Monday, 18 January 2016

Can you stop my MS?

#MSResearch on TV Tonight at 8.30 BBC1

Tonight on the BBC panorama at 8.30 there is a programme on Haematopeoitic stem cell transplantation called 

                                 Can You Stop My MS?



Prof Sharrack from Sheffield has agreed to do a Guest post and if it arrives we will launch it tomorrow.

Likewise, Dr Turner (QMUL) and colleagues (from around London) will provide information about access to this type of treatment on behalf of the London AHSCT collaborative group. 

This is the ultimate in Immune rebooting and is "Alemtuzumab Plus". You collect your bone marrow stem cells then wipe out your immune system and then replace it with stem cells which regrow and hopefully your MS goes. 

Maybe it is the drugs used in the treatment that do the business, but it can be very effective at blocking MRI activity and relapses. 

The data are relatively strong

However it is also clear that there can be significant risks from this proceedure, which maybe a 0.5-1% risk of death from fatal infections (the death rate depends on the centres doing the proceedures and this has dropped dramaticaly over recent years, but do not do this with an unreputable group as the fatality risk can be much higher!).

The data also suggest that the procedure is not successful in all cases and disease returns

Importantly this procedure works best for people with relapsing disease, who have not developed progressive disease yet, so it is probably not a miracle cure for progressive MS

Is this on balance better than other induction treatments, then the jury is out but people recieving HSCT tend to have aggessive course and so they would be predicted to do badly, yet the results are good.

However if a neuro is scared about prescribing alemtuzumab, then they are going to be bricking-it when it comes to HSCT, but should it be their choice?

The cost to the NHS is apparently more than cost of DMT but it could be a one-off cost

What does the programme show ?I don't know and will look forward to seeing it  tonight at 8.30 Greenwich mean time. 

The MS Society say

A Panorama documentary about MS and stem cell treatment will be broadcast on BBC One on Monday 14 December at 8.30pm.

The documentary was filmed at the Royal Hallamshire Hospital in Sheffield and focuses on the experience of patients who underwent Autologous (From yourself) Haematopoietic Stem Cell (Blood stem cells that originated in the bone marrow) Transplantation (AHSCT) some time ago and had dramatic results, as well as two patients who have just started the treatment. It also features interviews with the researchers involved.

What is AHSCT?

AHSCT is being investigated as a treatment for MS. The aim is to remove the harmful immune cells that attack the brain and spinal cord, and then re-boot the immune system using a person’s own (autologous) stem cells.

The Research Team at the National Centre will be happy to help with any queries

56 comments:

  1. The ABN is getting its act together: http://www.theabn.org/resources/abn-publications/m/abn-statement-ms-2016.html

    ReplyDelete
    Replies
    1. Highly disappointing but unsurprising statement from the ABN. I wonder if the BSH support that viewpoint.
      Either way the pressure will be on after tonight. Time for the lid to come off.

      Delete
    2. Hardly...

      Show me a single study that shows non-myelo HSCT (in non-cancer patients) has a "mortality rate of 1.5%". Utter, intentionally misleading and scaremongering nonsense.

      Some patients "anecdotally" report benefits... Is MRI acitivy/EDSS/relapse rate considered anecdotal?

      As per your fave quote Prof G... Truth goes through 3 stages; Ridicule (done), vigorous opposition (ABN), acceptance of obvious (not too far away, one would think).

      Matt

      Delete
    3. ABN says "At present, it does not have a place in the routine treatment of multiple sclerosis. At present, it does not have a place in the routine treatment of multiple sclerosis"



      Delete
    4. Yeah I read...
      I guess the question is how much faith (as an MS'er) you put in the ABN, who are broadly responsible for the failure to adopt early effective treatment principles, and the UK consequently sitting roundly at the bottom of the European league tables for access to treatment. The same guys who are regularly bashed on this blog for being a conservative old-boys club, who generally are well off the pace of the rest of the world (who, we're told, consider the approach in the UK to be so poor as to be unethical).

      I'd have more respect for them if they told the truth, instead of (at least) tripling the mortality stats.

      Poor.

      P.S. Not saying everyone should jump into HSCT by the way. I'm just saying we're all grown ups. A group like that have a responsibility to get their information right before publishing a statement.

      Delete
    5. Thanks Matt. I totally agree with you. The ABN needs some new blood.

