This study was really depressing. One of the more extreme therapies being tried is autologous stem cell transplantation, in which stem cells are harvested from the bone marrow of the patient, the immune system is destroyed with chemotherapy, then rebuilt.

The procedure has a mortality risk of 5% - 10%. Some reported results of this procedure -- which of course are never double-blind -- have seemed promising.

But this abstract makes clear that at least in some patients -- particularly those with higher EDSS scores -- the procedure doesn't work.

Multiple sclerosis pathology after autologous stem cell transplantation: ongoing demyelination and neurodegeneration despite suppressed inflammation

I. Metz, C.F. Lucchinetti, H. Openshaw, A. Garcia-Merino, H. Lassmann, M. Freedman, B. Azzarelli, O.J. Kolar, H.L. Atkins, W. Brück (Gottingen, D; Rochester, Duarte, USA; Madrid, E; Vienna, A; Ottawa, CAN; Indianapolis, USA)

Autopsy material from five multiple sclerosis patients who had received autologous stem cell transplantation was analysed. A total of 53 white matter lesions were investigated using routine and immunohistochemical stainings to characterise the demyelinating activity, inflammatory infiltrates, acutely damaged axons and macrophages/microglial cells.

We found active demyelination in all of the five patients. The inflammatory infiltrate within the lesions showed a tenfold reduction compared to literature data from chronic MS autopsy lesions and CD8+ cytotoxic T cells dominated the T cell population. High numbers of acutely damaged axons were found in active lesion areas.

Tissue injury was associated with activated macrophages/microglial cells. The present results indicate an ongoing demyelination and axonal degeneration despite pronounced immunosuppression. Our data parallel results from clinical phase I/II studies showing continued clinical disease progression in MS patients with high expanded disability system scores despite autologous stem cell transplantation.