Thursday, December 31, 2009

Innovation & Technology December 30, 2009, 10:28AM EST

Multiple Sclerosis: A Breakthrough Is on the Way

A number of improved treatments will be available soon, and Novartis' Fingolimod could lead the way

When Thomas Bullock was diagnosed with multiple sclerosis in 2001, several new treatments for the incurable, nerve-destroying condition had just hit the market. The automotive worker from Ontario spent two years on Bayer's blockbuster Betaseron, an injectable drug that can suppress a hyperactive immune system. But instead of getting better, Bullock endured constant flu-like symptoms and numbness in his limbs. When he developed severe nerve damage, he ditched the injections. "My body just couldn't handle it," recalls Bullock, now 41.

Then, in 2007, he joined a clinical trial for an experimental pill, Fingolimod, from Novartis (NVS). His MS hasn't flared up since. "This is the best shape I've been in for years," he says.

Bullock is one of an estimated 2.5 million MS patients worldwide with fresh cause for hope. Fingolimod and a slew of other drugs that attack MS in new ways are expected to become available starting in 2010. With 10 treatments in late-stage development and more than two dozen in early-stage research, some doctors believe therapy for the illness is at a turning point. Although doctors can't say which drugs will succeed, "we are getting closer to stopping the progression of the disease," says Dr. John Richert, a top executive at the National Multiple Sclerosis Society.

Switzerland's Novartis is vying with Germany's Merck to be first with an oral treatment, pursued closely by France's Sanofi-Aventis (SNY), Israel's Teva Pharmaceuticals (TEVA), and Biogen Idec (BIIB) in Cambridge, Mass. If regulators approve any or all of these products, the painful injections and infusions patients endure today may become obsolete—and the global market for MS drugs, currently at $8.8 billion, could double within five years, according to consultants Frost & Sullivan.

When MS strikes, rogue immune cells travel to the brain and spine, attacking and destroying myelin, the protective insulation surrounding nerves. These mysterious attacks produce sclerotic scar tissue and disrupt messages from the brain that control muscle movements, with symptoms ranging from mild numbness to paralysis and blindness.

MS drugs seek to quell these assaults. But any tampering with the body's immune reactions can be dangerous. "There is balance between treating the disease and potentially increasing the risk of infection and cancer," says Dr. Jeffrey Cohen, director of experimental therapeutics at the Cleveland Clinic's Mellen Multiple Sclerosis Center. Consider Tysabri, one of the most potent weapons against MS, which works by confining wayward immune cells in the bloodstream. The drug, made by Biogen Idec and Elan Pharmaceuticals (ELN), has been used by 65,000 patients. Of these, 28 have developed brain infections, and 7 have died.

The new wave of MS drugs face tough scrutiny. Fingolimod, for one, works through an entirely new mechanism: It traps the marauding immune cells in the lymph nodes, keeping them from entering the bloodstream. A two-year study shows it reduced the relapse rate in MS patients by 54%. It also may increase the nervous system's ability to protect itself, as may Biogen Idec's new pill, BG-12, says Richert.

What doctors can't guarantee is that the drugs will suppress the illness without triggering infections. "We desperately need new drugs for MS," says Dr. Mark Keegan, section chair of multiple sclerosis at the Mayo Clinic in Rochester, but "any new medication that alters the immune system needs to be used with caution."

Capell is a senior writer in BusinessWeek's London bureau .

Sunday, December 20, 2009

Wednesday, December 16, 2009

Happy Holidays to All

Canada has one of the highest rates of MS in the world… three new people are diagnosed with MS in our country every day. That is why we are working so hard this holiday season to give new hope to the estimated 55,000 to 75,000 Canadians living with MS.

You can make the season more meaningful with a gift to the MS Society of Canada.

Why not give a gift in Honor or Memory of someone.

Click here to find out more and how to give.

Monday, December 14, 2009

The latest from the MSRC

Tuesday, December 1, 2009

Found this blog on line. Interesting.You should read the whole article. by Wheelchair Kamihaze

Monday, November 30, 2009

CCSVI (the Vascular Theory of MS): Separating Fact from Fiction

Veins of the head and neck.

