Multiple Sclerosis treatment. Rituximab, Quilizimab, Brain’s lymph vessels Part 1 of 3. 7
You published a review of multiple sclerosis advances in diagnosis and treatment. It was printed in the leading journal Nature Reviews Neurology. Dr. Anton Titov, MD. Your review is titled “Decade in review: multiple sclerosis. New multiple sclerosis medications. Personalized medicine for multiple sclerosis.” Dr. Anton Titov, MD. What are leading breakthroughs in personalized medicine for multiple sclerosis treatment? The review focussed more generally on what has happened with multiple sclerosis treatment in the last decade. Dr. Paul M. Matthews, MD. It was a very personal and obviously idiosyncratic point of view. I thought several multiple sclerosis achievements were important. Let me just highlight the leading points from my review. First, I think the Dr. Stephen Hauser clinical trial of rituximab was important. It was a Phase 2 clinical trial. It demonstrated that anti-CD20 B-cell therapy provided a significant reduction in relapse rate of multiple sclerosis. Rituximab reduced new lesion formation. Rituximab decreased disability progression in patients with multiple sclerosis. It was a landmark clinical trial. It utterly transformed our view of the immunology of multiple sclerosis. Dr. Paul M. Matthews, MD. Multiple sclerosis was largely thought to be a T cell-mediated disease. Precisely why B cell therapies work in multiple sclerosis is still a matter for considerable research. But clearly there is much crosstalk between B cells and T cells. The influence of this work has been rapidly felt. Many physicians are now aware of it. Dr. Paul M. Matthews, MD. Recent clinical trials of the new anti-CD20 antibody Ocrelizumab (Ocrevus) have demonstrated similar outstanding efficacy in patients with multiple sclerosis. Ocrevus may have potential benefits in those with progressive multiple sclerosis. It is a terribly exciting space to watch! The second discovery is more on the basic science side of multiple sclerosis. Dr. Paul M. Matthews, MD. I think we began to really challenge current notions of mechanisms of multiple sclerosis. Dr. Anton Titov, MD. This research helps us understand how multiple sclerosis medications may fail to show complete efficacy despite their power. For example, Natalizumab. This was the discovery that the brain has a lymphatic system. Dr. Paul M. Matthews, MD. Prior to this discovery it was thought that the brain obeys very special rules. We thought that the brain was distinct from other organs. In the new work association of T-cells with the meninges was closely studied. Multiple sclerosis specialists used histological techniques. A lymphatic channel was clearly identified in the brain. Researchers used the expression of markers consistent with those for other endothelial channels. These markers are associated with the lymphatic systems. This work suggested a draining lymphatic path to cervical lymph nodes. Thus, there are multiple ways in this antigens can be presented to the immune system. Now we are going back to classical lymphatic presentation.
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