about three years.
Q: What kind of symptoms prompted you to see a doctor?
A: I was experiencing vertigo, numbness and tingling in my extremities. Later on I had dexterity issues and difficulty with gait, muscle strength, pain and fatigue. When I was first diagnosed with MS, I was given a disease modifying drug. It was not very effective for my type of MS and my disease continued to worsen. In 2006, I was told that I had progressed to a more aggressive form of the disease known as Secondary Progressive MS. My body was now experiencing continuous progression without attacks or remissions.
Q: When and how did you find out about the stem cell trial?
A: I originally heard about the stem cell trial on a local news radio show. This was before I was officially diagnosed with MS but was experiencing symptoms and suspected something neurological.
Q: What was the process of being accepted into the trial?
A: There were three factors: I had to be physically fit (with normal function of the heart and lungs), I had to have Secondary Progressive MS, and I had to have had unsuccessful results with a disease modifying drug. I was accepted in January of 2007 and my family relocated to Ottawa for a year. My husband was able to come with me and my parents also were extremely helpful and supportive. They moved to Ottawa and lived with us for four months. This was great for our children because they had some sense of normalcy in their lives. Before departing for Ottawa, our friends and family organized a benefit event which raised significant money and was a huge help. Without all the support, this treatment would have been much more difficult.
Q: How did you prepare to enter the study?
A: My son was five years old when I entered the study and I needed to explain to him the purpose of our move and what was going to happen to Mommy in the simplest of terms. It was very difficult for me as a mother with two small children (ages five years and nine months). The worst case scenario was the slight possibility that I would die. Dr. Freedman and Dr.Atkins made sure that we didn’t make the decision lightly, which I greatly appreciated. And I was the 16th subject in the study, so I felt very encouraged. Physically, I had to undergo many tests and procedures to ensure that my body was up for the treatment. At each stage of testing, there was a chance that I would no longer be eligible for the treatment. The doctors had to be certain that my body was strong enough to make it through the chemotherapy. I was very nervous that the results of this testing would not be favourable.
Q: What were your expectations going into the study?
A: I was given a copy of the treatment protocol to review. Dr. Atkins and Dr. Freedman were very helpful with my questions. and reviewed each step so that I could fully absorb the information. This was extremely helpful and comforting.
Q: What was the treatment like?
A: It was a very difficult procedure, but also very beneficial and life changing. The first step of this process involved having my medical files submitted to the ethics committee. After we received their approval, I had to undergo many tests and procedures prior to moving to Ottawa, to ensure that I was physically fit for the transplant. In May 2007, the first significant medical procedure to be performed was a bone marrow harvest. It was performed as a precaution so that my bone marrow could be used to re-grow my existing immune system if the new one did not grow as expected or if for any reason the transplant was unsuccessful. The next step was the harvest of my stem cells which were then purified and frozen until my body was ready for them. The following step was the most risky and difficult. It was the eradication of my existing immune system through heavy doses of chemotherapy (25 doses), in order to make way for a new, healthy immune system. After the last day of chemo and a day of rest, I received my purified stem cells.
Q: How did you feel throughout the different steps of the study?
A: I was very nervous prior to starting the trial, however, once I arrived in Ottawa I knew that I was in very good hands. The doctors and nurses were very sensitive and caring to me and my family. The hardest part for me, emotionally, was seeing my children while I was in the hospital receiving the chemotherapy. It was wonderful to be able to see them on a regular basis, but it was tough to watch my oldest child, Ethan, who was five years old at the time. During our talk before we left for Ottawa, I explained to him why we were moving. This treatment was going to make Mommy better. This is why it was so difficult for him when he saw the effects of the chemotherapy. The look on his face clearly revealed his thoughts that Mommy was not getting better, only worse. It was also very hard for me to see my one year old daughter as well, because I wasn’t able to really hold her. During the chemotherapy treatment, I was very ill. On one particular day, I remember saying to my husband that I was finished with the chemotherapy and I wanted to go home. My husband looked at me and said “No…you started this ride and now you have to finish it”. I knew this deep down, but it was just a very hard day and I needed a push.
Q: What were the outcomes of the study for you?