Since the airing of a Canadian television newsmagazine piece on CCSVI, there has been a veritable frenzy on Internet chat rooms and bulletin boards regarding this radical new theory. Unfortunately, the tsunami of information that is being bandied about is often misleading and sometimes just plain wrong. Based on scant knowledge, many are making extraordinary claims regarding the theory and the treatment options it presents, most of them based on little actual fact.

For those unfamiliar with CCSVI (chronic cerebrospinal venous insufficiency), I've made two previous posts about it, which you can find here and here. I've been fastidiously following the development of the theory and the treatments being used as a result of it for at least ten months now. Though I'm far from the be-all and end-all of CCSVI information, I do feel qualified to make some intelligent observations about it.

For readers unacquainted with CCSVI, the theory basically states that narrowing in the veins that drain the central nervous system (CNS) lead to an abnormal flow of blood through the CNS, which damages nerve tissue via several different mechanisms, and leads to the lesions and immune responses that are the hallmarks of Multiple Sclerosis. First proposed by an Italian doctor, Dr. Paolo Zamboni, whose wife was stricken with MS, the theory has won over several fervent supporters. Dr. Zamboni is treating MS patients with a modified balloon angioplasty procedure he calls "The Liberation Procedure", and another physician at Stanford University is opening up the blocked veins of MS patients using stents. There is also a doctor in Poland who appears to be using a combination of these two methodologies. As knowledge of the theory has spread, many harsh critics have quite expectantly begun to ring in. I'll attempt here to cut through the noise, and present the facts as I know them, along with some commentary.

To begin with, let me state that although I remain somewhat skeptical, I'm a cautious believer in the concepts put forth by the CCSVI theory. It is certainly my hope that the theory bears fruit, as it will offer MS patients a myriad of new options to treat the disease, and will lead research scientists in entirely new directions as they investigate the many aspects of Multiple Sclerosis. Hopefully, it will help bring about a rethinking of the autoimmune theory of MS, which states that, for reasons unknown, the immune system goes bonkers and starts attacking the body's own cells. Quite frankly, we've been fed that line of bullshit for far too long. If the CCSVI theory starts gaining significant traction, expect a withering storm of criticism to come from some mainstream neurologic circles, as well as from the pharmaceutical industry, which stands to lose untold billions in the sales of drugs designed to suppress the immune system.

Dr. Zamboni's research began with his imaging the vascular systems of MS patients, sufferers of other neurologic diseases, and healthy subjects. He reports that he found signs of vascular blockage in almost 100% of the MS patients he studied, but none in either the patients with other neurologic diseases, or the healthy subjects. On its face, this would seem to be very compelling evidence. However, as my doctors at the National Institutes of Health (NIH) have pointedly explained, this claim throws up some big red flags. Because MS is a notoriously hard disease to diagnose, and there are many diseases that mimic MS, in any large population of diagnosed MS patients, there will be a significant segment that have in fact been misdiagnosed. Therefore, finding 100% of practically any trait among a large population of MS patients is practically impossible. As a matter of fact, the way I first became involved with the NIH was as part of a study being used to identify patients that the National Institutes of Health could be certain actually suffer from MS, because misdiagnosed patients were skewing the results of many of the MS studies they had undertaken. The NIH is trying to identify a pool of patients they can be confident actually have MS, for use in future studies. This is how the NIH ascertained that it's very likely I do not have MS.

Still, the Zamboni findings appear to be compelling. Before they can be accepted as scientific fact, though, they must be replicated by independent researchers, and so far, no such evidence has been presented. There are several different research groups currently putting together studies of CCSVI, and a large imaging study is already ongoing at the University of Buffalo, so we should have either independent verification or refutation of the theory sometime within the next 6 to 12 months. Before we get these independent reports, however, it is extremely premature to state anything of certainty about the theory.

In my mind, the theory could explain several of the mysteries surrounding MS, but fails to explain many others. It's one of the first theories to adequately explain the formation of lesions and the immune response that are the calling cards of MS. It also explains findings such as those that tie cigarette smoking to an increased incidence of MS and a quicker progression of the disease. Since smoking is known to exacerbate vascular issues, if MS is in fact a vascular disease, it stands to reason that smoking would have a considerable negative effect on it.

