This work is presented at AAN2024 and is part of a BartsMS and chumbs trilogy. A few years ago we made the case that highly-effective disease modifying drugs targeted memory B cells and suggested that rather than being a T (and B) cell depleting agent, it was going to be a B (and T cell) depleting agent. We showed (click to see) this in our cohort of people who had been taking subcutaneous cladribine and this was replicated and extended in a company funded study with oral cladribine who took bloods every 1, 2, 3, 6, and 12 months (click here to see) and 15, 18, 24 (on the way, but Click here t ..read more

This week we have the American Academy of Neurology. In terms of what’s round the corner…there is quite a number of presentations on ozanimod which is a sphingosine-1-phosphate receptor modulator that inhibits lymphocyte migration due to activity on the S1P1 receptor and hopefully supports remyelination due to activity at S1P5 receptor. This is available already in the USA, but at present it is not generally available within the whole of the United Kingdom. Notably it has not been NICEd and I do not think the company was bothered with it being NICEd as the returns were not considered to be wor ..read more

Ocrelizumab 10 years on 10 years of anti-CD20 and it looks good for 75% of people in not developing progression over 48 weeks and this was about 20% better if you started treatment earlier rather than later Hauser et al. 10 Years of Ocrelizumab Treatment in Multiple Sclerosis: Long-term Efficacy and Safety Clinical Trial Data S31.005   Objective:To assess the long-term efficacy and safety of ocrelizumab (OCR) in patients with relapsing and primary progressive multiple sclerosis (pwRMS/pwPPMS). Background:OCR is a highly effective therapy approved for treatment of RMS and PPMS. Unders ..read more

CD27 delivers a survival factor for cells and is a marker of memory B cells but it is also found on T cells and notably activated T cells. This molecule can be shed and measured in biological fluids and here it is examined in the spina fluid of people with MS and it correlates with inflammation, The more T cells the more CD27 is released. Here they link this to the amount of T cell activity within the CNS. Maybe a new marker that can be monitored. However, it won’t be any use to measure in the blood as the CD27 can be coming from anywhere Objective: Soluble CD27 is a promising cerebrospin ..read more

As you may know the United Kingdom voted to leave the European Union and as we have noticed, there have not been a lot of benefits that have emerged yet……Whilst I don’t want to get into arguments on the Pros and Cons of this however, perhaps a positive effect that has resulted from our European Divorce is that  the ability of the UK Medicines Agency to React. This is because the regulators are now, not the European Medicines Agency (making decisions across the many countries in Europe), but the MHRA (Medicines and Healthcare products Regulatory Agency) responsible for UK medicines. Howev ..read more

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This idea comes from one of the readers Cohn EF, Clayton BLL, Madhavan M, Lee KA, Yacoub S, Fedorov Y, Scavuzzo MA, Paul Friedman K, Shafer TJ, Tesar PJ. Pervasive environmental chemicals impair oligodendrocyte development. Nat Neurosci. 2024 Mar 25. doi: 10.1038/s41593-024-01599-2. Exposure to environmental chemicals can impair neurodevelopment, and oligodendrocytes may be particularly vulnerable, as their development extends from gestation into adulthood. However, few environmental chemicals have been assessed for potential risks to oligodendrocytes. Here, using a high-throughput development ..read more

If EBV is the target.for attack and the cause it will be found in everybody. Lehikoinen J, Nurmi K, Ainola M, Clancy J, Nieminen JK, Jansson L, Vauhkonen H, Vaheri A, Smura T, Laakso SM, Eklund KK, Tienari PJ. Epstein-Barr Virus in the Cerebrospinal Fluid and Blood Compartments of Patients With Multiple Sclerosis and Controls. Neurol Neuroimmunol Neuroinflamm. 2024 May;11(3):e200226. doi: 10.1212/NXI.0000000000200226. Epub 2024 Apr 12. PMID: 38608226. Background and objectives: Epstein-Barr virus (EBV) infection is a major risk factor of multiple sclerosis (MS). We examined the presence o ..read more

What’s a Smouldering lesions I don’t normally post on reviews but this is a review that is open access and so if you want to you can have a read…It is about Smouldering lesions. Here they imply they are nothing to do with inflammatory cells. I am not sure I agree with this but worth a read if interested. Calabrese M, Preziosa P, Scalfari A, Colato E, Marastoni D, Absinta M, Battaglini M, De Stefano N, Di Filippo M, Hametner S, Howell OW, Inglese M, Lassmann H, Martin R, Nicholas R, Reynolds R, Rocca MA, Tamanti A, Vercellino M, Villar LM, Filippi M, Magliozzi R. Determinants and Biomarkers of ..read more

Someone’s Special Day Happy Birthday to ProfG to reaching another milestone before doom ..read more