TagB cells

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...

Beyond NEDA

Prof G are we being lulled into a false sense of security by being told that we have no evident disease activity (NEDA)? A patient of mine, who I have been looking after now for over 11 years, asked me in clinic a few weeks ago why despite being NEDA for 6 years, on a highly effective maintenance DMT (fingolimod), has she gone from being able to run 5-10 km to needing a stick and barely managing...

To T or not to T (2)

Prof G what happens to MS disease activity if you stimulate T-cells? About 2 years ago I attended a grand round during which a patient with a history of RRMS had had a catastrophic relapse after receiving ipilimumab for metastatic melanoma. The patient has a massive brain stem relapse and her MRI showed multiple Gd-enhancing lesions with several pseudotumoral lesions. She was in a bad way...

To T or not to T

I have always wondered why the genomic experts in the field of MS haven’t been able to sort out why specific human leukocyte antigen (HLA) subtypes increase your risk of getting MS and others don’t. HLA or human leukocyte antigens are the so-called signposting proteins that antigen presenting cells (APCs) use to communicate with T-cells. The APCs continuously sample the environment...

To B or not to B

Is targeting the B-cell sufficient to get on top of MS or do we need something extra? I spoke at the MS Nurses’ MS@TheLimits2019 meeting at the Royal College of Physicians yesterday. My brief was to cover the role of B-cells in the pathogenesis of MS and to review the converging evidence that supports B-cells being the central player in the pathogenesis of MS. It is clear that depleting B...

DMF inhibiting B cells numbers

  Times are a changing folks.  Not a year ago the same type of phenotpying data was reported in the blood of people treated with DMF.  The focus has now changed, guess where. B-cell composition in the blood and cerebrospinal fluid of multiple sclerosis patients treated with dimethyl fumarate. Høglund RA, Polak J, Vartdal F, Holmøy T, Lossius A. Mult Scler Relat Disord. 2018 Sep 6;26:90-95...

Memory B cells are there to help CD4 T cells

Memory B Cells present antigen to CD4 T cells in multiple sclerosis, so T cells are on top of the pile and B cells are there to help the baddie T cells. Therefore, the status quo is maintained and everything is super. However, has the latest autoantigen in MS been found? Memory B Cells Activate Brain-Homing, Autoreactive CD4+ T Cells in Multiple Sclerosis. Jelcic I , Al Nimer F , Wang J ...

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