Thursday, 2 June 2011

Is a cure possible?


Re Dr Oz comment in relation to my last posting: 




As usual the stem cell issue is over hyped and clearly creates unrealistic expectations. As scientists we need to manage expectations; not create unrealistic ones. In MS we will not know if we have a cure until we have followed up a patient after a particular treatment for 15 to 20 years. This is the duration of follow-up required for us to be confident that the disease won't return in its progressive form. Please see my previous posting on this issue: click here for previous posting. At the moment Alemtuzumab, Cladribine and bone marrow transplantation, i.e. immune system rebooters, are the only DMTs that offer the potential of a cure. All these therapies are believed to work by depleting the body of autoimmune cells and when the immune system reconstitutes the hope is the autoimmune cells don't return. This may be the case in some patients, but not all patients are rendered disease activity free for prolonged periods after these treatments. In comparison the non-rebooters work like "sticky-plaster", they are effective as long as the treatment is taken; when you stop the treatment the disease tends to return relatively quickly.  

3 comments:

  1. It's a pity the wait is so long. I understand that a group of RRMS patients were treated with Campath in the late 1990s, so there might be some data on it's longer term effect after 10+ years. Having a biomaker (such as your neuro-filament proposal) could be a good way of monitoring for disease activity after these treatments which re-boot the immune system.

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  2. Prof G,

    Is there any overarching strategy to find a cure for this disease? It seems as if there are lots of MS Research Centres (world class) across the world (in the UK there is Bristol, Cambridge, London, Oxford, Edinburgh), yet I don't have any sense that the work undertaken is co-ordinated. How is duplication avoided? I thought it would be possible to map out what is known / what is not known abiout the disease and then have programmes which focus on the latter. What are the objectives of research in the next 5 years, 10 years? What might be achieved in 10 years time, 15 years time etc. I have no real sense of what progress has been made so far - given that some big questions remain (e.g. cause, mechanims behind neuro-degeneration etc). It's a pity there isn't some measurable targets so progress could be tracked. I would certainly hope that by 2020 there will be some substantial breakthroughs (in terms of understanding and treatments), but I don't have any sense if this will be the case. Does your centre, for example, have a 10 year plan with some measurable objectives? [note: my comment is about MS research across the world, not just at your institution]

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  3. "As scientists we need to manage expectations; not create unrealistic ones."

    As an MS sufferer I want the scientists to be shooting for the moon. Be bold. Do the impossible. That's what scientists have been doing over the centuries with fantastic results. The trouble with MS research is that its objective appears to be to make little advances about knowledge of the disease and in treatments. The current injectibles have been around for 15+ years with efficacy of c.30%. Some new oral treatments have arrived with either equal or slightly better efficacy. Go for 100% reduction in relapses, go for 100% neuro-protection, go for 100% repair of existing damage. Scientists should be exceeding our expectations, not managing them -massive advances in technology, scanners, knowledge of the genome should be helping them. I'd rather the scientists went for gold and came second than put limits at the outset on what is possible. To quote Delboy Trotter "he who dares wins". Some suggestions (for all MS scientists) - ditch EAE (be bold - its only there for PhD students), use human guinea pigs (no more mice), start sharing knowledge / breakthroughs immediately with other researchers (don't worry about getting stuff published - get it out on the web for others to see for free), work with others e.g. researchers for Parkinsons etc, learn from cancer research (not just a money issue), avoid duplication with other research, have a target of moving to something else in 15 years time i.e. MS will be gone / treatable, imagine the sufferer is a close friend (big incentive to push the boundaries). Good luck.

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