Texting and walking: don't forget to self monitor

For soft science of the week, we have texting whilst walking. We know this can be bad for your health, particularly when crossing roads.

End of Year Revision

As the year draws to a close, it has been a productive year for papers and ideas. 

I predict that during 2018, we will get even more clarity on the story.

But do you believe the academic minnow or the whale?

Reduce your price or else seems to be the message

To follow on from NDG story

Multiple sclerosis - interferon beta, glatiramer acetate (review TA32) [ID809]: Appraisal consultation: 1

The key dates for this appraisal are:
Closing date for comments: 24/01/2018
Fourth appraisal committee meeting: 6 March 2018

Remyelination studies: Publishing the data after pharma has dumped the idea

Positive data for a target for remyelination.

I suspect you are hearing about it after clinical development has been stopped.

Guest post: Digesting Science makes it to Scotland

We've been trying to get Digesting Science up to Scotland since we started the project. Scotland has one of the highest rates of MS in the world; 11,000 people according to some estimates.

What you had to say about coffee and MS

Thank you for completing our recent survey on coffee consumption amongst pwMS and the reasons for drinking coffee. The results are quite interesting. What do you think? 

Education: What are B cell follicles?

The lymphatic system is part of the circulatory system and a very important part of the immune system, comprising a network of lymphatic vessels that carry a clear fluid called lymph (from Latin (lympha meaning "water") 

Want to learn more?

NICE and not so nice

Bah, humbug! 

The cynic in me would say would say that NICE (The National Institute for Health Care & Excellence) timed the release of this consultation document in the UK exactly right. Dare I say, an overused political strategy this year has been to shoe it under the door before anyone is the wiser (I won't mention any specifics). And again they will be correct in assuming that over the yuletide, key opinion leaders in MS would either be inebriated, or staving off the first signs of a diabetic coma to take much notice. I don't mind people exercising a bit of stealth when it is required. However, it is the calculated nature by which the process is undertaken that I take umbrage to. It would be a mistake to assume, just simply because their is acquiescence, their is also acceptance.

Can Jesus's Christmas Present stop MS

So a bit of festive research for today

Frankincense is an aromatic resin used in incense and perfumes, obtained from trees of the genus Boswellia. 

If you believe this stuff, it was brought by the Three Kings to Jesus's birth place, a long time ago.

But can it affect MS?

Happy Christmas

Happy Holidays to all our Readers

Best Wishes from TeamG

Unusual cases may hold key to understanding

Case reports can off insight into MS, 

B cells at the forefront but does this end of year case report burst the B memory bubble?

New MOD on the block. Is it too late?

Just as the Nibs are about to enter service here we see another MOD

The 9-Hole Peg Test detects change in Gaming trial

A big beast of the outcome measurement world has criticised our drive for self-assessment and self-monitoring in pwMS. Why? 

A new B cell drug on the way

Academics are saying "La, La, La, La, La, T cells, T cells, T cells"
and take no notice of our ravings, lucky for you Pharma is not that blinkered.

They can see the value of hitting the B cell and secretly they have been planning on targeting the B cell with some small molecule inhibitors. Want to know more?

A revolution: participatory medicine

‘‘Before the Internet, when first diagnosed, I depended on my neurologist. His opinion was the final say about everything from use of steroids to physical therapy to which disease-modifying medicine I would use. The Internet empowered me as a patient to become informed about my condition, to consider my options and the opinions of others, and to take charge of managing my disease in the best possible way for me.’’

How important are the internet and social media to you in managing your MS? 

MS News: too early for a high-dose biotin licence

The EMA has announced that Medday have withdrawn the licence application for high dose Biotin.

The EMA were not convinced by the data presented. 

Vitamin D effect in the pivotal fingolimod clinical trials

Chicken or egg? Causation or association (reverse causation)? Is vitamin D a DMT or not? Does this study muddy the waters or provide some clarity? 

PML warning on Cladribine by MHRA.

There has been a warning about the development of PML after the use of cladribine for the treatment of haematological problems issued by the MHRA. Therefore please be vigilant. 

Alemtuzumab stops working. I wonder why?

Alemtuzumab can stop working. Is it because CD4 T cells are no longer depleted or is it because they have neutralizing antibodies?

In some people this occurs, and could be more of a problem after the the second infusion cycle. 