      Delete
  2. "The data also suggest that the procedure is not successful in about 50% of cases and disease returns."

    I think people in this field are considering HSCT is an option for highly aggressive RRMS. Is this the population that 50% fail that you are talking about?

    ReplyDelete
    Replies
    1. Out of interest, what data is this (50% NEDA)... Is this something new out of the Sheffield study, or an existing published study? Just asking because the recent(ish) papers published by Burt and Nash (albeit the latter being a BEAM protocol rather than non-myelo) both peg this substantially higher than 50% - and in pretty disadvantageous cohorts versus, for example, the Alemtuzumab study.

      Burt's cohort, for example, included something like 20% SPMS patients, and everyone on it had failed 2 therapies already and had to have active disease. If you look at EDSS ranges, many treated have relatively established disability (up to EDSS 6, I believe).

      Presumably if you matched the Alemtuzumab criteria (low EDSS, treatment naïve, recent onset, RRMS only), the difference in efficacy would become more evident.

      Delete
    2. I would have to go to papers so simpler to remove number Basil cites the Burt work at 80% inhibition of relapse

      Delete
  3. "Professor Basil Sharrack, a consultant neurologist at Sheffield Teaching Hospitals NHS Foundation Trust, said: "Since we started treating patients three years ago, some of the results we have seen have been miraculous."

    Talking about hype! Good luck managing expectations after statements such as these.

    Tony Fonda

    http://www.telegraph.co.uk/news/health/12104774/Miraculous-results-from-new-MS-treatment.html

    ReplyDelete
    Replies
    1. Yes the phones will be ringing later on I suspect

      Delete
    2. social media was a hype too. look at it now. it's got advantages and disadvantages.

      Delete
  4. lies lies and more lies. im sp and had this done in mexico last year and for the first time in 5 years I am seeing my ms symptoms improving instead of worsening. I am representative of many people with the progressive phase who are seeing progression halted. I've heard of only one person who has died from having this done for ms in the last 5 years that's all! the same procedure is done routinely on a daily basis throughout the world for leukemia and other blood diseases without issue.

    ReplyDelete
    Replies
    1. I'm sure it worked for you, but please don't say it's done for blood cancers "without issue". It's frankly insulting to people with blood cancers.

      Delete
    2. Whats your point? If your read it again very slowly and carefully you might be able to grasp the actual content and see that it would obviously not be insulting to blood cancer patients--what would be insulting would be if their registered consultants refused to treat them with HSCT and they became more ill, thats what ms patients are up against-now thats insulting! Simple synario for you---someone goes to a consultant with leukaemia and the consultant says yes HSCT would be a treatment that would help you but i'm not prepared to let you have it! Thats the ISSUE I'm obviously referring to NOT the issue of how they physically cope with the HSCT procedure and quite frankly am surprised an educated neurologist hasn't haven't been able to comprehend the context.

      Delete
    3. I see you have not posted your response....Ihave posted and I do not see your response has any context to this particular thread and have not idea what you are refereing to. I am man enough to post and happy you have taken copies to post on other sites, but as you are threatening us you belong in spam Bye.

      Delete
    4. I am the Anonymous who thought you were being insulting to people with blood cancers. One of my parents has a blood cancer and let me tell you that HSCT is a last resort even there. My point to you is that it is rarely done for cancer patients "without issue" as you stated - consultants explain that it almost always has issues (at least for cancer patients), but sometimes they are just left with no other choice but to try it.

      I am genuinely happy for you that HSCT has improved your SP symptoms and I wish you all the best health. It's also true that HSCT definitely doesn't work for all progressive MSers..if it did why would one of the pioneers of this for MS (Dr Burt) not recommend it for non-inflammatory progressive MSers. Clearly it is doing something for some progressive MSers. But probably the same could be said for other drugs if you looked at just the inflammatory progressive MSers - but how often are they given those drugs? I think we can all agree that some groups of MSers will benefit from HSCT and many others probably not. Peace.

