CategoryLab Lessons

EBV infects T-cells

Why are experts important? In the so-called post-truth era experts are derided and ignored. Not at Barts-MS. Last Friday we held a lock-in to review and discuss our EBV research programme and bring in expertise from outside our group. We were fortunate to have card-carrying EBV experts, oncologists, B-cell biologists and protein and antibody experts around the table. A central plank of the EBV...

Brain Atrophy

ProfG has been addressing the issue of brain shrinkage and asking-Which agents are the best? We may not all agree on what is the best, but one can ask what is/are the worse. If we can address this problem and agree, then surely it is time to say “It’s rubbish! Throw it in the Bin!” (A comment I once heard at an MS Life meeting) The obvious answer is……yep you guessed...

Prof G how much brain have I lost this year?

How soon will MSers have brain volume measurements as part of their annual assessments? As a reader of this blog, you may be aware that ‘life is a sexually-transmitted age-dependent terminal neurodegenerative disease’. Homo sapiens, as a species, is pushing its biological capabilities to its limits. We have conquered most diseases that used to cull us before our mid-thirties and the end of our...

Blocking Calcium, Should we listen to mouse studies or plough on regardless

Calcium Influx through Plasma-Membrane Nanoruptures Drives Axon Degeneration in a Model of Multiple Sclerosis. Witte ME, Schumacher AM, Mahler CF, Bewersdorf JP, Lehmitz J, Scheiter A, Sánchez P, Williams PR, Griesbeck O, Naumann R, Misgeld T, Kerschensteiner M. Neuron. 2019 Jan 6. pii: S0896-6273(18)31123-1. Axon loss determines persistent disability in multiple sclerosis patients...

How big is your lesion

MRI has revolutionised the assessment of MS. If you have a lesion on MRI what does it mean? Evidence for a white matter lesion size threshold to support the diagnosis of relapsing remitting multiple sclerosis. Grahl S1, Pongratz V1, Schmidt P1, Engl C1, Bussas M1, Radetz A2, Gonzalez-Escamilla G2, Groppa S3, Zipp F3, Lukas C4, Kirschke J5, Zimmer C5, Hoshi M6, Berthele A6, Hemmer B7, Mühlau...

Beyond the B-cell

Do we have the right cell target in MS? Yes and no; we need a multicellular approach. Recently the attention in MS has been on the B-cell as if it was the holy grail of MS treatments. It is not. In several posts, over the last few weeks, I have made the case that the B-cell is important, probably as an antigen presenting cell, but it is not the ‘be all and end all’ of MS treatments. It is clear...

Microbiome Research Where will it lead us?

ProfG loves throwing a spanner in the works to get you thinking and keeping us on our toes. However, I have been charstisted for my outspoken views that many of my peers are unthinking lemmings that follow the masses jumping off the intellectual cliff. Microbiome is the answer to autoimmunity is a current dogma and you are spending millions of pounds doing trial after trial in every human disease...

NEDADI or ‘Nee Daddy’ another treatment target beyond NEDA

Prof G do you think disability improvement is a reasonable treatment goal? NEDADI = no evident disease activity and disability improvement Two weeks ago one of my patients with PPMS, who we treated with off-label subcutaneous cladribine, came for her annual follow-up appointment. Despite being treated with cladribine over 2 years ago she has unfortunately progressed from EDSS 5.5 to 6.5. Her...

Not All Data is Created Equal. Brain Atrophy

ProfG has put an interesting question about whether DMT are all born equal. Whilst the influence on relapse rates is much clearer in terms of the hierarchy, the effects on brain atrophy has led ProfG to ask a sensible question. It was suggested that HSCT and alemtuzumab are up there at the top of the pile in the atrophy states, leaving the B cell therapies in their wake. B cell therapies are...

The Learner

Do we need to include cognition as a treatment target in multiple sclerosis? In every clinic, I do patients with MS complain of cognitive symptoms. Either it is increasing forgetfulness, difficult multi-tasking, the inability to learn and use a new technology or cognitive fatigue. Case study: One of my high functioning patients, who worked in a large City law firm, simply could not keep up and...

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