Multiple sclerosis New Drugs Review
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Frontiers | Alemtuzumab Improves Cognitive Processing Speed in Active Multiple Sclerosis—A Longitudinal Observational Study | Neurology

Frontiers | Alemtuzumab Improves Cognitive Processing Speed in Active Multiple Sclerosis—A Longitudinal Observational Study | Neurology | Multiple sclerosis New Drugs Review | Scoop.it
Background: Several disease modifying drugs (DMDs) have shown promising effects on cognitive impairment in multiple sclerosis (MS). Alemtuzumab, a humanized monoclonal antibody, is effective in controlling disease activity, however has not been evaluated for its effects on cognition in detail so far. Objective: To explore the influence of alemtuzumab on cognitive impairment in active relapsing-remitting MS (RRMS) as well as possible clinical and neuroimaging predictors of cognitive changes during the first year of therapy. Methods: Extensive neuropsychological assessment was administered to 21 patients with active RRMS at baseline and again after the second treatment with alemtuzumab (mean time span: 15.05 months). Clinical and routine structural neuroimaging markers were explored for their capacity to predict individual courses of cognitive change. Results: Overall cognitive functioning remained stable or improved during the observational period of alemtuzumab treatment on average. Scores on two neuropsychological tests of processing speed significantly improved and clinically relevant individual gains of processing speed were seen in the majority of patients. Linear regression models showed that clinical and routine neuromimaging measures of disease activity could not fully account for these cognitive changes. Conclusions: Results suggest that alemtuzumab treatment in active RRMS stabilizes overall cognitive functioning and furthermore positively affects cognitive processing speed. Changes in processing speed were independent from clinical and structural neuroimaging parameters of disease activity and may thus represent an underrated and independent outcome measure to evaluate treatment effects.
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Daclizumab (Biogen, Abbott) Review: Multiple sclerosis - Krishan Maggon

Daclizumab (Biogen, Abbott) Review: Multiple sclerosis - Krishan Maggon | Multiple sclerosis New Drugs Review | Scoop.it
Daclizumab is a humanized monoclonal antibody which targets the CD25 alpha subunit of the high affinity receptor and inhibits...
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Nutrients | Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic

Nutrients | Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic | Multiple sclerosis New Drugs Review | Scoop.it
Abstract
The precise etiology of multiple sclerosis (MS) is unknown but epidemiologic evidence suggests this immune-mediated, neurodegenerative condition is the result of a complex interaction between genes and lifetime environmental exposures. Diet choices are modifiable environmental factors that may influence MS disease activity. Two diets promoted for MS, low saturated fat Swank and modified Paleolithic Wahls Elimination (WahlsElim), are currently being investigated for their effect on MS-related fatigue and quality of life (NCT02914964). Dr. Swank theorized restriction of saturated fat would reduce vascular dysfunction in the central nervous system (CNS). Dr. Wahls initially theorized that detailed guidance to increase intake of specific foodstuffs would facilitate increased intake of nutrients key to neuronal health (Wahls™ diet). Dr. Wahls further theorized restriction of lectins would reduce intestinal permeability and CNS inflammation (WahlsElim version). The purpose of this paper is to review the published research of the low saturated fat (Swank) and the modified Paleolithic (Wahls™) diets and the rationale for the structure of the Swank diet and low lectin version of the Wahls™ diet (WahlsElim) being investigated in the clinical trial.
Keywords: low saturated fat diet; Paleolithic diet; multiple sclerosis; modified Paleolithic diet; Swank diet; Wahls diet; Wahls Elimination diet
This is an open access article distributed under the Creative Commons Attribution License
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Gut microbiota-dependent CCR9+CD4+ T cells are altered in secondary progressive multiple sclerosis | Brain | Oxford Academic