A: The biggest change that I saw three months post transplant, was that I was no longer nauseated and I could keep my food down. Halloween night was the first time I felt strong enough to eat and keep food in my stomach. I think that it was sheer Mommy determination that helped me get through trick or treating with my husband and children. Last year, I was feeling stronger, but my immune system was still fairly new, and I would pick up colds and flues very easily. I was not able to receive the flu shot until this year because of the age of my immune system. This year, I feel terrific. I have had only a few colds. I feel stronger and as a result I am able to exercise and work a little bit, without getting ill. This August will be my third year anniversary of the stem cell transplant. There have been improvements, most noticeable has been the decreased fatigue. Prior to the transplant, I had to have naps at least five days of the week. Now, I don’t nap unless I am sick with a cold or if I’m extra busy with my children (ages 3 and 8). I’ve also noticed increased strength in my legs. The indisputable proof that this treatment has been successful is in the results of my bi-annual MRI scans. My brain and spinal cord show no new signs of the disease as there are no new lesions on any of my MRIs since the treatment.
Q: How has the study affected your life?
A: I have a new lease on life which is hard to put into words. My family and I have been given a second chance and I will always be extremely grateful for this and indebted to the doctors, nurses, family and friends who helped us make this a reality. At my last check up in Ottawa in February, my rating on the MS disability scale was a 2.0. Prior to starting the study, I was a 3.5. The transplant was successful and today I have an immune system which shows no signs of disease activity.
Q: What are your hopes for the future?
A: It would be nice to have more myelin repair, but I would be very happy if my body can stay the way that it is at this present time. I am just so relieved and overjoyed that I can play an active part in my family’s life. Without the support of my family, I would not have been able to get through the treatment. They helped me to fight this illness and the effects of the chemotherapy in the hospital.
Q: What do you hope people take away from your story? What do you want people to know about the trial and about stem cell science?
A: I would like people to know that there is hope. I am living proof of the success of this trial. I know that I am extremely fortunate and I will never take that for granted. I look at the results of this trial as miraculous. It still amazes me that I have a new immune system and my body has no memory of the MS. Sure I have the old lesions to contend with when I am ill or tired, but my hope is that they too will fade away physically and emotionally.
Cathy Nabuurs and her family were recently named the 2010 MS Family of the Year for P.E.I. Read about it here.
Maybe you’ve never heard of Hans Messner.
He has never scored a Stanley Cup playoff goal. Never starred in a movie or a television show.…
Maybe you’ve never heard of Hans Messner.
He has never scored a Stanley Cup playoff goal. Never starred in a movie or a television show. He has neither held public office, nor called a press conference to apologize for bad behaviour.
He is, however, directly and indirectly responsible for rescuing thousands of people from leukemia and other blood-borne cancers.
Dr. Messner, who is retiring this month after a 44-year career at Toronto’s Princess Margaret Cancer Centre, was a member of Canada’s first stem cell bone marrow transplantation team. For the past several decades, he led the Princess Margaret program that has performed more than 2,200 allogeneic (donor) transplants. The institution he served so well as both a caring doctor (former non-Hodgkin lymphoma patient Chris Taylor calls him “the epitome of hope”) and an internationally respected researcher (almost 200 publications listed on PubMed) honoured him Thursday with a symposium and reception.
More than 100 people — friends, family, colleagues and many young scientists he has inspired — braved bone-chilling weather to crowd into the MaRS Auditorium for the event.
Among them were some of the giants of stem cell research and bone marrow transplantation, then and now. Dr. James Till, who, with his research partner, the late Dr. Ernest McCulloch, first proved the existence of stem cells in the early 1960s, chaired the proceedings. The Fred Hutchinson Cancer Research Centre’s Dr. Rainer Storb, who worked shoulder to shoulder with Nobel-winner Dr. E. Donnall Thomas in developing bone marrow transplantation, flew in from Seattle. Many originals from the days when Till & McCulloch ruled the Princess Margaret’s former Sherbourne Street research labs (the University of Toronto’s Dr. Norman Iscove and the University of British Columbia’s Dr. Connie Eaves) were there to compare current findings to early work in the field. Others (Dr. Rick Miller, who devised some of the earliest cell-sorting tools to avoid graft-versus-host disease, and Dr. Allen Eaves, who took what he learned in Toronto and set up the transplantation program in Vancouver) attended simply to honour a man widely regarded as one of the hardest working and good-natured individuals ever to put on a white coat. Two of Canada’s top cancer researchers — Drs. Tak Mak and John Dick — spent a rare afternoon away from their labs to pay tribute.
Dr. Messner, a German national, was recruited to the Princess Margaret by Dr. McCulloch after the two became acquainted at a conference in Freiburg in 1966. After completing his MD, he did his PhD under Dr. McCulloch’s mentorship and by 1970 was a key part of the brand new transplant team.