      Delete
    5. By the way Anon 7:15pm what on earth makes you think I am a neurologist? You come across as a very angry person. I am simply an educated person who's father has a blood cancer and wife has MS. You are rude and come across as someone who lacks any ability to look at a situation with a cold and balanced mind. The only obvious thing to me is that for you HSCT worked because you probably have the type of progressive MS that it works well for. You obviously cannot speak for every progressive MSer can you because for many others it has not worked - care to explain this? You seem to have an agenda that you believe every MSer whatever their situation should have this done. Every patient needs to be looked at as an individual case. That is what a great doctor does. You also obviously think that there is some secret conspiracy stopping the widespread use of HSCT. From my experience of some great neurologists this just isn't true. Again, congratulations on the improving symptons. I am happy for you.

      Delete
  5. Its about time the actual truth came out about HSCT!!! Its been tried and tested successfully abroad for years for all types of MS. There is a facebook group FULL of people who were ppms and spms ms who have now HALTED their disease progression and many have seen symptoms decrease. There is clinical evidence from all these clinics that this works but this is ignored. The death rate quoted is inaccurate too. This was based on earlier trials using a slightly different and more aggressive technique. There are going to be a LOT of disappointed people with MS out there that after watching will think they can have this treatment only to find the clinical trial criteria is so narrow hardly anyone fits it. IT DOES WORK FOR PPMS AND SPMS and all this rubbish and lies just condemns those who are labelled as progressive to slowly decline when there is a treatment out there that halts progression. Think how much money could be saved on the NHS if they were all treated with this; just a one off cost instead of a lifetime of drugs. I think its disgusting. Its neither, new, poineering or being developed at Sheffield. ITS EXISTED FOR YEARS!!

    ReplyDelete
    Replies
    1. "There is a facebook group FULL of people who were ppms and spms ms who have now HALTED their disease progression and many have seen symptoms decrease."
      There are also numerous Facebook groups that swear that "Liberation" therapy (CCSVI) has cured their MS. We need to be a little cautious and see the published data from the HSCT trials before we get too carried away here.

      Delete
    2. When you write in upper case. This what is known as the "troll font" and tends to engender a negative response.

      Delete
    3. Michelle - I follow one of these groups and there certainly are people who have done well. However, there are also people for whom it has not worked and have suffered terribly in the aftermath. I'm not saying it isn't a good therapy, but it clearly does come with risks.

      If we want to make good decisions it is important that we remember that the plural of anecdote is not data. We need to recognise and control for our innate human biases.

      Delete
    4. It is interesting that even Dr. Richard Burt of Northwestern University acknowlges that HSCT is not appropriate for people who are progressive without signs of inflamation, yet he is running the MIST trial for HSCT.

      People on the Facebook pages have the notion that progressive MS is still an inflamitory autoimmune disease perpetrated by autoreactive t cells that have underwent epitope spreading.

      But if this was the case why wouldn't the ablation of your immune system halt progression?

      I think HSCT may have a role in the future but there is hype in that it is a cure which seems to go against what science knows about MS and is giving some people false hope.

      Delete
    5. lol. halted is a funny word. i looked it up and it means 'stopped for a period of time'. all dmds can halt ms.

      Delete
  6. MouseDoctor2
    Nice reply. Almost a clever reply... Except that the ridiculous CCSVI procedure, never had any scientific support. And was seriously "debunked" many years ago.

    HSCT has been used to treat blood and bone cancers for YEARS. A regular, established, scientifically proven procedure for cancer. The ONLY thing being proven in current clinical trials, is that it also works for AUTO-IMMUNE DISEASES (which of course includes MS).

    To even put HSCT for MS, into the same sentence as CCSVI, is a direct insult to all Haemotologists involved in HSCT. You disappoint me.

    ReplyDelete
    Replies
    1. I was being a little mischievous re CCSVI but I'm just warning people against believing all you read on Facebook, Mindy. Sorry to disappoint you :-(
      Yes, there is a much more robust evidential and scientific basis for HSCT in MS but we need to see the data, not only from Sheffield but also other groups performing these HSCT trials and not just make our minds up on the basis of a 30 minute Panorama episode. We also need to see what the long-term and short-term risks are, there are reports of secondary autoimmunities developing in some HSCT treated individuals plus the risks of infections etc.