Gut microbiota-dependent CCR9+CD4+ T cells are altered in secondary progressive multiple sclerosis | Brain | Oxford Academic | Multiple sclerosis New Drugs Review | Scoop.it
Abstract
The mechanism underlying the progression of relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis (SPMS), characterized by accumulating fixed disability, is yet to be fully understood. Although alterations in the gut microbiota have recently been highlighted in multiple sclerosis pathogenesis, the mechanism linking the altered gut environment with the remote CNS pathology remains unclear. Here, we analyse human CD4+ memory T cells expressing the gut-homing chemokine receptor CCR9 and found a reduced frequency of CCR9+ memory T cells in the peripheral blood of patients with SPMS relative to healthy controls. The reduction in the proportion of CCR9+ cells among CD4+ memory T cells (%CCR9) in SPMS did not correlate with age, disease duration or expanded disability status scale score, although %CCR9 decreased linearly with age in healthy controls. During the clinical relapse of both, relapsing-remitting multiple sclerosis and neuromyelitis optica, a high proportion of cells expressing the lymphocyte activating 3 gene (LAG3) was detected among CCR9+ memory T cells isolated from the CSF, similar to that observed for mouse regulatory intraepithelial lymphocytes. In healthy individuals, CCR9+ memory T cells expressed higher levels of CCR6, a CNS-homing chemokine receptor, and exhibited a regulatory profile characterized by both the expression of C-MAF and the production of IL-4 and IL-10. However, in CCR9+ memory T cells, the expression of RORγt was specifically upregulated, and the production of IL-17A and IFNγ was high in patients with SPMS, indicating a loss of regulatory function. The evaluation of other cytokines supported the finding that CCR9+ memory T cells acquire a more inflammatory profile in SPMS, reporting similar aspects to CCR9+ memory T cells of the elderly healthy controls. CCR9+ memory T cell frequency decreased in germ-free mice, whereas antibiotic treatment increased their number in specific pathogen-free conditions. Here, we also demonstrate that CCR9+ memory T cells preferentially infiltrate into the inflamed CNS resulting from the initial phase and that they express LAG3 in the late phase in the experimental autoimmune encephalomyelitis mouse model of multiple sclerosis. Antibiotic treatment reduced experimental autoimmune encephalomyelitis symptoms and was accompanied by an increase in CCR9+ memory T cells in the peripheral blood. Antibodies against mucosal vascular addressin cell adhesion molecule 1 (MADCAM1), which is capable of blocking cell migration to the gut, also ameliorated experimental autoimmune encephalomyelitis. Overall, we postulate that the alterations in CCR9+ memory T cells observed, caused by either the gut microbiota changes or ageing, may lead to the development of SPMS.

secondary progressive multiple sclerosis, microbiota, gut-homing chemokine receptor CCR9, CD4+ memory T cells
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JCI Insight - Longitudinally persistent cerebrospinal fluid B-cells can resist treatment in multiple sclerosis

JCI Insight - Longitudinally persistent cerebrospinal fluid B-cells can resist treatment in multiple sclerosis | Multiple sclerosis New Drugs Review | Scoop.it

B-cells are key contributors to chronic autoimmune pathology in multiple sclerosis (MS). Clonally related B-cells exist in the cerebrospinal fluid (CSF), meninges, and central nervous system (CNS) parenchyma of MS patients. We sought to investigate the presence of clonally related B-cells over time by performing immunoglobulin heavy chain variable region repertoire sequencing on B-cells from longitudinally collected blood and CSF samples of MS patients (n=10). All patients were untreated at the time of the initial sampling; the majority (n=7) were treated with immune modulating therapies 1.2 (+/-0.3 SD) years later during the second sampling. We found clonal persistence of B-cells in the CSF of five patients; these B-cells were frequently immunoglobulin (Ig) class-switched and CD27+. We identified specific blood B-cell subsets that appear to provide input into CNS repertoires over time. We demonstrate complex patterns of clonal B-cell persistence in CSF and blood, even in patients on immune modulating therapy. Our findings support the concept that peripheral B-cell activation and CNS-compartmentalized immune mechanisms can in part therapy-resistant.

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Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers

Incidence of multiple sclerosis misdiagnosis in referrals to two academic centers | Multiple sclerosis New Drugs Review | Scoop.it
Many conditions mimic MS, and despite validated diagnostic criteria (Thompson et al.,
2018), accurate diagnosis can be challenging. Patients without MS are commonly misdiagnosed
with MS. Though many MS specialists routinely identify misdiagnoses (Solomon et al., 2012), a problem acknowledged in...
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Erdheim–Chester disease mimicking multiple sclerosis or a new association?