Whats more, some people do not deplete in the first place.

What information do we need to know from the manufacturer?

A test for MS...Are we there yet?

Wow you said a new study that shows a simple test that can detect MS,

Hailing from “Gods own Country”,  I thought I would Investigate

DrK's Brain Attack trial

Time is Brain, even in MS! 

How quickly should we treat MS? 

DrK makes the case for treating everyone as quickly as possible. Do you agree? Can you help us convince Biogen about the case for a Brain Attack Trial?

Blockade of Interleukin 17. Is it the Bees Knees?

At a meeting (At the Limits) recently a pair of prominent immunologists took exception, when I hinted that Blockade of Interleukin 17 has been perceived to have failed in MS, because of modest efficacy.

I was challenged on this. I replied I did not say it did not work, but countered that it was not much better than beta interferon. They said that it was not that it did not work, but that it was dropped for operational reasons. 

Operational Reasons. I wonder?. 

Did they simply really mean, it wasn't good enough? 

Dying on your terms: is it possible?

The Australian state of Victoria has become became the country’s first to legalise assisted dying or suicide. Is dying a better euphemism? 

We need a new way to measure upper limb function in MS: can you help us?

As you may know, we at Barts-MS are passionate about the importance of upper limb function for people with MS. And our #ThinkHand campaign aims to increase awareness.

Part of this project is to develop a new way for people to record and measure their upper limb function. We currently work with Patient Reported Outcome Measures (PROMs), such as the ABILHAND, which is a questionnaire that patients are asked to complete at clinical visits.  Read more about that in a previous blog post.

Can you eat your way to happiness?

What is happiness? Once you defined it can you eat your way to the holy grail? 

Temperature dependence of impulse conduction in optic nerve axons

Thanks for the comments

We were grateful when a number of readers responded to our enquiry regarding temperature dependent symptoms in MS, and we learned more about how people cope with the symptoms. Following this conversation, I thought it worthwhile to draw attention to a paper we recently published, that suggests that there are functional differences between normal peripheral and central axons, and these differences provide a new view on temperature sensitivity.   

Education: What do antibodies do

You have full text access to this OnlineOpen article

Prospects from systems serology research

Kelly B. Arnold and Amy W. Chung

Version of Record online: 1 DEC 2017 | DOI: 10.1111/imm.12861

An internal cell signalling molecule found to support remyelination

Do you want to know about cell signalling and how the oligodendrocyte knows when to make myelin or not?

Measuring Hand Function

Online monitoring of hand function. Are you up for doing the BRAIN test or will the cardboard 9HPT do the job? 

Relapse without cell depletion in the blood

As you may be aware I have been banging on about the importance of B memory cells for most of the year, but it has been an uphill struggle to get this view accepted. 

However, response to therapy creates a powerful piece of insight that frankly can't be ignored. But I meet Ostriches ever day.

Fingolimod: does it help with upper limb function?

ProfG G has been been saying that we should #Thinkhand and target hand function for outcomes in clinical trials. This idea may be supported by studies with ocrelizumab and natalizumab but there are a couple of exceptions.

Reflections on the ECF 2017

I have just returned from the European Charcot Foundation meeting in Baveno, Italy. The meeting is small (< 500 attendees) with no parallel sessions and ample time to mix with attendees and chew the cud. I did a plenary presentation on "dealing with increasing economic constraints".  The feedback I received after my talk, and subsequently via email, has been extraordinary. An eminent neurologist said he was glad that someone was thinking about these issues and taking it on. I have also been contacted by a health economist and have been urged to write up the talk.

Yet more data supports the B memory Cell idea

I can hear you saying, "Oh no not another B-cell paper!". However, this is where the action is. It is the B-cell and not the T-cell. Do you agree or disagree? Have your say. 

Blood cancers after fingolimod treatment

How immunosuppressive is fingolimod? Does fingolimod's longterm immunosuppression result in an increased cancer risk? 

Guest Post: an update from Saúl Reyes

It has been a while since I last wrote a post for this blog and figured it was time to update you all! I have recently completed my training with Professor Giovannoni and it really confirmed my desire to pursue a career in MS. I am back home in Colombia just getting ready to finish my residency in Neurology. I am incredibly grateful for the time I spent with the Barts and The London Neuroimmunology Group. Every member of the team was very passionate about MS and brought that excitement to teach me. I am delighted to be able to keep in touch with you all through this blog. Please enjoy my new post and don't forget to leave your comments below!

