Thoughts from the beach on ‘Our Big Challenges’

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Apologies, no reliable internet access today.

As the new academic year is about to begin we have to set our research and teaching priorities for the year.

From a research perspective we will continue to work on symptomatic therapies, mainly spasticity, and neuroprotectivte strategies for progressive MS. The most exciting and pressing challenge is to get funding to test an anti-EBV drug in RRMS using a classic phase 2 trial design with MRI as the main outcome. Our first grant was rejected, but we are wiser and more prepared for our second attempt.

We will have to go back for funding to use CSF neurofilament levels as an outcome fir progressive MS trials. Although the grant application was rejected the reviews were positive and there is room for improvement. We will ask you to help with a survey; we need to show the funding bodies that people with progressive MS are prepared to have 3 lumbar punctures as part of a clinical trial. The feedback from our previous posting suggested yes.

We will continue to work on EBV, vitamin D and smoking and how they interact with genetic and epigenetic factors. This work is critical for putting forward a convincing argument that MS is preventable. I was dissappointed that prevention was ranked so low in our last survey. Maybe the arguments we have been making on the blog are not convincing enough.

Despite the wrath of the wrath of the CCSVI’ers, we will continue to report on CCSVI. However, it is looking increasingly likely that CCSVI will disappear from the radar as independent studies start to report their results.

Teaching people about MS remains as important as ever. We will continue with the blog and hopefully improve it with more posts designed for teaching rather than simply comunicating and interpreting research findings. How about ‘Espresso MS Facts’? Do you think there is a need for a weekly or monthly video blog on a specific topic?

We are partnering with shift.ms to report research results in a more quirky and relevant way. We must thank the Wellcome Trust for their generous grant that has made this possible.

Finally, we will continue to do commercial MS trials, this is part of our commitment to improving the lives of MS’ers at least in the short term. The combined ECTRIMS and ACTRIMS, meeting in Amsterdam, promises to be an exciting meeting with several phase 3 trials reporting results (Alemtuzumab, BG12, Laquinimod, Daclizumab, etc) so prepare for a data feast in October.

Signing off from a sunny Greek beach.

Prof. Gavin Giovannoni
Barts and The London
Sent from Samsung tablet

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

10 comments

  • Glad you're enjoying your hols 🙂 Two points:

    – I welcome your Research blog as MS 'info' is already widely available on the web, though any further info you blog on is to be welcomed

    – I think the reason prevention was low on the survey may be because if you can reverse damage already done, then it means that there will be help for you if you do get MS. I hope you understand what I mean.

  • RE “However, it is looking increasingly likely that CCSVI will disappear from the radar as all the independent studies start to report their results.”

    Really….This latest small study from Buffalo found balloon angioplasty treatment lead to reduced relapses and fewer brain lesions:

    “A small study of 15 patients with multiple sclerosis suggests those who get balloon angioplasty treatment earlier have fewer disease relapses, and may have decreased brain volume that could indicate a lessening of inflammation in their brains.

    The results were published Friday (12-08-2011) in the European journal of Vascular Endovascular surgery.

    All 15 patients had the relapsing-remitting form of MS, and all were found to have abnormal blood drainage from their brains — a condition known as Chronic Cerebrospinal Venous Insufficiency (CCSVI).

    They were divided into two groups. Eight patients were given immediate balloon angioplasty to open blocked veins. Seven others did not receive the treatment for six months. All remained on their medications.

    After one year, researchers found that the patients who were treated first had fewer lapses. Two of the eight patients in the immediate-treatment group had relapses over the one-year study. In the delayed-treatment group, five of the seven patients had relapses.

    MRI scans also showed that patients had fewer brain lesions over the first six months, with a 10 per cent drop in the early treatment group compared to a 23 per cent increase in those treated later.

    The other change was a decrease in brain volume in the early treatment group, which may be due to decreased inflammation, or a normalization of blood flow in the brain, Dr. Zivadinov said. There were no complications from the procedure. However, researchers did find that 27 per cent of the patients saw their veins re-narrow during the one-year study.”

  • Prevention ranked low for selfish reasons. If you had asked us to rank research areas, I would have put prevention at number 2. Since we could pick only one, it had to be Curing MS.

  • Re "Buffalo …."

    Dr Zivadinov and the Buffalo group are not independent; they work closely with Zamboni et al.

  • RE Independent:

    So by 'independent' I guess you mean trials done by neurologists whose lifestyles are greatly enhanced with cash from the pharma industry. Laughable.

    This is a published trial which can be challenged with legitimate enquiry. What is your issue with the way it was conducted or is this just another baseless smear on your part?

  • Prof G, in the past you have been quite happy to quote Dr Zivadinov's studies. For example, when he said his results on an earlier trial point towards CCSVI not causing MS. I guess he is only biased when he doesn't agree with your point of view.

  • Re: "So by 'independent' I guess you mean trials done by neurologists whose lifestyles are greatly enhanced with cash from the pharma industry."

    No; by independent I mean not done in collaboration with Zamboni, who described CCSVI.

    I am not aware of any pharma sponsored CCSVI trials, although the device companies who make stents may be interested.

  • Re: "In terms of measuring damage to nerves, have the Australians beaten you to the neurofilamnet approach?"

    No, not at all. This is the same protein we measure. Unfortunately, measuring it in the blood is not as sensitive as measuring it in the spinal fluid.

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