Erdheim–Chester disease mimicking multiple sclerosis or a new association? | Multiple sclerosis New Drugs Review | Scoop.it
A 53-year-old man was admitted to our department for paroxysmal episodes of paresthesia
in the legs associated with painful contraction of the extremities lasting seconds.
The results of the initial neurological examination were normal.
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We sincerely apologize, but you don’t have MS –

We sincerely apologize, but you don’t have MS – | Multiple sclerosis New Drugs Review | Scoop.it
The rate of misdiagnosis of MS around the globe is roughly a quarter. We are so focused in making an early diagnosis in MS that before we know it, it’s a runaway train.Sometimes, even the be…...
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Stereotactic Radiosurgery for Trigeminal Neuralgia in Patients With Multiple Sclerosis: A Multicenter Study

Stereotactic Radiosurgery for Trigeminal Neuralgia in Patients With Multiple Sclerosis: A Multicenter Study | Multiple sclerosis New Drugs Review | Scoop.it
Neurosurgery 84:499-505, 2019 Facial pain response (PR) to various surgical interventions in patients with multiple sclerosis (MS)-related trigeminal neuralgia (TN) is much less optimal.No large p…...
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Monomethyl Fumarate Challenges Multiple Sclerosis

Monomethyl Fumarate Challenges Multiple Sclerosis | Multiple sclerosis New Drugs Review | Scoop.it
A novel bioequivalent of dimethyl fumarate (Tecfidera) may soon be offering another treatment option for patients with multiple sclerosis. ...
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Approved Beta Interferons in Relapsing-Remitting Multiple Sclerosis: Is there an odd one Out? - Alexis Clapin, 2012

Approved Beta Interferons in Relapsing-Remitting Multiple Sclerosis: Is there an odd one Out? - Alexis Clapin, 2012 | Multiple sclerosis New Drugs Review | Scoop.it
Abstract
Three interferons are marketed for the treatment of relapsing-remitting multiple sclerosis. In its pivotal trial, one of them demonstrated impressive efficacy as a once-weekly regimen, but later head-to-head studies and reviews questioned its superiority. Analysis of this pivotal trial in publications and health authority reviews has shown that its early termination might have caused attrition bias. Censored patients were different from those completing the study on magnetic resonance imaging parameters and benefited from placebo in terms of relapse rate. Early progression of disability and differences in follow-up duration could have favored the benefit observed for the progression of disability outcome. Only the raw data could be of help to confirm or refute doubts about this trial. Raw data should be made available to the scientific community.

Keywords interferons, relapsing-remitting multiple sclerosis, efficacy
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Remyelination promoting therapies in multiple sclerosis animal models: a systematic review and meta-analysis

Remyelination promoting therapies in multiple sclerosis animal models: a systematic review and meta-analysis | Multiple sclerosis New Drugs Review | Scoop.it
Abstract
An unmet but urgent medical need is the development of myelin repair promoting therapies for Multiple Sclerosis (MS). Many such therapies have been pre-clinically tested using different models of toxic demyelination such as cuprizone, ethidium bromide, or lysolecithin and some of the therapies already entered clinical trials. However, keeping track on all these possible new therapies and their efficacy has become difficult with the increasing number of studies. In this study, we aimed at summarizing the current evidence on such therapies through a systematic review and at providing an estimate of the effects of tested interventions by a meta-analysis. We show that 88 different therapies have been pre-clinically tested for remyelination. 25 of them (28%) entered clinical trials. Our meta-analysis also identifies 16 promising therapies which did not enter a clinical trial for MS so far, among them Pigment epithelium-derived factor, Plateled derived growth factor, and Tocopherol derivate TFA-12.We also show that failure in bench to bedside translation from certain therapies may in part be attributable to poor study quality. By addressing these problems, clinical translation might be smoother and possibly animal numbers could be reduced.
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Intereye RNFL differences useful for predicting optic nerve lesion in multiple sclerosis

Intereye RNFL differences useful for predicting optic nerve lesion in multiple sclerosis | Multiple sclerosis New Drugs Review | Scoop.it
The optic nerve is a frequent site for involvement in multiple sclerosis (MS).Using OCT, the authors sought to determine optimal thresholds for intereye differ...
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Biogen beats estimates on multiple sclerosis drugs sales | Reuters

Biogen beats estimates on multiple sclerosis drugs sales | Reuters | Multiple sclerosis New Drugs Review | Scoop.it
Biogen Inc beat analysts' estimates for fourth-quarter profit and revenue o...
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Frontiers | Do Antiretroviral Drugs Protect From Multiple Sclerosis by Inhibiting Expression of MS-Associated Retrovirus? | Immunology

