CategoryLab Lessons

Vaccine Trumpism for President!

A pneumonia might not sound like something you necessarily want to avoid in life, or not something that ‘coughs’ you awake. However, outcome data on pneumonia in non-hospitalised individuals do indicate it’s not a benign condition. A large study in Germany showed a 30-day mortality of 6.3%. Obviously, this was mainly driven by age (mortality was 2.2% below 65 years old) and nursing home status...

Two, four, six, eight, who do you appreciate?

Barts-MS rose-tinted-odometer: ★ This week I was asked by two patients independently of each other who had delayed access to treatment if this could explain why they now have secondary progressive MS. In parallel, I had a meeting with a friend yesterday, who was the primary driver of the 21-year interferon-beta follow-up survival study (see below), who said that to him this was the most...

The Star-MS trial: to be HSCTed or not

Barts-MS rose-tinted-odometer: ★★★ There is little doubt in my mind that HSCT is the most effective DMT we have for treating MS. The latter is based on NEDA (no evident disease activity) rates post-HSCT and brain volume loss data after year one. HSCT appears to put the majority of treated patients into long-term remission and normalises end-organ damage as measured by brain volume loss. In...

Minimalism in MS: More is Less!

Our eyes are a very promising window into the brain. By looking into the eye with a technique called optical coherence tomography (OCT), we are able to visualise the retina’s ganglion cell layer that consists of naked, unmyelinated neurons. When MS’s inflammatory lightning affects the myelin sheet of the optic nerve (which is the case in 99 % of pwMS), this ultimately leads to dying back of...

The Plasma cell story – how MS begins and ends

In 1875, a famous German scientist; Wilhelm Gottfried Waldeyer Hertz, described an immune cell with a large cytoplasm (the space within the cell aside from the nucleus), he was the first to name it the “plasma cell”. We now know that this large cytoplasm hosts a production line that is solely dedicated to antibody formation (up to 10,000 molecules per second per cell). They account for less than...

“Only your eyes can show the suffering” dixit Fausto Coppi

Once upon a time, there were cyclists as Fausto Coppi. He was the kind of guy that attacked 5 km after the start of the race (Milan San-Remo 1946), and then dropped the rest of the lead group with 14 minutes on the ‘Passo del Turchino’ or ‘who-wins-on-the-Turchino-wins-the-race’. He not only won the Tour de France twice, he did it with a ‘martian’ dominance. In 1949, there was a 14’ difference...

How soon does the shredder begin to shred?

Barts-MS rose-tinted-odometer: zero-★s She was only 26-years and she couldn’t understand why she was falling behind her peers at work. She started working at an ultra-competitive law firm after finishing as one at the top of her peer group at Oxford. She was clearly the best-performing intern in the 2017 intake, which is why she was kept on after her internship. However, things were now...

St Elsewhere

Barts-MS rose-tinted-odometer: zero ★’s St Elsewhere is a euphemism in medicine for a fuck-up done under someone else’s watch, i.e. at St Elsewhere’s hospital. In this week’s NEJM there is a tragic case of a 22-year old Pakistani man who was misdiagnosed as having MS at St Elsewhere, started on natalizumab, which was ineffective, before being switched to interferon beta. By the time he was...

Why does fingolimod affect antibody responses?

Barts-MS rose-tinted-odometer:  ★ The Twittersphere is abuzz with the preliminary seroconversion rates in Israelis patients with MS on various DMTs in response to the Pfizer-BionTech COVID-19 vaccine (see below). As expected the antibody seroconversion rates in response to anti-CD20 therapies and S1P modulators are blunted and in most cases inhibited. The backstory or biology around anti...

Progressive MS is a T cell Problem?

Kaufmann M, Evans H, Schaupp AL, Engler JB, Kaur G, Willing A, Kursawe N, Schubert C, Attfield KE, Fugger L, Friese MA. Identifying CNS-colonizing T cells as potential therapeutic targets to prevent progression of multiple sclerosis. Med (N Y). 2021 Mar 12;2(3):296-312.e8. Multimodal single-cell profiling of blood and spatial RNA sequencing of brain tissueVLA4 blockage mobilizes CD161+/LTB+...

Translate

Categories

Recent Posts

Recent Comments

Archives