While bone marrow transplantation is now standard care for leukemia, it was highly experimental at the time. In the 1960s, hundreds of attempts at transplantation by teams around the world ended in failure. The Princess Margaret team scored its first success –a long-term survivor — with a 1972 transplant. The program, led by the persistent and persuasive Dr. Messner, has been extending, enhancing and saving lives ever since.
The store of knowledge that Dr. Messner built at Princess Margaret has been shared with clinicians and researchers across the country. As Dr. Lothar Heubsch explained at the symposium, the transplantation protocols Dr. Messner championed have been adopted and adapted to successfully treat multiple sclerosis patients at his Ottawa General Hospital and are now being used for other autoimmune disorders such as neuromyelitis optica, Stiff Person’s Syndrome and Crohn’s disease. That work is led by Dr. Harry Atkins, a true disciple of Dr. Messner.
“Hans exemplified a personal commitment to care,” Dr. Robert Bell, CEO & President of the University Health Network, told the audience. He described Dr. Messner as “a terrific doctor” and a “translational scientist who has had a huge impact on this country.”
On a personal note, Dr. Messner was an enormous help when I was writing the book Dreams & Due Diligence about Till & McCulloch’s stem cell discovery and legacy. A very busy man (does a life get any busier than treating cancer patients and conducting research?), Dr. Messner took the time to explain Canadian bone marrow transplantation history, drawing attention to one of the first procedures ever performed — in Regina in 1957. He did this even though we had never met and he had no idea who I was. Apparently, such acts of kindness are entirely typical.
Regular readers of this blog will be familiar with the work that Drs. Mark Freedman and Harry Atkins are doing to fight multiple sclerosis and other autoimmune diseases with stem cells. We have profiled both doctors and featured patients like Jennifer Molson, who had her MS eliminated by the treatment more than a decade ago.
On Friday, the Ottawa Citizen provided a comprehensive update headlined ‘Ottawa doctors behind breakthrough multiple sclerosis study.” The report focuses on Alex Normandin, who was a third-year medical student in Montreal when he became patient No. 19 of 24 in the original trial and underwent his bone marrow stem cell transplant in 2008. Now a practising MD, he told the paper that “Life is great.”
So far, more than 30 MS patients have been treated with stem cell transplants arising from the Ottawa study, which received funding from the Research Foundation of the Multiple Sclerosis Society of Canada.
It is not a treatment to be entered into lightly: the extreme chemotherapy patients go through before their own fortified stem cells are reintroduced to reboot their immune systems can be fatal.
However, in a country with one of the world’s highest rates of MS — between 55,000 to 75,000 Canadians are affected —- such innovative treatments are enormously encouraging.
Across Ontario, hundreds of people have a stronger appreciation of stem cells, thanks to the Ontario Institute for Regenerative Medicine’s (OIRM) Stem Cell 101 — The Promise and Potential.…
Across Ontario, hundreds of people have a stronger appreciation of stem cells, thanks to the Ontario Institute for Regenerative Medicine’s (OIRM) Stem Cell 101 — The Promise and Potential.
The spring lecture series — featuring world-leading scientists explaining the field, talking about their research and discussing the ethical issues involved — concluded last night in Ottawa where an audience of about 100 listened, asked thoughtful questions and exchanged ideas with the experts.
Co-sponsored by the University of Ottawa and The Ottawa Hospital, Tuesday’s event followed similar free-to-the-public sessions in London, Hamilton and Toronto held in partnership with Western University, McMaster University and SickKids Hospital, respectively.
At each event, local scientists addressed such questions as: “What is a stem cell?” “What’s new in stem cell research?” “What kinds of treatments are using stem cells today?” “What is stem cell tourism?”
At last night’s session, Dr. Bill Stanford, a senior scientist at The Ottawa Hospital, told the audience how he left an uncertain regulatory environment in the United States, where President George W. Bush had imposed a ban on federal funding for research on new embryonic stem cell lines, to come to work in Canada. President Barack Obama lifted the ban, but Dr. Stanford chose to stay in Ottawa, he told CBC News, because “here in Ottawa people work together instead of working by themselves and that makes things go much faster and better.”
As part of his discussion on ethics, Dr Jeff Blackmer, Vice-President of Medical Professionalism at the Canadian Medical Association (CMA), focused on private versus public banking of umbilical cord blood, which provides a rich and non-controversial supply of stem cells for transplant. He noted that private cord blood banks, which charge significant collection fees and annual storage fees, can contain an implied messages in their advertising that parents who don’t use their services are letting their children down. While such a decision is a personal one, he noted that public cord blood banking reflects the spirit of universal health care. Canada’s Cord Blood Bank now operates in four cities.