Danger! Danger! How does the brain sense damage?

The mechanisms which drive inflammation and neuron death in MS are very complicated. These processes involve interactions between multiple cell types in and outside the brain. The crosstalk between nerve cells (neurons), immune cells from the blood, and brain-resident supporting cells (glia) is important to study because it could open up new avenues for disease-modifying therapy. 

Plasma cells live for a long time in the CNS

Pollok K, Mothes R, Ulbricht C, Liebheit A, Gerken JD, Uhlmann S, Paul F, Niesner R, Radbruch H, Hauser AE. The chronically inflamed central nervous system provides niches for long-lived plasma cells. Acta Neuropathol Commun. 2017 Nov 25;5(1):88

Although oligoclonal bands in the cerebrospinal fluid have been a hallmark of multiple sclerosis diagnosis for over three decades, the role of antibody-secreting cells in multiple sclerosis remains unclear. T and B cells are critical for multiple sclerosis pathogenesis, but increasing evidence suggests that plasma cells also contribute, through secretion of autoantibodies. Long-lived plasma cells are known to drive various chronic inflammatory conditions as e.g. systemic lupus erythematosus, however, to what extent they are present in autoimmune central nervous system inflammation has not yet been investigated. (Who are they kidding...oh yes the referees) In brain biopsies from multiple sclerosis patients and other neurological diseases, we could detect non-proliferating plasma cells (CD138+Ki67-) in the parenchyma. Based on this finding, we hypothesized that long-lived plasma cells can persist in the central nervous system (CNS). In order to test this hypothesis, we adapted the multiple sclerosis mouse model experimental autoimmune encephalomyelitis to generate a B cell memory response. Plasma cells were found in the meninges and the parenchyma of the inflamed spinal cord, surrounded by tissue areas resembling survival niches for these cells, characterized by an up-regulation of chemokines (CXCL12), adhesion molecules (VCAM-1) and survival factors (APRIL and BAFF). In order to determine the lifetime of plasma cells in the chronically inflamed CNS, we labeled the DNA of proliferating cells with 5-ethynyl-2'-deoxyuridine (EdU). Up to five weeks later, we could detect EdU+ long-lived plasma cells in the murine (mouse) CNS. To our knowledge, this is the first study describing non-proliferating plasma cells directly in the target tissue of a chronic inflammation in humans, as well as the first evidence demonstrating the ability of plasma cells to persist in the CNS, and the ability of the chronically inflamed CNS tissue to promote this persistence. Hence, our results suggest that the CNS provides survival niches for long-lived plasma cells, similar to the niches found in other organs. Targeting these cells in the CNS offers new perspectives for treatment of chronic autoimmune neuroinflammatory diseases, especially in patients who do not respond to conventional therapies.

Plasma cells which produce antibody are often found in bone marrow and can live for years but you put them in cell culture and they are dead in a few days. This is because the cells survive in niches where they recieve survival factors from surrounding cells. In this study they track the presence of plasma cells over weeks in animals and suggest that plasma ells survive for some time. I guess we have thought this happens for some time and it is evident that many of the plasma cells in the CNS are not directed to myelin antigens.

The question is what are we going to do?

Have a read if you are interested

The problem here ,is the pictures show the random isolated plasma cell and not B cell follcles

Clinical trial destroys another good idea

Amiloride does not protect retinal nerve fibre layer thickness in optic neuritis in a phase 2 randomised controlled trial.

McKee JB, Cottriall CL, Elston J, Epps S, Evangelou N, Gerry S, Kennard C, Kong Y, Koelewyn A, Kueker W, Leite MI, Palace J, Craner M.

Mult Scler. 2017 Nov 1:1352458517742979.

BACKGROUND:

Recent basic and clinical evidence suggests amiloride may be neuroprotective in multiple sclerosis (MS) through the blockade of the acid sensing ion channel (ASIC).

OBJECTIVE:

To examine the neuroprotective efficacy of amiloride in acute optic neuritis (ON).

