CategoryLab Lessons

Taking flak for off-label prescribing

I was still wet behind the ears, in my 3-year as a neurology registrar in Johannesburg, when I first used an off-label DMT in MS. I manage to convince Vivian Fritz, my professor of neurology, to allow us to treat one of her patients with MS with mitoxantrone. This was shortly after the first case series had emerged from Germany. The patient concerned was a young woman with malignant MS who had...

Getting rid of MRI as an outcome measure in trials may be feasible

Blood neurofilament light as a potential endpoint in Phase 2 studies in MS Maria Pia Sormani, Dieter A. Haering, Harald Kropshofer, David Leppert, Uma Kundu, Christian Barro, Ludwig Kappos, Davorka Tomic, Jens Kuhle Objectives To assess whether neurofilament light chain (NfL) could serve as an informative endpoint in Phase 2 studies in patients with relapsing–remitting multiple sclerosis (RRMS)...

What has getting old got to do with MS?

The brain and spinal cord were not necessarily designed by evolution to last longer than approximately 35 years. It is only relatively recently that as a species we have extended our lifespans. Once you go beyond approximately 35 years of age there is a gradual loss of nerve cells, axons and synapses. This explains why as we get older we notice the effects of ageing; reduced vision, loss of...

Going round the guts to get to the brain.

MAdCAM-1-Mediated Intestinal Lymphocyte Homing Is Critical for the Development of Active Experimental Autoimmune Encephalomyelitis. Kuhbandner K, Hammer A, Haase S, Terbrack E, Hoffmann A, Schippers A, Wagner N, Hussain RZ, Miller-Little WA, Koh AY, Stoolman JS, Segal BM, Linker RA, Stüve O. Front Immunol. 2019;10:903 Lymphocyte homing into the intestine is mediated by binding of leukocytes to...

HSV-2 encephalitis with Ocrelizumab

The effect of DMTs on lymphocytes causing lymphopenia (from E Fox et al. Neuol Clin Pract Feb 2019) Why does this not come as a surprise to all and sundry, the report of a potentially harmful infection following immunosuppressive treatment, but this time from the new kid on the block, ocrelizumab (Ocrevus). Not to sound cliched, but if you hadn’t seen this one coming, well then the rest is...

MS, it’s in the Genes

A systems biology approach uncovers cell-specific gene regulatory effects of genetic associations in multiple sclerosis. International Multiple Sclerosis Genetics Consortium. Nat Commun. 2019:10(1):2236. Madireddy L, Patsopoulos NA, Cotsapas C, Bos SD, Beecham A, McCauley J, Kim K, Jia X, Santaniello A, Caillier SJ, Andlauer TFM, Barcellos LF, Berge T, Bernardinelli L, Martinelli-Boneschi...

To deplete or Not to Deplete.That is the Question? Microglia are the good Guys?

Microglia suppress the secondary progression of autoimmune encephalomyelitis.Tanabe S, Saitoh S, Miyajima H, Itokazu T, Yamashita T. Glia. 2019 May 20. doi: 10.1002/glia.23640. [Epub] So all you will remember here is microglia inhibit secondary progression. They are the good guys. Which is funny because we have been saying they are the bad guys. They report Microglia depletion...

AAN 2019 posters #3

All good things unfortunately come to an end, and sadly this is the last in the series of three on AAN 2019 posters. What has captured my attention from this years AAN has been the varied interests of the clinician scientists who have presented their work here. This is a good sign, because without varied interests, science and ultimately progress slowly comes to a standstill. I call it the...

The biggest danger to science is the airbrush

You write a paper and maybe get 5minutes of fame, but sadly with time this may get forgotten and this may get airbrushed out of history. Recently, I have been feeling the paint spray as our work on B cells in MS is being forgotten as the big-swingers wake up and tell us all that memory B cells are important, but that gripe is for another day. Today hopefully you are arriving here by following the...

The Natalizumab #AttackMS Trial

We propose the very early use of natalizumab to maximise outcomes in people with very early relapsing MS. In the European Union, natalizumab is licensed to treat adults with highly active relapsing-remitting multiple sclerosis for the following patient groups: Patients with highly active disease despite a full and adequate course of treatment with at least one disease-modifying therapy (DMT) or...

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