Monday, 1 January 2018

Happy New Year Q&A Jan 2018

Happy New Year!



For those who want to say something unrelated to the posts this the place for you.


So whilst ProfG prepares a year that was, it is a two-way street 




This is a message I came across this Christmas from Lucy Woods,  she was 5 years old when she was diagnosed with MS. So as the year turns a message to us.

43 comments:

  1. 2 year study suggests treatment with Gilenya (fingolimod) may limit cerebral gray matter atrophy in relapsing-remitting multiple sclerosis (RRMS) patients

    Assessing brain atrophy by measuring cerebral gray matter has gained particular interest in MS for several reasons. First, the volume of gray matter is less susceptible to external factors such as inflammation; second, gray matter atrophy may precede the onset of MS symptoms, and third, it may help predict some MS clinical disabilities.

    http://www.sciencedirect.com/science/article/pii/S0022510X17343848

    ReplyDelete
  2. Has Prof G abandoned the blog? He hasn't written anything for weeks. Why is he publishing on another site? His new article on high-fat diets should be published on the Barts-MS blog.

    https://medium.com/@gavin_24211/evolutionary-medicine-why-low-fat-diets-are-bad-for-you-95922f2f1999

    ReplyDelete
    Replies
    1. Radio silence will be broken shortly, you'll be glad to know ;-)

      Delete
    2. I have been on holiday; actually a much needed holiday. We are trying not to overload you with too many posts. We also suspect readers are getting bored of hearing the same-old, same-old, stuff. Our aim is to spread things around a bit with other bloggers using the Barts-MS platform. This is why we want potential guest posters to contact us (bartsmsblog@gmail.com).

      I am still experimenting using Medium as a platform. I have bought into Evan Williams' philospophy about how Social Media should evolve. I am one of many who is trying to help keep good quality publishing alive.

      Thanks for the read.

      Delete
  3. Hi quick question alemtuzumab. In some patients if their white counts is 0 at day1 after treatment, Then 0.2 at month 1. 1.2 at month 2. 0.8 at month 3. How can the count go down if the drug alemtuzumab has left the body at month 2? If it's not the effect of the drug then what else can cause the count to go down?

    ReplyDelete
    Replies
    1. The lab tests are highly variable and at month 2 there may have been another stimulus increasing the counts that was not present at month 3; for example an infection.

      Delete
  4. Thanks Dr Gavin. Welcome back from your holidays

    ReplyDelete
  5. Hi I was wondering if the 'stand up wheelchairs' would be really helpful for some pwMS and help their independence? I can imagine they would be.
    Any thoughts?

    ReplyDelete
  6. "We also suspect readers are getting bored of hearing the same-old, same-old, stuff"

    ... ineffective, extortionate DMDs.

    ReplyDelete
    Replies
    1. I agree "bearms" with a very stagnant MS research world. Many MSers have become very disenchanted with the current disgustingly expensive, partially efficacious neuroinflammatory treatment model only, particularly in progressive MS patients. I do not feel optimistic about our future unless your MS is caught immediately right now and even then the NEDA is less than 50% with all current DMDs (excluding HSCT in early highly active MSers or disease < 10 years)

      However, I think sometimes we misplace our anger at the researchers at Barts MS for this miserable disease and that is not right either. I do believe that they are trying to help and appreciate learning online from them.

      Delete
    2. MD, do you think that everyone going on a DMD, like Ocrevus, should be tested for JCV status prior to initiating?

      Delete
    3. Do you get involved with MS research, as a person with MS?

      I do and it helps me feel I'm involved and contributing to MS research, I feel more positive about the future. I don't just mean being a participant on a MS drug trial. There are opportunities to be involved.

      Delete
    4. Should everyone be tested for JCV.

      I would like to know but I know it is not tested for everyone

      Delete
  7. Researchers at GlaxoSmithKline (GSK) have identified the histamine receptor 3 (H3R) as a potential new therapeutic target for promoting remyelination in patients with multiple sclerosis (MS).

