Motor neuron diseases or MNDs describe a group of progressive neurological conditions that affect or alter the nerve cells that are in charge of controlling a patient’s voluntary movement.
Conventional MND treatments, like Riluzole, an oral medicine, Edavarone, an intravenous treatment, and targeted gene therapies are widely used to help manage symptoms and in some cases even slow the progression of the disease, however, at the time of publishing this article there is currently no cure for MND. A lack of a cure for Motor Neuron Disease has been the catalyst behind regenerative medicine being one of the most active areas of research in the search for new approaches to treatment.
Unlike conventional treatments, which tend to focus on a single pathway, regenerative medicine aims to build a supportive environment to help the surviving neurons. There are many different approaches to regenerative medicine for MND including, but not limited to: reducing neuroinflammation, supporting neuronal survival, improving the function of surrounding cells, and potentially encouraging repair.
At Verita Neuro, we take a unique approach to regenerative care by combining Stem Cell treatment with intensive rehabilitation and paired associative stimulation or PAS. We aim to address multiple aspects of the condition at the same time, while also tailoring our treatments to each individual patient’s case and circumstances.
What is Motor Neuron Disease?
Motor neuron disease or MND is an umbrella term that describes a group of progressive neurodegenerative conditions that affect the neurons in the brain, brainstem, and spinal cord. The condition causes motor neurons to become damaged or die and those affected by the disease can experience progressive muscle weakness, stiffness, loss of mobility and in some extreme cases can also affect speech, swallowing, and breathing.
While there are different types of MND the most common form is Amyotrophic Lateral Sclerosis or ALS. ALS can affect both the upper and the lower motor neurons, while other forms of MND include; Primary Lateral Sclerosis or PLS, Progressive Muscular Atrophy, and Progressive Bulbar Palsy.
In ALS, there are several biological processes that can cause motor neuron damage, including oxidative stress, mitochondrial dysfunction, excitotoxicity, abnormal protein accumulation, and chronic neuroinflammation. Having a combination of these mechanisms is what makes it particularly difficult to treat with a single treatment.
Currently, the main treatments include Riluzole, Edavarone, and Tofersen which can help slow the progress of the disease but doesn’t reverse motor neuron loss.
Why is Regenerative Medicine being Explored for MND?
Unlike conventional MND treatments, including; Riluzole, Edavarone, or targeted gene therapy, regenerative treatments don’t simply treat individual symptoms and instead focus on trying to change the biological environment surrounding surviving motor neurons.
Researchers are currently and increasingly investigating whether this might be possible and their current potential objectives include:
- Reducing inflammation
- Supporting healthy motor neurons
- Helping nerve cells to grow and survive
- Protecting nerve cells from damage
- Supporting nerve fibre heal for nerve repair
It is important to note that regenerative medicine is not currently a cure for MND, and the scientific evidence is still developing. As medical scientists continue to develop their investigations, larger and better controlled clinical trials are needed to further establish which treatments are effective, as well as for which patients and at what stage of the disease.
How does Stem Cell Treatment work for Motor Neuron Disease?
One of the most widely investigated areas of regenerative medicine for MND is Stem Cell treatment. One of the biggest reasons for this is their ability to release biological signals that can influence the surrounding cells. Instead of acting as replacement cells, many different researchers believe there could be potential therapeutic effects from paracrine signalling, which is the release of growth factors and other molecules that might influence the local environment.
A main area of Stem Cells for MND study is the Mesenchymal Stem Cells, or MSCs.
Mesenchymal Stem Cells
Mesenchymal Stem Cells (MSCs) can be harvested from several different sources, including the bone marrow, adipose tissue, and umbilical cord tissue. In terms of potentially aiding in treating MND they could release neurotrophic factors such as Brain Derived Neurotrophic Factor, Glial Cell Derived Neurotrophic Factor, and Vascular Endothelial Growth Factor.
By using these cells, the end goal isn’t necessarily to replace the motor neurons, but rather to influence the surrounding environment with supportive biological signals to protect or improve surviving neurons.