Asked about when new therapies will make it to the clinic, The Ottawa Hospital’s Dr. Harry Atkins said that while the field is progressing rapidly, significant technological challenges remain. That makes it difficult to predict whether a new treatment might become available, he said, noting that in some cases “it could be two years, it could be a decade.”
(Note: The Spring edition of our Cellections newsletter features some of the leading-edge stem cell research underway in Ottawa. Subscribe here, by clicking on “Newsletter.”)
When it comes to treating multiple sclerosis (MS), Dr. Mark Freedman would like to move beyond damage control.
“We can limit, to some extent and in some cases completely, the damage,” says Dr.…
When it comes to treating multiple sclerosis (MS), Dr. Mark Freedman would like to move beyond damage control.
“We can limit, to some extent and in some cases completely, the damage,” says Dr. Freedman, a clinician/researcher at the Ottawa Hospital Research Institute. “But fixing the damage that’s been done? Not yet. “
Fixing the damage done by MS is the ultimate goal of a new $4.2-million clinical trial that Dr. Freedman is co-leading with Dr. James J. Marriott of the University of Manitoba in Winnipeg. It’s called MESCAMS (for MEsenchymal Stem cell therapy for CAnadian MS patients).
“The excitement surrounding the MESCAMS has been tremendous,” says Yves Savoie, President and CEO, MS Society of Canada, a major supporter of the clinical trial. “Not only is Canada fortunate to have two trial sites in both Ottawa and Winnipeg – accepting a total of 40 Canadian participants – but MESCAMS is also part of a larger international research effort studying mesenchymal stem cells that pools scientific resources and expertise from nine countries. This level of collaboration will yield important answers about the efficacy of cell-based treatments.”
Found mostly in the bone marrow, fatty tissue and cartilage, mesenchymal stem cells have a natural anti-inflammatory effect that makes them an intriguing possibility for treating MS, which occurs when a person’s immune system attacks and inflames the protective sheath (myelin) covering nerves. Myelin damage snags the signals that flow from the brain through the nervous system to the rest of the body.
“These cells possibly will act like anti-inflammatory drugs to control the disease,” says Dr. Freedman. ”But what we’re really looking for is the potential for something to heal up, for a sign that these cells are doing something. Other people have noted it in the optic nerve system, which is actually an extension of the brain and is affected by MS.”
Readers may be familiar with the story of Jennifer Molson, the Ottawa woman whose MS symptoms were eradicated by a stem cell bone marrow transplant conducted by Dr. Freedman and Dr. Harry Atkins as part of an earlier clinical trial. Each trial participant underwent a harrowing course of chemotherapy that virtually destroyed their immune system before being given a fortified version of their own bone marrow stem cells to rebuild it. With MESCAMS no such chemo bombardment is necessary.
“We don’t exactly know why Jennifer, and others in the trial, recovered. We think the reason is we were able to curb the inflammatory response to the point where the body could heal. These cells that we’re using (mesenchymal stem cells) have been shown, at least in early studies in humans, to repair — period. But they happen, at the same time, to have an anti-inflammatory effect. So they may be able to accomplish both things together. And without the need of any chemo, there is very little risk to the people taking it.”
The real challenge, says Dr. Freedman, will be measuring — and scientifically documenting — repair, if it happens. “When was the last time you heard something that could repair things in MS? Nobody’s been able to show it. So we’re hoping we will be able to see it and measure it. That’s the real goal of this study. If we can all show the same signal through nine or 10 sites around the world doing this, then we’re going to have the evidence we need to move to the next stage, which is doing this en masse with people who have already acquired damage . That’s what our MS patients are all hoping for.“
However, Dr. Freedman urges caution. This is an early stage clinical trial. If the mesenchymal stem cells do affect repair, it may be minimal. “The primary outcome is going to be the effect on gadolinium-enhanced lesions in MS as shown by MRI. It will prove whether we have biologically viable cells capable of creating an effect that can be measured in humans. It may sound trivial, but it’s never been done.”
Editor’s Note: MESCAMS organizers have published a Frequently Asked Questions page about the trial here (http://bit.ly/1ES3jN1). Full eligibility criteria are available here(https://clinicaltrials.gov/show/NCT02239393).