Date: October 09, 2007
UCSD Physicians Breathe Life Into Cutting-Edge Stem Cell Procedure
Patients living with Myasthenia Gravis (MG) may breathe easier thanks
to a rare bone marrow transplant procedure performed at The
UCSD/Sharp Blood and Marrow Transplant Program, the only program in
the western United States that has attempted this procedure.
Myasthenia Gravis (MG) is a rare neuromuscular autoimmune disease
where the body's immune system, which normally protects the body,
mistakenly attacks itself. The transmission of nerve impulses to
muscles is interrupted, which ultimately prevents the muscles from
contracting. Without the proper nerve impulses, muscles that control
breathing can't function.
"It's like dying in your own body," said Ewa Carrier, M.D., associate
professor of medicine and pediatrics in the UCSD Blood and Marrow
Transplant Division at UCSD's School of Medicine. "Eventually, MG
patients can't walk, can't breathe, can't swallow. The signal just
doesn't go to the muscles."
This new procedure reprograms the patient's stem cells, destroying
them with chemotherapy, before re-introducing purified blood-forming
stem cells. After the transplant, the modified stem cells build new
bone marrow, renewing the immune system with correct signaling and
with cells that don't attack the body.
The Patient
The Myasthenia Gravis Foundation of America estimates only 20 out of
100,000 individuals in the country have been diagnosed with MG.
However, MG is considered under-diagnosed and many more are likely
affected but do not know it.
Martin Glasser, M.D., is one of the confirmed cases. Every other day
for the past three years, he has visited the plasmapheresis clinic at
UCSD Medical Center. Plasmapheresis is a procedure much like
dialysis which is used to help MG patients feel better for short
periods of time. Glasser's disease was progressing, causing weakness
in the legs, arms and diaphragm. Plasmapheresis made breathing
easier "but it's a very crude way of keeping you alive," said Glasser.
The Procedure
The procedure was conducted by a team consisting of Ewa Carrier,
M.D., Arnold Gass, M.D., professor of medicine at Veterans Affairs
San Diego Healthcare System, Geoffrey Sheehan, M.D., UCSD professor
of neurosciences and myasthenia gravis specialist and David Ward,
M.D., UCSD professor of medicine and Apheresis program founder.
According to the International Bone Marrow Transplant Registry
(IBMTR) this rare procedure has previously been performed only three
times, all at Northwestern University Hospital in Chicago.
In preparing for the transplant, Glasser's native bone marrow was
literally obliterated. Most of the T cells in the body were
destroyed.
"The theory is that if the T cells are destroyed before introducing
new stem cells, the new stem cells will not receive the old message
to attack. After the transplant, the modified stem cells build new
bone marrow, renewing the immune system," said Carrier.
Glasser's transplant involved harvesting 16 million of his stem
cells. These cells were cleaned with a special device resulting in 8
million pure stem cells. Stem cells at this early stage of
development have the greatest chance of producing a healthy line of
blood cells.
After the transplant, patients must take antibiotics to protect them
from infection. They cannot go to crowded places and must follow
special diet requirements until the immune system is fully recovered,
which takes about three months.
"There's a possibility that there's also some form of tissue repair
going on," said Carrier. "For example, Dr. Glasser did not have
feeling in his feet before the transplant and now he has feeling in
his feet again, possibly indicating that his peripheral
polyneuropathy is improving as well."
Background
The Rebecca and John Moores UCSD Cancer Center is one of only 40
facilities in the country, and the only one in San Diego County, to
receive the Comprehensive Cancer Center designation from The National
Cancer Institute (NCI).
The UCSD/Sharp Blood and Marrow Transplant Program is a joint venture
between the UCSD Medical Center and Sharp Healthcare and is located
at the Moores Cancer Center in La Jolla. It is the only Blood and
Marrow Transplantation program in the San Diego region that is
affiliated with a renowned School of Medicine and accredited by the
Foundation for the Accreditation of Hematopoietic Cell Therapy
(FACT). This accreditation is the patient's assurance that a BMT
program has passed rigorous standards regarding the qualifications
and experience of staff, quality management and patient volume.
The UCSD Apheresis Program, founded by David Ward, M.D., F.R.C.P., in
1982, is the only program in North America to receive full
accreditation. Now with units at both the Hillcrest hospital and the
Moores UCSD Cancer Center, the program treats many different diseases
with several different procedures.
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Media Contact: Kim Edwards, 619-543-6163, kedwards@ucsd.
http://health.
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StemCells subscribers may also be interested in these sites:
Children's Neurobiological Solutions
http://www.CNSfoundation.org/
Cord Blood Registry
http://www.CordBlood.com/at.cgi?a=150123
The CNS Healing Group
http://groups.yahoo.com/group/CNS_Healing
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