CategoryLab Lessons

Zipping the DMT pyramid: What’s your sNfL Z-score? 

Neurofilament light (NfL) levels are a promising biomarker of disease activity in MS. These brain proteins are released into the cerebrospinal fluid when neurons die and they tell us when MS-related focal inflammation is still damaging the brain or spinal cord. The biggest advantage of NfL over other techniques to measure brain volume loss such as brain MRI is that they can be measured in the...

Pathologists should play more cluedo:-)

Cluedo is a game where someone gets killed and you have to work out who is the perp, the weapon and the place where the attack took place. Pathology is like murder case (Hopefully this will launch when we were on blogger this word triggered the post to become for 18 year olds) and you are left with the crime scene. You have to work out who dunnit. So you find John Doe in a pristine bedroom. What...

Th17 are a menace and must be stopped?

Eksin MA et al. Secukinumab in the treatment of psoriatic arthritis or ankylosing spondyloarthritis with multiple sclerosis: a case series with literature review. Immunotherapy. 2022. doi:10.2217/imt-2021-0128 Plain language summary Background/aim: Multiple sclerosis (MS) is a central nervous system disorder, with rare cases reported to have associated spondyloarthritis (SpA) spectrum...

Mass Cytometry finds B memory cells in MS spinal fluid

Flow cytometry occurs when cells are put through a “machine that goes ping” in fact it is a machine that makes cells pass through a laser and the scatter of the laser light is detected and converted into an image. The cells can be labeled with antibodies. It is one colour per antibody. Historically you would do one or two colours but the latest machines can pick up about 15-20 colours...

Understanding cladribine

Recently it has been sugested that Paxlovid (COVID-19 anti-viral) and Cladribine shouldn’t mix. The question is why? This is because cladribine does not influence the cytochrome P450 degradation enzymes which are thought to increase the levels of some drugs if given with paxlovid. It seems the answer may be because it is a substrate for the Breast Cancer Resistance Protein also known as...

The case for extended interval dosing and over-dosing of CD20 depleting antibodies.

Someone said that my last long-post was not an “Easy read”. I suggested that in the Post-G era, I could’nt be bothered with ProfG-invented categories after all, what is “Thought-4-the-day” and “clinicspeak”? However, if you feel it helps ,I will continue to report the reading level from easy to super scientific Clinical trials are important human...

Is neurofilament a good biomarker of neuroprotection in MS?

Truism, numbers don’t lie, especially in science. Crystallographic calculations gave us the answer to our genetic construct, whilst, the observation of fixed stars from different locations gave us measurements on the Earths curvature. So, why is it that a clinical trial that has previously demonstrated a reduction in brain volume loss doesn’t now similarly show an effect on...

Sipping siponimod and other SIPs

Go grab a cup of tea There are a group of drugs used in MS called Sphingosine-1-phosphate receptor modulators. These are known as “the imods”. Here, mod means modulator” and “i” means immune so the immune modulators have been shortened to “imod”. Some people get paid a load of cash to come up with drug names and they have come up with interesting ones...

What influences if your CSF Neurofilament comes down?

Many of you will have now heard about neurofilament light chain (NfL) measurements. You may even have a record of your last reading. A large bulk of the published literature on NfL now is on blood NfL, because it is easier to obtain (less invasive) allowing you to carry out large scale analyses. However, sampling the CSF has the added advantage that it is close to the brain and is therefore...

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