Do You Get Prof G's Newsletter?
You ought to. It is a brilliant patient focused resource. If you ask him nicely it is free.
The big US MS meeting has just ended. It is called ACTRIMS. This is an excerpt from Prof G's report
'There were excellent talks on the biology of myelination and remyelination and their complexity. The question I ask is, is remyelination a problem in MS? If you switch off the disease, for example, with alemtuzumab or AHSCT, patients remyelinate and recover function spontaneously. Indeed, the real issue is using their treatments early. Trying to remyelinate a damaged nervous system without curing someone of having MS is foolhardy. If the autoimmune target in MS is myelin or the oligodendrocyte, the cell that makes myelin, repairing these two components will invite further attacks on their integrity. It is like doing a kidney transplant in someone with an autoimmune kidney disease. In many autoimmune diseases of the kidney, the disease reoccurs in the transplanted kidney.
This is why remyelination therapies in isolation will not work. Similarly, targeting remyelination therapies a long time after the event, i.e. after the loss of neurons and axons, won’t work either. You need a surviving neuron and demyelinated axon to remyelinate it successfully. This is why remyelination and neurorestorative therapies are so many decades away. There are too many issues to overcome, the biggest being poor phase 3 trial design and the need to include the physiological stimulus to promote repair (rehabilitation) as part of the trial design.'
I subscribe to his newsletters, lots of interesting new dmt updates. Not sure I entirely agree with his dismissal of complimentary/alternative treatments though, I know they're not scientifically proven but, dmds are not universally available to all sufferers around the world. 🌐
He is one of the very top people in the field. I work with him at times but we are not friends. I can say that he is in no-one's pocket. He is a scientist to the core. Things are given short shrift because they can't show evidence. If alternative medicine worked it'd just be called medicine. Digitalis for the heart is from a plant, Foxgloves. It isn't referred to as alternative medicine. You are very wise to observe the disparities in access to DMTs are the world. It is inequitable and many people are working hard to change that. Not only are DMT's not available but the entire structure to diagnose and support MS patients is lacking or non-existent. Prof K - Klaus Schmierer at Bart's who has taken over from Gavin as clinical lead - is heavily involved in trying to increase access to subcutaneous cladribine in poor countries. It is a tough one as MS is a distant follower to hunger, fresh water, malaria prevention and the like. One could look at alternatives as providing a form of mental palliative care. The belief that something works is very strong and if that eases things for folks it is a good thing.