The idea of MS-SMART trials was started many years ago and the drug candidates were selected based on evidence in MS, some evidence in EAE (Which was all largely irrelevant because EAE studies are not done in a way that they are very informative about protection) and evidence from other conditions. We even tested some candidates in EAE for this approach. They were not found to be very good. This was all done systematically.
One candidate was Ibudilast and this was selected but it turns out that a study is doing this in the USA. (Two studies on the same drug, well it was not possible for technical reasons and so next they come up with Fluoxetine (commonly known as Prozac), which is a selective serotonin re-uptake inhibitor. So it is of interesting that FLUOX-PMS is now ongoing in primary and secondary progressive MS in the homes of people in Netherland and Belgium
Serotonin is removed from the space around cells by a transporter system that sucks it up into cells. So it can bind to serotonin (5-HT) receptors. This can reduce depression. How does increasing serotonin affect progression, well I’m not sure there is some EAE data showing an immunomodulating effect, but as I think that such an effect is irrelevant to control of progression we need some more ideas. Some people think that SSRI may affect astrocyte function,that may affect sodium-dependent glutamate uptake by astrocytes, and the release of lactate, which serves as energy source for axons Fluoxetine also stimulates the release of the neuroprotective brain-derived neurotrophic factor (BDNF) from astrocytes, and may improve cerebral blood flow by dilating cerebral arterioles independent of the endothelium.
Maybe if you are not depressed then you are less stressed and this slows things down.
If you have SPMS and live in the UK, please seriously consider signing up to MS SMART (CLICK), not all sites may be active yet, but it is coming.
Will it work? I have my thoughts, but I don’t really know. P.S. please do not ask for my thoughts as a penny or a few pounds is not going to let me part with them
Innovation is the future and we have to be prepared to fail otherwise change will never happen.
CoI: This is nothing to do with me…but I would be very happy if you volunteer to take a drug that may (I won’t guarantee it) do you some good.