Repair from within – endogenous repair

  The brain and spinal cord of adults contains a large number of progenitor or precursor cells that can differentiate into oligodendrocytes, and hence make new myelin when myelin has been damaged. In fact, early on in the course of MS, these cells are very effective at repairing myelin. However, for reasons that are not clear at present, this repair process – remylenation – is not sustained during the disease. So, one promising approach to repairing myelin and protecting nerve fibres in MS is to stimulate the brain's own progenitor cells. This requires an understanding of what makes these cells differentiate.

Endogenous means 'growing from within' – and scientists are studying how the brain's own progenitor cells can be stimulated to repair MS damage. In other words, scientists are trying to promote endogenous repair. Repairing MS damage by stimulating the cells 'within' is a major focus of the MS Society Cambridge Centre for Myelin Repair.  

Scientists at the The MS Society Cambridge Centre for Myelin Repair have discovered a molecule called Olig 1 as being fundamentally important in the differentiation process by which adult brain precursor cells become oligodendrocytes. Scientists in Cambridge are currently identifying other genes involved in remylenation and are devising ways of influencing the actions of these genes to help remylenation in MS.  

Preventing damage: bone marrow transplantation

Scientists are testing bone marrow stem cells in two different ways in MS: to provide brain cells to repair damage in multiple sclerosis, and by transplanting bone marrow stem cells to try to replace the immune system and so, hopefully, prevent MS damage. 

Ablative bone marrow transplantation is an immune treatment for severe MS. Strong drugs are used to ‘knock out’ the body’s immune system, then the person’s bone marrow is replaced (using bone marrow stem cells from a donor, or the person’s own preserved bone marrow stem cells) in order to replace the immune cells and indeed the immune system. Since the immune system is misfunctioning in MS, this should prevent further immune damage to myelin and oligodendrocytes. This has been a controversial therapy in MS, largely because of its significant mortality (death) rate. Further clinical trials are continuing in people with very severe forms of MS.