      Delete
    2. i felt like Mindy did for the comparison between ccsvi and hsct. i made a a comment on another post about it. low shot and passive aggressive MouseDoctor2Monday, January 18, 2016 3:25:00 pm, i know you are a kind person and can do much better than that. i know that barts school of lond ms blog admins have been liasising with Mstranslate and combining forces. The reason I really enjoy MStranslate is the respect and the lack of sarcasm and poor me type of responses. Come on people, we can achieve world peace. Or at least lessen the sarcasm a bit, it's hurtful to people who are actually suffering not just working too hard and feeling unappreciated for their work. The estimated secondary immunity risk associated with non myeloablative hsct without lemtrada part of the protocol is about 3-5% and if you need a reference for this please let me know and i will dig up. short term risks (say 0 to 3 years) are known as the procedure has been performed since 1995 and we know as much about the long risks of hsct as we knew about the long term risk of tysabri in 2004. sometimes this whole golden science thing feels like political correctness.

      Delete
    3. I know "blog admins have been liasising with Mstranslate"....sorry but news to me.

      Delete
  7. As I said above.... good luck managing expectations!

    Basil Sharrack should be "miraculously" whipped for his imprudent statement.

    Tony

    ReplyDelete
    Replies
    1. I'm sure its going to be a busy evening, Tony.

      Delete
  8. Neuros need to get their act together (I.e. come to a consensus on the use of stem cell therapies). I realize this therapy is in its infancy but patients are confused after reading such articles.

    ReplyDelete
  9. So MD, are you saying there are no published evidence to say that HSCT works? What I don't understand about all your statements is the same risks of secondary autoimmunity disease exist with Alemtuzumab, good pastures syndrome about 2%, PML up to 1% risk with natalizumab, are the risks any different with HSCT. Compare the risks properly and see if there is any difference?
    Also, there is already published data on HSCT, have you not reviewed them or are you just waiting for MIST?
    Oh wait don't tell me Clabridine will be better than HSCT, with your £2000 quoted price that will go up to 30K when licenced.

    ReplyDelete
    Replies
    1. No, I'm not saying there is no published evidence that autologous HSCT works for MS but there are risks as detailed in this paper.
      http://www.nature.com/pr/journal/v71/n4-2/full/pr201157a.html

      Delete
    2. Just chipping in here...

      I agree there are risks for sure, but the paper you've linked to here is referencing TBI, the EBMT studies which were predominantly BEAM (and even some with stronger protocols than that), and even allogeneic transplants - all of which are significantly more risky than the non-myeloablative protocol proposed in the BBC documentary this evening, which has a substantially lower risk profile. And this paper is also across all autoimmune disease (including, for example, Scleroderma - where patients often have existing organ damage going into it).

      Definitely people should go into it with eyes open - but if you're going to post stats, at least post the right ones. Any BMT centre in the UK should be able to furnish you with these.

      [No offense intended - appreciate the well intentioned point]

      Matt

      Delete
    3. The problem here is that when there is any chance of a healthy debate on HSCT the blog authors tend to avoid it, I have never understood why, but it is a good point. TBI is not s protocol used, it would be like me quoting risks of Clabridine when used as a cancer medicine, which is a completely different dose and risk profile.

      Delete
    4. What is your point what debate do you want?

      Delete
    5. I honesty think that you don't believe in this treatment. (I'm yet to understand why) and want the facts to be discussed debated and not overlooked.
      1) HSCT has a better results than Alemtuzumab, natalizumab and 'Clabridine' for RRMS. The 5 years results of relapse free are more like 70% which you can get from numerous published sources (which I can post if allowed)
      The risk of death now is about 1%, the risk of PML is about the same, Alemtuzumab has similar risk with ITP.
      The risk of secondary autoimmunity in alem is around 50%, in HSCT the only info I can find points to around 20% (but I don't have published data on that)
      The risk of infection in HSCT is very high, and that comes with considerable risks. Same for cancer patients having the same drugs (normally cyclophosphamide and another chemo drug (rixuimab/alem etc) the risks are no different, so why emphasise them for MS and not for cancer?
      Whilst you focus a lot of your time on Clabridine, why not focus on HSCT that has better results. Why is the higher risk better benefit not an option for your patients, rather than another drug with similar efficacy as alem/tysabri. I don't understand why mediocrity is your focus when there is better options. But you believe that Clabridine is a better choice - why?
      Your argument I have seen before is that 'it's not an approved therapy my NICE' yet you are busting your guts to get Clabridine approved, why not HSCT?
      This is long winded but I'm trying to understand why if a treatment has better results (that have been sensationalised by panorama now) why you don't think it's worth it..
      Before I get critized I sign as anonymous as signing with a name comes up on a Google search, and I hope you get my point.