Frontiers | Do Antiretroviral Drugs Protect From Multiple Sclerosis by Inhibiting Expression of MS-Associated Retrovirus? | Immunology | Multiple sclerosis New Drugs Review | Scoop.it
The expression of human endogenous retroviruses (HERVs) has been associated with Multiple Sclerosis (MS). The MS-related retrovirus (MSRV/HERV-W) has the potential to activate inflammatory immunity, which could promote both susceptibility and progression toward MS. A connection between HERVs and MS is also supported by the observation that people infected with the human immunodeficiency virus (HIV) may have a lower risk of developing MS than the HIV non-infected, healthy population. This may be due to suppression of HERV expression by antiretroviral therapies (ART) used to treat HIV infection. In this pilot study, we compared RNA expression of the envelope gene of MSRV/HERV-W, as well as Toll-like receptors (TLR) 2 and 4, in a small cohort of HIV+ patients with MS patients and healthy controls (HC). An increased expression of MSRV/HERV-Wenv and TLR2 RNA was detected in blood of MS patients compared with HIV patients and HC, while TLR4 was increased in both MS and HIV patients. There was, however, no difference in MSRV/HERV-Wenv, TLR2 and TLR4 expression between ART-treated and -untreated HIV patients. The viral protein Env was expressed mainly by B cells and monocytes, but not by T cells and EBV infection could induce the expression of MSRV/HERV-Wenv in Lymphoblastoid cell lines (LCLs). LCLs were therefore used as an in vitro system to test the efficacy of ART in inhibiting the expression of MSRV/HERV-Wenv. Efavirenz (a non-nucleoside reverse transcriptase inhibitor) alone or different combined drugs could reduce MSRV/HERV-Wenv expression in vitro. Further, experiments are needed to clarify the potential role of ART in protection from MS.
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Spanner in the works for intrathecal rituximab –

Spanner in the works for intrathecal rituximab – | Multiple sclerosis New Drugs Review | Scoop.it
Figure: To-and-fro bi-directionality of CSF flow in the brainBy © Nevit Dilmen, CC BY-SA 3.0 I get a sinking feeling in the pit of my stomach when I read this article.Starting out in science, one …...
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Promising Stem Cell Therapy For Multiple Sclerosis - CBS Chicago

Promising Stem Cell Therapy For Multiple Sclerosis - CBS Chicago | Multiple sclerosis New Drugs Review | Scoop.it
An experimental treatment for multiple sclerosis is showing promise in stopping symptoms of the disease, according to a new study that found that a single stem cell transplant could stop or delay symptoms better than some medications.
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Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis

Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis | Multiple sclerosis New Drugs Review | Scoop.it
Multiple sclerosis (MS) has a severe impact on patients’ quality of life (QoL) and
affects their functionality in numerous ways. Physical disability and upper extremity function can restrict the daily routine considerably and have been shown to correlate with measures of QoL (Van Schependom...
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Natalizumab in secondary progressive multiple sclerosis

Natalizumab in secondary progressive multiple sclerosis | Multiple sclerosis New Drugs Review | Scoop.it
Although several disease-modifying treatments are available for relapsing types of
multiple sclerosis, additional treatment options for progressive types of multiple
sclerosis are needed, especially since the available treatments tend to focus on patients
who are actively relapsing.
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Trial of intrathecal rituximab in progressive multiple sclerosis patients with evidence of leptomeningeal contrast enhancement

Trial of intrathecal rituximab in progressive multiple sclerosis patients with evidence of leptomeningeal contrast enhancement | Multiple sclerosis New Drugs Review | Scoop.it
Leptomeningeal inflammation was described in patients with secondary progressive multiple
sclerosis (SPMS) in 2004 and has subsequently been identified at all stages of the
disease (Howell et al., 2011; Lucchinetti et al., 2011; Magliozzi et al., 2007; Serafini
et al., 2004).
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Health information work and the enactment of care in couples and families affected by Multiple Sclerosis - Mazanderani - 2019 - Sociology of Health & Illness - Wiley Online Library

Abstract

Given the considerable emphasis placed on informed choice, the management of health information has become an increasingly important part of living with chronic illness. This paper explores the intra‐familial dynamics of managing health information in the context of chronic illness. Drawing on 77 interviews with people affected by Multiple Sclerosis in the UK (patients, partners, family members and close friends), we show how families develop their own idiosyncratic information practices, including the careful, at times strategic, seeking, sharing and withholding of information. We describe how one individual, most commonly either the patient or their partner, often takes primary responsibility for managing growing quantities of health information. Doing this is a complex task, yet its dynamics within the family unit remain invisible and unacknowledged. In this paper we: (a) stress the importance of understanding information management in chronic illness as a collective process across all those affected, patients as well as carers; (b) conceptualise the process of managing health information in this context as ‘health information work’; and (c) analyse it as part of the wider care practices families engage in and as a form of care in its own right.

