Innovations In Clinical Neuroscience

HOTTOP Multiple Sclerosis DEC 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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11 Hot Topics in Multiple Sclerosis [December 2017] U p d ate s i n Cl i n i c a l Pra c t i ce impact on the development of effective treatments. Some treatments have been able to slow or reduce the chance of relapsing-remitting MS (RRMS) converting to secondary progressive MS (SPMS), but once a patient reaches the point of SPMS, as of now, it is irreversible. Ocrelizumab, an anti-CD20 antibody, was just approved by the United States Food and Drug Administration (FDA) to treat both RRMS and primary progressive MS (PPMS). Siponimod has been shown to "reduce the risk of disability progression in PPMS patients." The researchers propose that the study of metabolic pathways could lead to effective treatments against progressive forms of MS. In particular, biotin therapy has been shown to improve Expanded Disability Status Scale (EDSS) scores and Timed 25-foot Walk times in some patients with progressive MS. The role of biotin appears to be tied to iron, which uses some of the same metabolic pathways. Investigators note one study that examined the role of inflammation in MS, reporting that inflammation could lead to a "reduction in the availability of iron for biochemical pathways in neurons and oligodendrocytes." Additionally, vitamin D has been shown to decrease iron-induced toxicity, meaning supplementation of the vitamin for patients with MS might counteract iron-related damage. Research also suggests that people with lower levels of vitamin D in general could be at a higher risk to develop MS later on in life. Additional studies that measure therapies that increase adenosine triphosphate (ATP) production could result in remyelination in the central nervous system, but many of these studies are only on patients with RRMS. In a study using rats, a ketogenic diet over a three-week period led to increased levels of kynurenic acid in certain areas of the brain involved in neuroprotective properties. Finally, researchers have studied the possibility of using stem cells to treat MS. Studies have already demonstrated the successful use of stem cells to replace cells and myelin. Ultimately, the authors suggest stem cells as a potential way to improve the negative effects of progressive MS and note that any process involving metabolic pathways as a treatment for MS would have multiple steps. The investigators also add that therapy using ocrelizumab, which can deplete B cells, would be more beneficial than any therapy that only implemented metabolic support. * Access the full study National MS Society Endorses MS "NARCRMS" Data Registry. The National Multiple Sclerosis Society officially endorsed the North American Registry for Care and Research in MS (NARCRMS), "a physician/clinician-based MS registry and longitudinal database of clinical records and patient-centered outcomes." The society said this registry allows for facilities all over the country to have a better way of sharing information with each other on patients with MS. The data from the registry also includes patient-reported outcomes, and it will help with recruitment of patients with MS for future clinical trials. "We are grateful the society has decided to partner with us on this pioneering effort to accelerate collaboration and more effective utilization of data on behalf of all people living with MS," said June Halper, the president and CEO of the Consortium of Multiple Sclerosis Centers (CMSC), which oversees the registry. The article notes that NARCRMS is the first registry of its kind of connect MS centers in the United States and parts of Canada. * Access the full study.

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