METHODS:

A total of 48 patients were recruited to a phase 2, double blind, single site, randomised controlled trial. Scanning laser polarimetry (GDx) at 6 months was the primary outcome measure and optical coherence tomography (OCT) and visual and electrophysiological measures were secondary outcome measures. Participants aged 18-55 years, ≤28 days of onset of first episode unilateral ON, were randomised to amiloride (10 mg daily for 5 months) or placebo ( clinicaltrials.gov , NCT 01802489).

RESULTS:

Intention-to-treat (ITT) cohort consisted of 43 patients; 23 placebo and 20 amiloride. No significant drug-related adverse events occurred. No significant differences were found in GDx ( p = 0.840). Visual evoked potentials (VEP) were significantly prolonged in the amiloride group compared to placebo ( p = 0.004). All other secondary outcome measures showed no significant difference. Baseline analysis of OCT data demonstrated a significant pre-randomisation thinning of ganglion cell layer.

CONCLUSION:

Amiloride has not demonstrated any neuroprotective benefit within this trial paradigm, but future neuroprotective trials in ON should target the window of opportunity to maximise potential neuroprotective benefit.

                                     Data from Brain Seq

Amiloride is blocker of ASICS1 channel. This is a neuronal voltage-insensitive sodium channel activated by extracellular protons permeable to Na+, however ASIC1 also shows low Ca2+permeability. It was shown to be neuroprotective in animal models so of we go and do a trial and as we can see as occurred here...the trial fails and animals studies take a beating, like so many other studies.

However I have been arguing that animal studies are not always the problem. I am sorry to say clinicians conspire to mess things up. Sorry but it bursts my bubbles too.

In this study people who had optic neuritis had a month to get on drug. But this is too late as the damage has been done. The damage is done within a few days as we showed in animals, which led to a positive trial when people were recruited and put on treatment within 1-2 weeks as shown in

Raftopoulos, R, Hickman, SJ, Toosy, A. Phenytoin for neuroprotection in patients with acute optic neuritis: A randomised, placebo-controlled, phase 2 trial. Lancet Neurol 2016; 15: 259–269

However, this has chucked away our animal data as this trial was not followed up to change practice such that people with optic neuritis get treated with phenytoin. However I think the amiloride has another problem as it made the nerve transmission slower suggesting that it block remyelination.

It is interesting that oligodendrocyte presusor cells have loads of ion channels on them and this includes ASIC1 (ACCN2) and this drops once cells produce myelin. See the picture. So is this chnnel involved in myelination

Comments, Questions and Answers-December

If you have a question unrelated to the Posts this is the place for you. 

In the past we have done an advent calendar in December, to advertise the Research Day.

However, we do not know about the planning of this, 

So the mice are off on tour.

Copaxone: yet another mechanism

Previously on this blog I've written about Copaxone and its "mechanism of the week". For example, here and here. I haven't done it for a while, but can't resist bringing this one to your attention.

Now it's anti-bacterial. What next? It inhibits EBV :-)

But I guess it must be working by blocking the microbiome:-).

Can coffee really be good for you?

As you see we are trying to post less often on the blog so that you have more time to read and discuss the posts. The following blog post is a bit of a cheat as I have reviewed three papers. However, they are all related to coffee and are relevant to pwMS and their families.

Are you addicted to coffee? If you are, don't worry, the latest research suggests it may be good for you. However, if you have urinary symptoms, anxiety, tremor or sleep problems there may be a downside. 

Alemtuzumab hair today gone tommorrow

NeuroDoc Gnanapavan I didn't sign-up for this!

 I want my hair back ;-(

Training the next generation of UK's MSologists

Tony Blair is famously quoted as saying 'Education, education, education, ...' and putting education at the centre of New Labour's manifesto in 1997. However, is it the type or the quality of education that makes the difference and changes the world?

We are trying to change the world of MS treatment.

Study shows a B cell depleting treatment is effective

A new study tests a B cell depleting treatment in MS. The results are interesting.

Are we Overdosing Ocrelizumab

The eagles (ocrelizumab for RRMS and PPMS)  may have landed in Europe, but how often should the birds be used to kill cells in MS?

A view-point argues it's too often and that it can be personalised and smart.  I agree but for different reasons.....

Searching for the Miracle Cure. MS in the Media

Last night we had a programme in the UK on  someones journey to Israel to examine the effect of mesenchymal stem cells.