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The prodrome in relapsing remitting and primary progressive multiple sclerosis - Wijnands - - European Journal of Neurology - Wiley Online Library

The prodrome in relapsing remitting and primary progressive multiple sclerosis - Wijnands - - European Journal of Neurology - Wiley Online Library | Multiple sclerosis New Drugs Review | Scoop.it
Abstract
We examined the existence of a prodrome in relapsing‐onset multiple sclerosis (RMS) and primary progressive MS (PPMS) by comparing the number of physician encounters (via International Classification of Diseases diagnoses and physician speciality) in the five years before symptom onset in 1,887 RMS, 171 PPMS cases, and 9,837 matched population controls. Negative binomial regression models were sex, age, socioeconomic status and calendar year adjusted. Compared to RMS cases, PPMS cases had more nervous system‐related encounters (adjusted rate ratio [aRR]=3.00;95%CI:1.06‐8.49) and fewer encounters with dermatologists (aRR=0.53;95%CI:0.30‐0.96). Findings suggest that RMS and PPMS cases may both experience a prodrome, although aspects differ.
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Response to: Comment on “Transorbital ultrasonography for measuring optic nerve atrophy in multiple sclerosis” - Candeliere Merlicco - - Acta Neurologica Scandinavica - Wiley Online Library

Response to: Comment on “Transorbital ultrasonography for measuring optic nerve atrophy in multiple sclerosis” - Candeliere Merlicco - - Acta Neurologica Scandinavica - Wiley Online Library | Multiple sclerosis New Drugs Review | Scoop.it
Reply Response to: Comment on “Transorbital ultrasonography for measuring optic nerve atrophy in multiple sclerosis” Laura Gabaldón Torres Isidoro Fernández Romero Eladio Aparicio Castro First published: 05 February 2019 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ane.13076 You do not have access to the full version of this article.View access options below. Institutional Login Log in with Open Athens, Shibboleth, or your institutional credentials. If you have previously obtained access with your personal account, Please log in. Abstract We thank the authors for the comments on our recent work (1) and we would offer some clarification. The blooming effect is a doppler imaging artifact (2). In our work the doppler mode has not been used, so it is not possible that the blooming effect could artifact the images. On the other hand, we have already commented that, the difficulty in correctly visualizing all the structures that make up the optic nerve (ON) is one of the limitations of transorbital ultrasound, but we doubt that the use of the A‐mode can be of any help. This article is protected by copyright. All rights reserved. Accepted Articles Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future.
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Frontiers | The Effect of Disease Modifying Therapies on Disability Progression in Multiple Sclerosis: A Systematic Overview of Meta-Analyses | Neurology

Frontiers | The Effect of Disease Modifying Therapies on Disability Progression in Multiple Sclerosis: A Systematic Overview of Meta-Analyses | Neurology | Multiple sclerosis New Drugs Review | Scoop.it
Background: Disease modifying therapy (DMT) efficacy trials make an essential contribution to the development of evidence-based clinical treatments and practices for people with multiple sclerosis (MS). Meta-analysis is a critical part of this process and provides a powerful tool to assess the effects of DMT on MS progression. However, although there have been several meta-analyses on the effect of DMT on MS disease progression, they often do not reach the same conclusions.

Objective: Our aim was to better understand and contextualize the results of meta-analyses evaluating DMT, identify differences in methodology that might explain their differing conclusions, and highlight areas for future research that will improve our ability to develop clinical recommendations.

Methods: We conducted an overview of systematic reviews with meta-analyses assessing the efficacy of DMT on disability progression in people with MS in PubMed (Medline) and the Cochrane Database of Systematic Reviews.