    Histamine Receptor 3 negatively regulates oligodendrocyte differentiation and remyelination

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189380

    ReplyDelete
    Replies
    1. MD has already posted on this work

      http://multiple-sclerosis-research.blogspot.com/2017/12/remyelination-studies-publishing-data.html

      Looks like it is has gone nowhere

      Delete
  8. Hi. Has there been a policy shift on Alemtuzumab that 2nd dose is no longer guaranteed if there a been no response to the 1st I've been told by my nhs care provider. My 2nd round of Alemtuzumab will depend on my Mri after 6 months of the first dose

    ReplyDelete
    Replies
    1. Sorry just realised. Wasn't trying to pit one his trust against another. Let rephrase my question. Is it okay to switch therapies. After just one dose of Alemtuzumab?

      Delete
    2. Don't see why not, particularly if there is no response.

      Delete
    3. Thanks MD2. Hopefully by then ocrelizumab be available on NHS.

      Delete
  9. https://medicalxpress.com/news/2018-01-multiple-sclerosischolesterol-crystals-regeneration-central.html

    dysfunctional cholesterol transort and clearance following oligodendrocyte cell death leads to the inflammatory environment in MS lesions.

    ReplyDelete
  10. The "Black swan " still alive and kicking..... :)

    Relationship of human herpes virus 6 and multiple sclerosis: A systematic review and meta-analysis

    http://onlinelibrary.wiley.com/doi/10.1002/jcp.26000/abstract

    Obrigado

    ReplyDelete
  11. I think Luis had mentioned it at the comment section somewhere, so I will try to ask again:
    Is there a way to predict a relapse through B cell blood levels? (I am not referring to monitor the response to anti cd20 therapies). I think its mostly used to NMO patients.
    Thanks.

    ReplyDelete
    Replies
    1. You can certainly have a relapse with few B cells in the blood and we have yet to see the results for MS but Kim et al has been using CD27 memory B cell levels to determine retreat mentioned of NMO and has certainly reduced the relapse rate and it also helps reduce the number of rituximab infusions.The Five year data has been published in 2013 and the ten year data was presented at ECTRIMS 2017.

      Delete
    2. Good question

      As you know i had had hsct 1/5 months ago, and i am doing cbc´s and cmv and ebv blood screening every 15 days (hoppefully they are still negative)
      So last time i was with the neuro doc i ask to do also cd3 cell populations and cd 19 and cd27 cell populations to

      (base line from 2 months ago where whitin normal values)

      I ask neuro doc that same question about Nmo and cd19 and cd 27 screening

      He said that since in Nmo you have antibodies against

      auquaporin chanels ,you have to screen the b cell that

      produce those antibodies and keep them in a tight range .

      In neuro doc words ,since Nmo is a very dangerous disease he

      likes to see b cell total in the first year in 0.05 and then as a maintenance therapy no more than 0.1

      Eyestarday in went to do cd19 cd 27 hoppefully tomorrow i will have the results

      Hope that helps :)

      Obrigado

      Luis

      Delete
    3. I agree screening for aquaporin 4 specific B cells would be good but I am not sure this is done yet.

      Also not all NMO is aquaporin 4.

      Delete
  12. One more for the black swan :)

    Comparative Effectiveness of Rituximab and Other Initial Treatment Choices for Multiple Sclerosis

    This observational study of patients with newly diagnosed RRMS who are new to treatment demonstrates that patients receiving RTX displayed a significantly better drug survival compared with all DMT included in the analysis and a lower risk of switching because of disease breakthrough compared with platform DMT.

    https://jamanetwork.com/journals/jamaneurology/fullarticle/2668462

    Obrigado

    ReplyDelete
  13. "Final results of the study are expected in the second quarter of 2019."