      Delete
    6. I do not understand why you think I don't believe in the treatment..the results look very good. This would not be surprising if MS is driven by an immune response, so I absolutely think it is a valuble approach.

      The results look impressive

      Risk of death is 1%. Natalizumab risk of PML is about 1 in hundred with risk of death about 20% so about 0.2% and you can switch before 2years is up and that risk drops. The death risk is largely from infection and yes is the same as cancer risk for infection.

      Why dont I shout about it...At the present I have no interest in it. Simple as that. I have no interest in MRI either and many other things.
      However, when HSCT papers surface we post on them.

      As for animals, we have moved on and we can stop disease without need to replace immune system so HSCT would be a waste of time. I can stop disease withot any risk of infection I would rather spend my energy on this.

      Why do we focus on Cladribine and not HSCT. We are not doing HSCT although Dr Turner in group is part of London Consortium. You need infrastructure for HSCT and you need an interest and if I have to explain why we are interested then you have not read what we have written.

      Will the results be as good as HST maybe not, but is the NHS going to pay for this for every one. I doubt it.

      The result have indeed been sensationalised by Panoama and I suspect ProfG you show the same with Alemtuzumab and Natalizumab, When the docs get this nearer approval then we will ge more excited by a trial from 2006-2020 is a long time to wait and someone is being sold a dummy

      Delete
    7. I'm interested as you say you have no interest in the treatment but it is potentially the most effective thing out there to treat MS and provide long term remission. Even for some forms of progressive MS as if orceluzimab worked for progressive then HSCT in theory would as well.
      If finding and promoting the most effective treatment out there for MS using the immune system as your target isn't your interest, can I ask what is? This isn't just aimed st the MD's as I know researchers have various interests, but at neuros as well.

      Delete
    8. We're interested in anything that can halt MS. End of.Us MDs are focussed on neuroprotection to save as many nerves as is possible after the disease has been halted to slow/stop the progression of disability and as good as HSCT may prove to be, its unlikely to stop that completely.
      The bottom line is if HSCT proves to be the most efective therapy, then it should be widely available but the infrastructure/resources would need to be put in place to achieve this in the UK.
      On a lighter note, I reckon that Pharma are getting worried but maybe it'll give them the big nudge they need to properly get into neuroprotective therapies if their DMT revenues disappear as a result of HSCT.

      Delete
    9. The problem is that the effort you have put into trying to get Clabridine approved by NICE, has taken years with so many hiccups, what chances is there that HSCT would ever get approved. The only chance is that if Neuros and researchers really put the case to NICE. As patients have no access to that organisation, and the MS Socieites will only support a treatment that is supported by the Neuros, and so many Neuros are tied to pharma, so it's a vicious circle. This is why a blog like this could continue that education to neuros and promote this treatment and continue the change in attitudes, as it did for 'time is brain' and using highly effective treatments (MABS vs CRABS)

      Delete
    10. I'm shocked you have no interest in it MD. MD2 - I hear you but MD has clearly stated his views.
      I appreciate everyone has different interests they wish to focus on but as authors of this blog I thought beating MS was and is the priority. I'm saddened by your views MD but appreciate your honesty.

      Delete
    11. I think you're missing the point, MD isn't "interested" in HSCT because it falls outside our particular areas of expertise. We can't do everything!
      Beating MS is and will always be the priority and whichever is the best method to achieve this (with the lowest side effects) will get our full support, even if we aren't directly or indirectly involved.
      We choose to focus on areas such as neurorpotection, which will still be needed even idf HSCT proves to be successful in my opinion.

      Delete
    12. "MouseDoctorTuesday, January 19, 2016 1:14:00 am"

      "Why dont I shout about it...At the present I have no interest in it. Simple as that. I have no interest in MRI either and many other things.
      However, when HSCT papers surface we post on them."

      I understand you are a researcher with your own interests and career ambitions. I understand medicine and MS are such large fields not one person can be an expert on all things MS. I am a commercial lawyer and I know nothing about family law. But imagine if I told a client, say a woman whose hubby ran away to Iran with their 3 children, I tell that client "At the present I have no interest in family law. Simple as that. I have no interest in children either and many other things. Good luck. However when a paper on family law surfaces i'll definitively post on it"
      The audience on this forum are your clients. You are providing a service, an excellent service for free. That cannot be commended enough. But can you not see how telling someone with MS you have interest in a treatment that's really promising is insulting and unprofessional?