• Mesenchyme is embryonic connective tissue that is derived from the mesoderm and that differentiates into haematopoietic and connective tissue, whereas MSCs do not differentiate into haematopoietic cells.

It was dubbed a "Search for a Miracle Cure" and was on Channel 4, but there was no evidence presented to suggest it was a cure.

Guest post: Young carers in Newcastle try Digesting Science

We have recently reached out to a number of young carer organisations across the country, encouraging them to hold a Digesting Science event (the Barts-MS set of activities explaining MS to 6-12 year olds). Recently, we got some great feedback from the South Tyneside Young Carers, and thought we'd share their fantastic work with you. Post by Levi Cosker, South Tyneside Young Carers Activity Officer.

Results of Rumble in the Jungle 2

As you are aware Prof. Baker (Proud Yorkshireman / Englishman) took on Prof. Heinz Weindl (Proud German) in a dramatic debate. Who won?

Who Needs T cells..Not EBV infected Memory B cells

To finish off the debate...a prominent T cell immunologist in the red corner said B cells need T cells.....However, do some reading and listening and as said with EBV in the equation...maybe not.

Did people listen to the Evidence with an open mind and no preconceptions?

Imaging B cells

B cells are becoming increasingly seen as an important subset of cells and they have been implicated as drivers of progressive MS. 

There will be an increasing number of B cell therapies arriving and so being able to assess whether they get rid of B cells in the brain is an important step. 

This study reports on the production of an imaging tool.  They use rituximab to image B cells in EAE. They show an increased disease. I was excited

CCSVI may it rest in peace...

Finally, it's time for CCSVI to rest in peace! 

Rumble in the Jungle Part II

The "Rumble in le Jungle" at ECTRIMS2017 turned into a "Bumble in the Immunological jungle" as the Heavyweight clash turned into a love-fest. 

UPDATE: Slides added

Have you been involved in shared-decision making?

A recent study published in the British Medical Journal (BMJ) proposes a simple three talk model for shared-decision making in the clinic. 

Have you been involved in a shared-decision making process, or have you simply been told what is best for you? 

Please have your say.

The good, the bands, and the ugly: do oligoclonal bands mean more brain shrinkage?

Oligoclonal bands (OCBs) are now back in the diagnostic criteria for MS - they can be used to support a diagnosis. If someone has a clinically-isolated syndrome - an episode of symptoms or signs due to demyelination without any evidence of previous events - the presence of OCBs makes it much more likely that they will go on to develop clinically-definite MS. 

Guest Post: Self-catheterisation

Note: This is a no-nonsense and detailed post on self-catheterisation.

As MS progresses we often have to self-catheterise. This presents few problems for some. Others, like me, aren’t so lucky.

Latest natalizumab PML risk update

The latest PML risk figures from Biogen. If you are on natalizumab and are JCV seropositive this post is for you.

Why does smoking increase your risk of MS?

We don’t understand yet why people get MS. The accepted view is that there is an interaction between risk genes and environmental factors like EBV, smoking, and vitamin D status. Epidemiological studies have helped to identify these risk factors for developing MS, but it is unclear how these factors actually contribute to disease evolution and progression.

LDN does not affect MS

"Low dose naltrexone (LDN) has become a popular off-label therapy for multiple sclerosis (MS). A few small, randomized studies indicate that LDN may have beneficial effects in MS and other autoimmune diseases. If proven efficacious, it would be a cheap and safe alternative to the expensive treatments currently recommended for MS. We investigated whether a sudden increase in LDN use in Norway in 2013 was followed by changes in dispensing of other medications used to treat MS."

HSCT in MS - what have we learnt?

More and more HSCT procedures (aka bone marrow transplants) are being performed for MS around the world than ever before. Currently, we lack convincing data on the conditioning regimen that best balances efficacy and safety. Patient selection is key and HSCT should be considered as an early option in aggressive cases of inflammatory MS, rather than as salvage therapy in later disease. 

Translocator protein: useful to see, useful to target?

Translocator protein (TSPO) is found on the outer mitochondrial membrane (in other words, on the outside of the powerhouse of the cell). It is thought to be involved in regulation of several cellular processes but its actual function is still up for debate. 