Results: We included 22 meta-analyses in this overview: eight general (on >3 DMT), 11 specific (on ≤3 DMT), 2 that evaluated subsets, and 1 that evaluated long-term effects. We found that there is good evidence that DMT improve short-term (≤2–3 years) disability progression outcomes relative to placebo in people with relapsing-remitting MS. However, results varied substantially between meta-analyses, and there is little evidence of their efficacy in other populations or over longer periods. The relative effects of individual DMT also remain unclear. The variance in results between meta-analyses may be related to the substantial differences in inclusion criteria, which was reflected in the limited overlap in included studies, as well as the year of meta-analysis publication. Of the 123 total unique studies included in the general meta-analyses, 77 (62.6%) were included in only one meta-analysis. This incongruence was also evident in the included DMT. Six of the 16 (37.5%) DMT evaluated in the general meta-analyses were only included in one meta-analysis.

Conclusions: Translating DMT efficacy studies into evidence-based clinical practice requires greater methodological consistency in meta-analyses, more data on the relative effects of DMT through head-to-head clinical trials, and better reporting of adverse events.
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Intereye RNFL differences useful for predicting optic nerve lesion in multiple sclerosis

Intereye RNFL differences useful for predicting optic nerve lesion in multiple sclerosis | Multiple sclerosis New Drugs Review | Scoop.it
The optic nerve is a frequent site for involvement in multiple sclerosis (MS).Using OCT, the authors sought to determine optimal thresholds for intereye differ...
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Fumarates target the metabolic-epigenetic interplay of brain-homing T cells in multiple sclerosis | Brain | Oxford Academic

Fumarates target the metabolic-epigenetic interplay of brain-homing T cells in multiple sclerosis | Brain | Oxford Academic | Multiple sclerosis New Drugs Review | Scoop.it
Abstract
Cell-permeable formulations of metabolites, such as fumaric acid esters, have been used as highly effective immunomodulators in patients with multiple sclerosis and yet their mechanism of action remains elusive. Since fumaric acid esters are metabolites, and cell metabolism is highly intertwined with the epigenetic regulation of gene expression, we investigated whether this metabolic-epigenetic interplay could be leveraged for therapeutic purposes. To this end we recruited 47 treatment-naïve and 35 fumaric acid ester-treated patients with multiple sclerosis, as well as 16 glatiramer acetate-treated patients as a non-metabolite treatment control. Here we identify a significant immunomodulatory effect of fumaric acid esters on the expression of the brain-homing chemokine receptor CCR6 in CD4 and CD8 T cells of patients with multiple sclerosis, which include T helper-17 and T cytotoxic-17 cells. We report differences in DNA methylation of CD4 T cells isolated from untreated and treated patients with multiple sclerosis, using the Illumina EPIC 850K BeadChip. We first demonstrate that Krebs cycle intermediates, such as fumaric acid esters, have a significantly higher impact on epigenome-wide DNA methylation changes in CD4 T cells compared to amino-acid polymers such as glatiramer acetate. We then define a fumaric acid ester treatment-specific hypermethylation effect on microRNA MIR-21, which is critical for the differentiation of T helper-17 cells. This hypermethylation effect was attributed to the subpopulation of T helper-17 cells using a decomposition analysis and was further validated in an independent prospective cohort of seven patients before and after treatment with fumaric acid esters. In vitro treatment of CD4 and CD8 T cells with fumaric acid esters supported a direct and dose-dependent effect on DNA methylation at the MIR-21 promoter. Finally, the upregulation of miR-21 transcripts and CCR6 expression was inhibited if CD4 or CD8 T cells stimulated under T helper-17 or T cytotoxic-17 polarizing conditions were treated with fumaric acid esters in vitro. These data collectively define a direct link between fumaric acid ester treatment and hypermethylation of the MIR-21 locus in both CD4 and CD8 T cells and suggest that the immunomodulatory effect of fumaric acid esters in multiple sclerosis is at least in part due to the epigenetic regulation of the brain-homing CCR6+ CD4 and CD8 T cells.

multiple sclerosis, DNA methylation, fumaric acid esters, CD4 T cells, metabolic-epigenetic interplay
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The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019

The Out-of-Pocket Cost Burden for Specialty Drugs in Medicare Part D in 2019 | Multiple sclerosis New Drugs Review | Scoop.it
Medicare Part D has helped to make prescription drugs more affordable for people with Medicare, yet many beneficiaries continue to face high out-of-pocket costs for their medications.Specialty tie…...
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