ArchiveJune 2022

Benign verses active disease shows brain shrinkage

Your thalamus is your body’s information relay station. All information from the body’s senses (except smell) must be processed through your thalamus before being sent to the brain’s cerebral cortex (front bit) for interpretation. The thalamus also plays a role in sleep, wakefulness, consciousness, learning and memory. Shrinkage of the thalamus sems to be a common feature of...

Which iMod

There are four different S1P receptor modulators available and they include fingolimod, siponimod, ozanimod and ponesimod but how are they used. In the USA it is simple any of the agents can be used. The labels of the FDA say “ XXXXXX (insert any of the above drugs) “is a sphingosine 1-phosphate receptor modulator indicated for the treatment of relapsing forms of multiple sclerosis...

Understanding the biology of paramagnetic rims in Multiple Sclerosis

Some of you may have not yet heard about paramagnetic rims in MS lesions. Their presence on MRI scans is felt to represent iron rich microglial inflammation in the brain occurring in a subset of individuals. Pathologically iron rims reflect slowly expanding chronically active MS lesions (see below). Figure: Paramagnetic lesion arrowed in (a) in a 34 y with RRMS. [Source-this article] The presence...

How does alemtuzumab work

We have made the case that many agents work because they target B cells, but the prevailing”immunologist” view is that augmentation of T regulatory cells is the key. This in part because following depletion there is a relative balance shift that causes more depletion of the CD4 T cells. Therefore there is a relative increase in the T reg to CD4 ratio. However if you look at the...

Watch out for Space Travel

Every now and then we get an unusual paper that draws me like a magnet. If you have a few million squid to blow….you may be considering lining the pockets of Elon Musk or Sir Richard Branson for a trip into space….but as you go weight-less, I guess you are pondering what does space do to your oligodendrocytes….Fear not someone has been looking at this….and you can read it...

EBV vaccines in Animals

For many years the MS community has been extremely sceptical about the importance of EBV in the cause of multiple sclerosis, but following a couple of papers last year (one compelling, the other not really) and the MS World woke up to stuff prof G has been banging on about for years. Moderna who have made a COVID-19 vaccine have an EBV vaccine in trial. Here they look at another vaccine that is...

There is more to SPMS than active inflammation

ASCEND is a clinical trial of natalizumab in secondary progressive MS and based on looking at EDSS (a walking scale at the point tested) the trial failed and natalizumab was, in the eyes of many neuros, chucked on the maggot pile as far as treating progressive MS has been concerned. However, this view has been challenged based on response to changes in hand function and in relation to effects on...

It’s Not Cancer? Phew, That’s OK Then. 

By Dominic Shadbolt (theMSguide.com)  This is a follow-up to an article recently published on the MS Research Blog that you can read here. Like much of life, people like the simple binary explanations. A is bad and B is good. Multiple Sclerosis has been tarred by this need for simplification. Cancer kills, MS doesn’t is the rough equivalent. Now the requirement for understanding the...

Thyroid problems post alemtuzumab in MS, the endocrinologists take on this

Thyroid dysfunction is the commonest treatment related side effect after alemtuzumab. Alemtuzumab targets CD52 on the surface of T and B cells taking them out of circulation. The precursor cells to the adult T and B cells are left intact because of their lack of the CD52 surface marker. After cell depletion, which occurs very quickly there is then a period of immune reconstitution resulting in...

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