Seizures, epilepsy, and MS

Any type of injury to the brain - whether focal or diffuse - can increase your risk of developing epileptic seizures. pwMS who have lots of lesions or significant atrophy are probably more at risk of developing epilepsy. The exact risk of epilepsy in MS has been a bit variable in reported studies. Because the absolute numbers of pwMS who also develop epilepsy is quite low, you need a really big cohort to see if there is any increased risk compared to people without MS. 

Guest Post: Dr Rune. Høglund A potential pathological mechanism for memory B cells

A potential pathological mechanism for memory B cells

Bio: RAH is a Norwegian MD, currently a PhD candidate in the MS section of the Clinical Neuroscience group at Akershus University Hospital. Previous work includes examining the many effects of glatiramer acetate on the immune system. Our current work is focusing on B cells in particular, and their potential pathological collaboration with T cells in pwMS.

Ocrelizumab news: finally two eagles have landed

Landmark decision by the CHMP; ocrelizumab gets licensed for both relapsing and primary progressive MS.

The season of MS: Glandular fever may not be linked to time of year

Vitamin D (as measured by time of year) and glandular fever are not linked. Should we be surprised?

I guess it boils down to how you think it is all working. 

#MS News. NICE being Nice for a change. Oral Cladribine now available on NHS in England

Imaging Microglia

Although this won't make me popular with the "imagers", here you have it from the horse's mouth "magnetic resonance imaging alone provides limited information for predicting an individual patient's disability progression".

Will Biogen walk-the-talk and do another natalizumab SPMS trial?

At #MSParis207 I presented a new analysis of the data of the ASCEND trial (natalizumab in SPMS) that shows natalizumab is very effective in protecting upper limb function, and to a lesser extent lower limb function, in people with more advanced MS (majority needing walking aids). 

The turn of the fungi

Fungal infections have not been widely studied in MS, many lines of evidence are consistent with a fungal etiology.

Guest post: will the COMBAT-MS study disrupt the MS market?

You may be aware that people living with MS in resource-poor environments are often not treated with disease-modifying therapies. To address this we have been promoting a Barts-MS Essential Off-label list of DMTs. The problem with this list is that it is often not backed by a so-called 'class 1 evidence'. 

To address this lack of evidence, trials such as COMBAT-MS are being performed to provide data from real-life practice to support off-label prescribing. We are therefore privileged to have a guest post from the team running the COMBAT-MS trial explaining what the trial is about.

Can blood neurofilaments be used to monitor disease activity?

Are we ready for a simple blood test to monitor MS disease activity?

Unrelated Comments & Questions - November 2017

Sometimes you want to say something unrelated to the thread or ask a clinical question or some other MS-related question that has not been answered in past. This is the place for you.

A BAFFling tale: how does fingolimod affect B cells?

Fingolimod is an effective DMT which binds to the sphingosine-1-phosphate receptor on white blood cells. We don’t fully understand why it works in MS, but the most popular theory is that it traps lymphocytes inside the lymph nodes, preventing them from entering the blood and therefore from penetrating into the CNS. It may also have direct anti-inflammatory effects, protect the integrity of the blood-brain barrier, and (possibly) act directly in the CNS as a neuroprotective agent.

Cognition: to measure routinely or not?

At ECTRIMS I gave a short TED-type talk on why I think we need to measure cognition in people with MS in routine clinical practice. Do you agree?


Podcast: 

News: daclizumab handcuffed by the EMA

After a second person with early RRMS died from fulminant liver failure whilst being treated with daclizumab the EMA are restricting daclizumab's use. 

Posters Galore @ECTRIMS #MSParis2017

ECTRIMS/ACTRIMS 2017 in Paris

How would I describe this year's ECTRIMS/ACTRIMS?

Are you what you eat?

Circumstantial evidence has suggested an association between diet and MS, but hard evidence proving a causal link has been lacking. 

A new multicentre, prospective, longitudinal cohort study from the USA tried to crack this problem. They recruited children with MS from 11 centres. 

Guest Post: Anoymous Blogger on How Autoimmune B cells can be generated

This was posted in comments

I have added the bits in purple

AnonymousSunday, October 22, 2017 3:07:00 pm

Late Breaking ECTRIMS News. Ibudilast sprints to the lead and shows success in progressive MS

It is time to eat humble pie

Are we on the cusp of a self-monitoring revolution?

Self-monitoring and the socialisation of web-based apps is the revolution waiting to happen in MS care.