On the other hand, the theory does not address what we know about the geographic distribution of MS, the male-female ratio that is well known to exist in MS, the existence of "MS clusters" (which would seem to point to an infectious cause), or the unmistakable link between MS and Epstein-Barr virus (100% of MS patients are infected with EBV. I know, many of you reading this have never had Mono, but the vast majority of people infected with EBV have no idea that they carry the virus. It can often be asymptomatic, or present as a bad cold or flu).

Having said that, MS is an extremely heterogeneous disease, and it may be that CCSVI is THE answer for a subset of MS patients, but may play only a partial role, or no role whatsoever in others diagnosed with the Multiple Sclerosis.

As for the surgical interventions now being used on patients whose imaging (via MRV and/or Doppler imaging studies) indicates that they have venous abnormalities related to the CNS, there are controversies surrounding these, as well. The problems stem from the fact that the procedures being used were all developed for use in clearing out the obstructed arteries of cardiac patients. Remember, CCSVI is concerned exclusively with veins.

There are major differences between arteries and veins, both in form and function. Arteries are designed to facilitate the outflow of blood from the heart to the various organs and regions of the body. They must be able to withstand the tremendous internal blood flow pressures generated by the beating heart, and thus their walls are stiff and resistant to tears and breaks. Veins, on the other hand, function to return deoxygenated blood to the lungs and heart. They are designed to be flexible and pliant, and their walls are much thinner and more prone to tearing than the walls of arteries. Arteries grown narrower in the direction of blood flow, while the opposite is true of veins, which grow wider as they return blood to the cardiopulmonary system. Therefore, a stent that gets loose in an artery is typically only pushed deeper into that artery. A stent that gets loose in a vein generally has a clear path to the heart.

In self-reported results, Dr. Zamboni's balloon angioplasty Liberation Procedure appears to be quite effective in reducing relapse rates and disease severity. Unfortunately, as many as 50% of the patients treated suffer restenosis of the veins opened by the Liberation Procedure, and thus require multiple interventions. As with any surgery, there is risk involved, and that risk is multiplied each time the intervention must be repeated. Furthermore, stenosis that is found in problematic areas, such as high in the jugulars, is not treatable by balloon angioplasty.

The surgery being attempted at Stanford University is much more aggressive, and places stents at the stenosed areas of blockage. Stenting has very rarely been tried in veins, and much less so in veins associated with the brain and spinal cord; the stents used have been almost exclusively designed for use in arteries. So far, slightly over 60 patients have been treated with this procedure, and there have been some serious complications reported. Despite the fact that I have a significant stenosis in my left upper internal jugular, both the doctors at the National Institutes of Health and my primary neurologist have repeatedly and adamantly warned me against undergoing this procedure, citing the possibilities of brainstem hemorrhages, stent migration (which would almost inevitably lead to stents finding their way into the heart), and the ever present danger of bleeding and blood clots. Although the majority of the patients that have undergone this procedure report positive results, a minority have had a difficult time recovering from surgery, and have reported nerve pain and nerve damage. There have also been reports of much more serious complications.

In short, the research surrounding CCSVI appears to be very promising. Until this research is replicated by independent organizations, no real conclusions can be drawn. There have been many other promising leads in the history of MS research that have eventually led to dead ends. I'm hopeful that CCSVI will not be one of them, and instead will lead to a seismic shift in our understanding of not only MS, but other so-called autoimmune diseases as well. I cannot make any such statement, however, until the research is verified by multiple sources. As for the surgical procedures now being offered to treat stenosed veins, they must be characterized as experimental, and as such, carry with them a sizable degree of risk, more so with the stenting procedure than with balloon angioplasty. If CCSVI theory turns in to CCSVI fact, these surgical procedures will in time be refined, and the risk in undergoing them diminished.

I found this fascinating quote today:

As exciting as Dr. Zamboni's research is, I think it's important that the MS community as a whole steps back and takes a breath, and waits to see what further research bears out. I understand how hard this can be with a progressive neurologic disorder breathing down your neck. Believe me, I'm nearing the point of desperation myself, but in situations like these, we cannot let hope and emotion cloud our actions and understanding of the issues. These are potentially life and death matters, and need to be approached with clarity of mind and a complete grasp of the complicated issues at hand.The Wheelchair Kamikaze, Wheelchair Kamikaze, Nov 2009