Clinical research is still ongoing and has produced mixed results. While larger studies have provided encouraging safety data, consistent evidence of universal meaningful clinical benefits with patients hasn’t yet been established. Due to this many researchers are looking into why particular patients respond better to cell based treatment.
Amniotic Fluid Derived Stem Cells
Another popular stem cell research area is amniotic fluid derived stem cells, or AFSCs. These cells have characteristics that are associated with mesenchymal stem cells, alongside developmental markers such as OCT-4. Due to their biological immaturity there is an increasing interest in exploring the potential regenerative, anti-inflammatory, and antioxidant properties.
Research has suggested that their effects could help support nearby cells and reduce inflammation, rather than simply replacing the lost motor neurons.
The clinical evidence surrounding amniotic fluid derived stem cells in ALS and other MNDs is a lot less due to less studies and lower study sizes, making the evidence from studies preliminary until larger, controlled studies can be performed.
What is Verita Neuro’s Approach to Stem Cell Treatment for MND?
At Verita Neuro, our MND protocol has been built around two stem cell types. MSCs and Amniotic Fluid Derived Stem Cells, or AFDS cells. There is no “one size fits all” approach, the choice of cell type, dose, and delivery method is individualised according to each patient’s circumstances.
We recognise that regenerative medicine is only part of supporting someone living with MND, therefore we combine our Stem Cell treatment with a structured rehabilitation program. Our programs can include physiotherapy, occupational therapy, and speech and swallowing therapy, based on the patient’s individual needs.
Watch Q&A session where Dr Nasir explains more about the available Treatments at Verita Neuro.
Why is Rehabilitation Important?
When undergoing treatment for MND it’s important to remember that treatment is not separate from maintaining function and independence.
Every rehabilitation program can provide a different aspect of improvement. For example, physiotherapy can focus on strength, mobility, and maintaining spasticity, while occupational therapy can help patients to maintain independence with everyday tasks and activities.
For patients suffering with speech or swallowing difficulties, specialist speech and swallowing therapy can also become an important part of multidisciplinary care.
Paired Associative Stimulation: Combining Stem Cells with Neuromodulation
One of the biggest distinctions of our unique MND programs at Verita Neuro is Paired Associative Stimulation or PAS.
PAS uses Peripheral Electrical Stimulation alongside Repetitive Transcranial Magnetic stimulation or rTMS, aiming to coordinate the stimulation of peripheral and central nervous systems and encourage activity-dependent strengthening of the residual motor pathways.
We combine PAS with Stem Cell treatment as part of a multimodal approach to helping patients living with MND. Our belief is straightforward, regenerative treatment is here to support the biological environment around surviving neurons, while neuromodulation and rehabilitation are designed to make use of the neural pathways that remain.
Verita Life describes itself as the first international clinic to combine stem cell treatment with PAS for MND patients.
What Does the Future of Regenerative Medicine for ALS Look Like?
Ongoing research into regenerative medicine for MND is currently moving in a number of different directions and one of the most important is personalised treatment. Instead of assuming that every patient will respond positively to the same type or dose, currently, researchers are exploring the idea that biomarkers, genetics, and disease characteristics can help identify potential responders.
Some of the other important areas of research include:
- Biomarkers: neurofilament light chain and other markers that could help monitor disease progression and treatment and treatment response.
- Gene-targeted therapies: approaches aimed at genetic causes of ALS.
- Artificial intelligence: helping researchers to improve patient selection, clinical trial design and drug discovery.
- Organoid intelligence: using patient derived laboratory models to study disease and other potential treatments.
- Larger clinical trials: essential for determining whether promising laboratory findings and early clinical signals can turn into meaningful improvements for patients.
As these developments are made, it highlights how quickly the stem cell for MND field is evolving. However, further research is essential to find out if regenerative treatments can be established as a disease modifying therapy.
Is stem cell treatment a cure for motor neuron disease?
No. As it stands there is not currently a cure for MND or ALS.
If you or a loved one is living with MND, ALS, or PLS and want to know more about whether your condition might be improved by Verita Neuro’s MND programs, our medical team offers an obligation free video consultation to discuss your unique needs.
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