Today at ECTRIMS: Barts MS Google Hangout

This afternoon Mouse Doctor and Neuro Doc Gnanapavan broadcast live from the MS Paris ECTRIMS ACTRIMS conference for a one hour Google Hangout. This was your opportunity to listen to the summary of what they've seen but also respond to questions posted by readers of this blog.

Today: The Burning Debate

Join us today for the Burning Debate at ECTRIMS

Cell lysis and anti-trafficking treatments in MS

My first presentation from Paris. A talk on DMTs that target cell trafficking and cell lysis mechanisms. 

ECTRIMS2017 Is Here! What do you want us to report on?

The Programme (UK)/Program (US) is online (CLICK HERE) The abstracts are now live

Come and see us at the Google Hangout 15.45-16.45 Central European Summer Time = GMT + 2 h) with NDG and ProfB your hosts to answer your questions and to report on what's "Hot" and What's "Not"....OK, they won't waste their time, and your time, with the what's not :-).

If you miss the Hangout some of us can be found on the ClinicSpeak and DigestingScience stands. 

Prof G and Barts MS win healthcare awards

The Barts MS team will go to ECTRIMS this week with a spring in our step. On Saturday night, we attended the Zenith Global Healthcare awards and won a Team Recognition award. Not only this, but Professor Giovannoni was awarded with a Lifetime achievement award. 

JCV index in Natalizumabers - does anyone really understand this?

Are you on natalizumab? This paper will be of interest to you. 

MS in the news today

You may have seen this BBC news article today about two pwMS. One of which had a well-planned trip to Switzerland to end his life. After meeting a local woman with MS he appears to have a new outlook and has postponed his trip to Switzerland indefinitely.

(Image is a screen shot of the article on the BBC website)

Programmed Death 1 disappears and leaves EBV to trigger Activity

Now that we know what PD-1 is, it's time to look at this paper

What is programmed death 1?

This is about a protein expressed by the immune system. It is a protein involved in limiting the immune response.

Temperature

Twists and turns in the MS research trails

Tackling progressive MS

Tackling Progressive MS is a priority. ECTRIMS had a meeting on this subject and they have done a special issue on this.

Here's a list of several papers on this subject.

Does MS affect peripheral nerves?

There are few things that all MSologists agree on. 

Perhaps one of the least controversial statements you can make about MS is that it is a disease of the Central Nervous System - i.e. the brain, brainstem, cerebellum, and spinal cord - and that it does not affect the peripheral nerves.

Plus ca change.

Remyelination....a reality

Good news from repair studies! 

A few years ago Jonah Chan and his team developed a neat screening assay to show myelination (making myelin) by myelin-forming cells (oligodendrocytes). 

#ChariotMS - Time for action

The latest news from our #ChariotMS Project

Chariot ms 4_ms-society_feb2018_4_slsh from Klaus Schmierer

For some time we have been talking about this trial which builds on a number of recent insights we feel quite strongly about. They are not only our own insights, of course; others have thought and worked hard too, and this becomes no less evident than by reading the list of collaborators, and their teams, colleagues and respective networks. So let's do it - MS Society, National MS Society, companies, beneficiaries, philanthropists - please read, comment and make it happen. Here's my email: k.schmierer@qmul.ac.uk

CoI: Our research has helped oral cladribine (Mavenclad) to a licence in people with relapsing MS. #ChariotMS will test injectable cladribine, we've used on a compassionate basis in people with progressive MS for the past three years.

Plot thickens: McDonald criteria for MS

Interested in reading about a Catch-22?

Barts MS at ECTRIMS 2017

In just over a week, MS researchers, Nurses and Clinicians will travel to Paris for the annual ECTRIMS conference. This is an important meeting where new research, trial results and treatment information is shared across the community. And we'd like some input from you, our readers!

Being in the Army Can be Bad for your Health

This post contains potentially sensitive reading about mortality.

Depletion of neutrophils after alemtuzumab

Neutrophils are your first line of defence against infection, but they express CD52 and therefore they are depleted by alemtuzumab. This will contribute to infections post treatment, but, whilst common, the level of depletion is rarely severe and long-lasting.  We have commented on this in a previous post, but you can now get a free copy of the paper.

Introducing MouseDoctor3

Hello, and thank you for reading my first post as MouseDoctor3.  Here's a brief introduction so you know my background...