    Disease burns like fire..science/medical research is like ice age.

    https://multiplesclerosisnewstoday.com/2018/01/08/board-allows-ab-science-to-continue-phase-3-progressive-ms-trial-without-more-patients/

    ReplyDelete
  14. Replies
    1. Very impressive, more ammunition for the B cell camp!
      Full paper here (free to view) for those interested.
      https://jamanetwork.com/journals/jamaneurology/fullarticle/2668462

      Delete
    2. As expected! Would that mean anything for RTX in other countries? Will EMA take it into account? Thats the question.

      Delete
    3. Post on this latest study to come asap!!!!!!

      Delete
  15. I see that Prof G is now posting research articles on his Twitter account (he seems to have ditched this blog IE no clinic posts). The posts on this blog have reduced in number and quality. Is it time to close the blog down. After almost 10 years the message has got through (treat early and hard) and we are now aware of the importance of brain health. Thanks for all your efforts.

    ReplyDelete
    Replies
    1. "After almost 10 years the message has got through (treat early and hard)"................
      Sadly, I think there is much more to be done before we can say this is widely accepted so IMO there's life in the old blog yet ;-)

      Delete
  16. Eu gives full backing to Ocrelizumab. How long now before nice gives backing? And clears the cupboard of ineffective injectibles. In my Opinion. Only the following drugs should be used RRMS. Ocrelizumab, Alemtuzumab, Natlizumab, Caldribine, Tecfidera. Period. Oh yeah daclizumab.

    ReplyDelete
  17. An innovative PET tracer can measure damage from multiple sclerosis in mouse models

    In the January 12, 2017 online issue of the journal Scientific Reports, a multi-institutional team based primarily at the University of Chicago Medicine and the National Institutes of Health, describe early tests of a novel minimally-invasive way to assess myelin damage using positron emission tomography (PET).

    These PET scans use a radioactive molecule designed to target voltage-gated potassium channels, a protein found on demyelinated axons. The PET images, based on the detection of this molecule, provide quantitative information about underlying biochemical processes. A PET tracer that can target potassium channels.

    https://medicalxpress.com/news/2018-01-pet-tracer-multiple-sclerosis-mouse.html

    ReplyDelete
    Replies
    1. Yes interesting.

      If we can truly image demyelination
      then remyelination trials get a massive boost.

      It works on principle of targeting potassium channels that are not normally exposed unless there is no myelin.

      One confusion is the colouring. The areas of high myelin code green in the pet images compared to staining but based on the scale red is more intense than green so why are areas of lower myelin coloured red?

      I wonder if the fact that the label accumulates in the kidney will be of concern to use in humans. I don't know enough about PET

      Delete
  18. Ocrelizumab (Ocrevus) gets European licence for relapsing and primary progressive MS

    The European Commission has granted marketing authorization for ocrelizumab (Ocrevus) for the treatment of both active relapsing MS and early active primary progressive multiple sclerosis. This follows a recommendation from the European Medicines Agency in November that a licence should be granted.

    Active relapsing MS means people who are having relapses or showing new lesions on MRI scans
    Early primary progressive MS is defined as people who have had symptoms of MS for 15 years or less, have an EDSS of 3.0 to 6.5 and evidence of MS activity on MRI scans

    https://www.mstrust.org.uk/news/news-about-ms/ocrelizumab-ocrevus-gets-european-licence-relapsing-and-primary-progressive-ms

    ReplyDelete
  19. Any updates pertaining to the PROXIMUS trial? Enquiring minds wanna know....

    ReplyDelete
  20. Brain repair

    https://www.youtube.com/watch?v=6d6oq0zGGmw

    Autologous Adult Cortical Cell Transplantation Enhances Functional Recovery Following Unilateral Lesion of Motor Cortex in Primates: A Pilot Study

    https://academic.oup.com/neurosurgery/article-abstract/68/5/1405/2607670?redirectedFrom=fulltext


    Can this be use in humans with ms ?

    From 2011 till now ,nobody cares?

    obrigado

    Ps: 2 Kgs of papers work :(

    ReplyDelete
    Replies
    1. I don't know but moving this type of technology into humans is not simple

      Delete

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