Monday, 25 December 2017

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?

Stürner KH, Stellmann JP, Dörr J, Paul F, Friede T, Schammler S, Reinhardt S, Gellissen S, Weissflog G, Faizy TD, Werz O, Fleischer S, Vaas LAI, Herrmann F, Pless O, Martin R, Heesen C. A standardised frankincense extract reduces disease activity in relapsing-remitting multiple sclerosis (the SABA phase IIa trial).
J Neurol Neurosurg Psychiatry. 2017 Dec 16. pii: jnnp-2017-317101. doi: 10.1136/jnnp-2017-317101. [Epub ahead of print]

OBJECTIVE: To investigate whether oral administration of a standardised frankincense extract (SFE) is safe and reduces disease activity in patients with relapsing-remitting multiple sclerosis (RRMS).
METHODS: We performed an investigator-initiated, bicentric phase IIa, open-label, baseline-to-treatment pilot study with an oral SFE in patients with RRMS (NCT01450124). After a 4-month baseline observation phase, patients were treated for 8 months with an option to extend treatment for up to 36 months. The primary outcome measures were the number and volume of contrast-enhancing lesions (CEL) measured in MRI during the 4-month treatment period compared with the 4-month baseline period. Eighty patients were screened at two centres, 38 patients were included in the trial, 28 completed the 8-month treatment period and 18 of these participated in the extension period.
RESULTS: The SFE significantly reduced the median number of monthly CELs from 1.00 (IQR 0.75-3.38) to 0.50 (IQR 0.00-1.13; difference -0.625, 95% CI -1.25 to -0.50; P<0.0001) at months 5-8. We observed significantly less brain atrophy as assessed by parenchymal brain volume change (P=0.0081). Adverse events were generally mild (57.7%) or moderate (38.6%) and comprised mainly gastrointestinal symptoms and minor infections.  
Mechanistic studies showed a significant increase in regulatory CD4+ T cell markers and a significant decrease in interleukin-17A-producing CD8+ T cells indicating a distinct mechanism of action of the study drug.
INTERPRETATION: The oral SFE was safe, tolerated well and exhibited beneficial effects on RRMS disease activity warranting further investigation in a controlled phase IIb or III trial.
The study looks at the effect of Frankincense in a bicentric trial. Whilst this means it occurred in two places on first sight, I thought it was eccentric.

Anyway the logic is Frankensence contains Boswellic acids that are anti-inflammatory. Incensole acetate and its derivatives, which are major components of Boswellia resin, to be nuclear factor-kappaB inhibitors so they will block cytokine responses. The number of MRI lesions dropped by a half (P<0.001). Brain atrophy slowed.
When they looked T regs were up (Yippie if you follow the fashion or Yawn if you are me) and a decrease in IL-17 (Yawn....only joking but it is funny that dogma has dictated which studies were done...next year they will be looking for memory B cells....Yeah who am I kidding:-).

So it looks interesting and there were more infections which you might expect for an anti-inflammatory. Will they be doing a phase II /III in Germany where this study was done or Oman where the trees grow?
 However, this was a before and after trial. The problem here is that you tend to get recruited to these types of trials when you have been active as you see a neuro and then you get "regression to the mean" meaning that by chance you will get better.  Also to put it in perspective beta interferon reduces MRI lesions against placebo by about 70%, so a 50% drop is not that great compared to over 90% with the highly active agents.

8 comments:

  1. Ok. There's massive breakthrough in treating heart disease. Using a anti inflammatory drug canakinumab. Surely this will be useful in MS? As researchers isn't this something you should investigate.

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    Replies
    1. Maybe but will this anti-IL-1 get into the brain

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  2. Ooops. Maybe not. Enjoy your Christmas dinner.

    http://n.neurology.org/content/88/16_Supplement/P2.384

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  3. "Eccentric" (not) was the word that leapt out at me.

    I love to words repurposed in this way.

    For example I was told a few weeks ago that the blood one morning in my urine was "not frank" and therefore nothing to worry about.

    A Cool Yule for us all, posters and commenters...

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  4. Love this study!
    Simply the best result of this year, looking at the KOLs on the publication list, well powered by brilliant brains...god-like study rank if they had managed to include a placebo-arm...
    I am not worrying about the 50%, inflammation might go to zero after months of treatment, who knows

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  5. I read there are favorable studies of Boswellia serrata for more autoimmunes such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, with no serious side effects.

    "The initial clinical studies suggested that Boswellia serrata resin could be effective in IBD. In 2002, the European Medicines Agency categorized Boswellia serrata gum resin extract in the category of “orphan drugs”. Serrata gum resin extracts could influence the immune system in many ways. Boswellia serrata represses the formation of leukotriene via inhibition of 5-lipoxygenase with the action of two boswellia acids, namely 11-keto-β-boswellic acid and acetyl-11-keto-β-boswellic acid"

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  6. Thankfully Boswellia was used orally, because if it were like incense I would actually be rejecting it.
    Incense, or anything that quenches smoke makes me super sick.

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  7. Still baffled by this study:
    1. ) What about all those MS-patients in the pre-interferon age, roughly +15 years? Being told that there was no treatment for MS, many of them went down pretty quickly. Unbelievable, if the three kings offered a real remedy and not just fragrances.
    2. ) One cannot compare Frankincense to Campath, it is like with the apples and the oranges. Campath is like a nuke and Frankincense more of a diplomatic approach that takes time and continuous effort.

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