      Delete
    13. No. I am saying I have limited knowledge in the subject area. I have done abit more reading in the past few days, but we do not kow everything

      But getting on a high horse is not insulting either?

      Delete
  10. I know it may be a silly question but does the positive effect of HSTC is due to the high immunosuppression? Because if the problem would be in the immune cells (genetic, more environmental factors, etc.) stem cells grow, the problem would return to the cause or causes are still in the body ...

    ReplyDelete
    Replies
    1. It is immunosuppressive, but it seems the treatment effect is not only down to immunosuppression otherwise you would expect to see MS re-emerge when the immune system repopulates (over a couple of years). That doesn't appear to be the case.

      The best way I've heard it described is that it reboots the immune system, and gives it a chance to go down the right path.

      Since nobody knows what triggers MS in the first place, nobody can say whether it will spontaneously re-emerge years down the line. It's that 20+ year experiment, same as Lemtrada.

      This paper by Muraro et al studied the immune reconstitution post HSCT and concludes:

      Here, we showed that a sequential combination of thymus-independent peripheral reconstitution pathways (early; CD8
      CD4) and thymus-dependent immune rejuvenation (later; CD4
      CD8) profoundly reconfigures the immune system in patients with MS who received HSCT and results in a pro-
      longed disease activity-free interval that is not reliant on immunosuppression. These findings substantiate the induction
      of immune regeneration as the rationale of HSCT and pro-
      vide a mechanistic basis for ongoing and future clinical trials
      of this therapeutic strategy in autoimmune diseases.

      https://www.researchgate.net/publication/7995966_Muraro_PA_et_al_Thymic_output_generates_a_new_and_diverse_TCR_repertoire_after_autologous_stem_cell_transplantation_in_multiple_sclerosis_patients_J_Exp_Med_201_805-816

      Delete
  11. "Importantly this procedure works best for people with relapsing disease, who have not developed progressive disease yet, so it is probably not a miracle cure for progressive MS"

    Have the patients with "RRMS" who have had this treatment "been given time" to become progressive, i.e. is it certain that they do not have underlying progression which surfaces later, despite repression of immune system flares?

    ReplyDelete
  12. Bit disappointed with that, to be honest...

    I guess it was good in that it was a positive take, and got it out there for the masses, but you didn't really see much of the treatment, or much of a debate around the politics, risks vs efficacy, or its place in the ongoing treatment of MS compared to other therapies. Or a real view of what it's like to go through it.

    I thought, on the whole, perhaps a bit of a missed opportunity - maybe needed an hour to be a bit more scientific. Fair play to the docs and patients who took part though.

    Thoughts from Team G?

    ReplyDelete
    Replies
    1. Rather fluffy I suspect people will be asking where do I sign up as it apparently works without problems. There was no discussion about the issues faced to get this developd
      any risk, besides hair loss, no discussion of what next and what is need to get this available.

      Delete
    2. I was surprised how little the programme referred to risks. An hour would have been better. It was nice to see the treatment completed and talked about calmly though. Whenever there are discussions about HSCT they always seem to focus on risks, deaths and side effects so it was nice to see people walking out still looking human.

      Delete
    3. It's tv. Of course it's fluffy. If the medical community preempted sensationalist tv with some real information (not information that is so summarised it borders on incorrect) then tv picks up the slack and makes it sensataional so that everyone will watch it. Why is there so much anger about this? I'm from Australia, my partner and I watched television program about HSCT (not even the Kristy Cruise 60 minutes drama) before deciding on having the procedure. I disconnected myself from all but one zealous facebook groups, went to work and printed 300 pages of journal articles. I borrwed 6 different coloured markers from work and spend the next 6 months reading instead of working in order to help my partner make the decision. TV is not the problem. Medical community needs to look at the mirror a little bit more.

      Delete
    4. "Medical community needs to look at the mirror a little bit more"..ranting:-)

      Panorama is supposed to be a current affairs programme, where you would like to see balance and fact.

      Delete
  13. And anyone has thought of later track who did HSTC as acquired or repurchased infections such as EBV for example?
    How will the response to infections of this new immune system?

    ReplyDelete
    Replies
    1. Precisely my thoughts....

      Tony F

      Delete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.