Jan Hillert, MD, PhD

“There is an increasing body of evidence indicating that the effectiveness of such procedures is very good. The proportion of patients having gone through such a procedure having NEDA is unparalleled by other trials and ways of treating MS.”

In recent years, a growing number of researchers have begun to probe into the possibility of treating multiple sclerosis (MS) with stem cell transplantation therapy. A number of different types of stem cells—including hematopoietic, mesenchymal, neural, human embryonic, and induced pluripotent stem cells&mdash;are all of interest, though the field is still in its infancy.

, September 11-13 in Stockholm, Sweden, Jan Hillert, MD, PhD, professor and senior physician, clinical neuroscience, Karolinska Institutet, spoke with 

 about such treatments. The meeting also featured the design of the MESEMS phase 2 study of mesenchymal stem cells in the treatment of MS, which is still ongoing with more than 140 patients with relapsing (n = 92), secondary progressive (n = 31), and primary progressive (n = 17) disease.

Hillert shared his perspective on these treatments, which have thus shown positive results in relapsing MS. He pointed to the need to identify the safest methods of administering the treatments, as well as how more research is still needed into their effect on disease progression in patients.

1. Uccelli A, Laroni A, Burdin L, et al. MEsenchymal StEm cells for Multiple Sclerosis (MESEMS): a multi-center, randomized, double blind, cross-over phase 2 Clinical Trial with autologous Mesenchymal Stem Cells (MSC). Presented at: ECTRIMS 2019; September 11-13; Stockholm, Sweden. Poster 1378.

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The professor and senior physician in the department of clinical neuroscience at the Karolinska Institutet spoke to the use of stem cell transplantation as a potential method of treating multiple sclerosis.

Jan Hillert, MD, PhD: Stem Cell Transplants in MS

“In a way, the blood-brain barrier is important, but it isn’t as central to our thinking as it used to be. On the other hand, many of our drugs affect the blood-brain barrier in many ways. Even the first-iteration drugs do that to a certain extent.”

The blood-brain barrier has proven over the years to be an important topic in multiple sclerosis (MS) treatment. Studies have suggested that improvements in the understanding of its molecular mechanism of functioning could, in turn, lead to improvements in the quality of life of patients with MS, with recent literature pointing to calnexin as one possible target.

, September 11-13 in Stockholm, Sweden, Jan Hillert, MD, PhD, professor and senior physician, clinical neuroscience, Karolinska Institutet, discussed the need for more information on the other aspects of the progression of MS outside of focal inflammation. Although the main targets of the disease are the processes taking place within the central nervous system, the need to pass through the blood-brain barrier to impact these processes proves the validity of this conversation in MS.

, Hillert shared insight into how the conversation around the blood-brain barrier in MS has evolved with the clinical understanding of it, and what might still be left to uncover.

1. Ortiz GG, Pacheco-Moisés FP, Macías-Islas MÁ, et al. Role of the blood-brain barrier in multiple sclerosis. 

. 2014 Nov;45(8):687-97. doi: 10.1016/j.arcmed.2014.11.013.

2. Jung J, Eggleton P, Robinson A, et al. Calnexin is necessary for T cell transmigration into the central nervous system.

 2018;3(5):e98410. doi: 10.1172/jci.insight.98410.

3. Hillert J. The road not (yet) taken: targeting new pathways of MS pathophysiology. Presented at: ECTRIMS 2019; September 11-13; Stockholm, Sweden. Satellite Symposium 5.

The professor and senior physician in the department of clinical neuroscience at the Karolinska Institutet discussed the evolving understanding of the blood-brain barrier in MS, and what might still be left to uncover.

Jan Hillert, MD, PhD: The Blood-Brain Barrier in Multiple Sclerosis

“There are other mechanisms also at play in MS, and the concentration on focal inflammation only gives sort of part of the answer of how to treat MS. There is, very evidently, a void there in our full capability of controlling this devastating disease.”

While patients with multiple sclerosis have a not insignificant number of available treatments compared to other neurologic diseases, these therapies, though effective, only address one part of the puzzle. Jan Hillert, MD, PhD, professor and senior physician, clinical neuroscience, Karolinska Institutet, spoke about this need for more information on the other aspects of the disease’s progression which aren’t linked to focal inflammation.

These include neuronal loss, brain volume loss, and other neurodegenerative symptoms which the current armamentarium of treatments don’t address. In addition to that, no therapies have yet proven capable of completely preventing patients from transitioning to progressive disease. Hillert said that the drugs “do a lot of good, but they don’t do everything”

, September 11-13 in Stockholm, Sweden. Hillert shared insight into the need for treatments in these devastating aspects of MS, and for further research into exactly what roles they play in the disease process.

Hillert J. The road not (yet) taken: targeting new pathways of MS pathophysiology. Presented at: ECTRIMS 2019; September 11-13; Stockholm, Sweden. Satellite Symposium 5.

The professor and senior physician in the department of clinical neuroscience at the Karolinska Institutet spoke to the aspects of MS&mdash;such as brain volume loss&mdash;which are not currently being addressed by the available disease-modifying therapies.

Jan Hillert, MD, PhD

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