New Oral Therapy, Plus A Life Coach

Ok, it has, again, been FAR too long since I posted.  Taking care of an infant is very demanding and, therefore, my blog has been on the back burner for awhile.  I have been meaning to post for some time now, but haven't (obviously), but with the news that the 2nd oral therapy had been approved by the FDA, I knew I would have to post today!

Before I get to that, however, I want to tell you all a little about my friend, Rhonda.  She is a Life, Wellness and Career Coach!  If you feel stuck, whether it be because of a job-related issue, a health-related issue, or just a life issue and you need someone to help you through, I would encourage you to contact Rhonda.  Although she is equipped to help with a range of issues, I should mention (since this blog is about MS) that I met Rhonda through her work for the MS Society, so I know she fully understands MS and how it affects people's lives (not just their health).  If you think you might benefit from her services, check out her website.  Disclaimer: I am, in no way, benefiting by telling you about her services (She is not paying me or anything for this "plug").  She is just a friend who I believe can make a difference in people's lives and if you or someone you know could use help getting out of a "rut", then she may be able to help.

Ok, now onto the exciting news!  If you didn't already know, the FDA approved teriflunomid, an oral therapy for relapsing forms of MS!  The following excerpt was taken from the NMSS website (here):

The U.S. Food and Drug Administration has approved teriflunomide once-daily pills (Aubagio,® Genzyme, a Sanofi company) to treat relapsing forms of MS. This is the second oral disease-modifying therapy approved for the treatment of multiple sclerosis. The therapy is expected to be available for prescription by October 1, 2012 in the U.S. The company has also applied for regulatory approval in other parts of the world.
“We are greatly encouraged to see a new oral therapeutic option become available to people living with MS,” advised Bruce A. Cohen, MD, Professor, Davee Department of Neurology and Clinical Neurosciences at Northwestern University’s Feinberg School of Medicine, and incoming Chair of the National MS Society’s National Medical Advisory Committee. “As with any new therapy, the long-term safety of Aubagio will need to be carefully monitored,” he added. Dr. Timothy Coetzee, Chief Research Officer at the National MS Society agreed. “With the collaborative research underway around the world today, this is an extremely hopeful time for anyone who is diagnosed with MS.”

About Teriflunomide/Aubagio: Multiple sclerosis involves immune system attacks on the brain and spinal cord. Aubagio (pronounced oh-BAH-gee-oh) is a novel oral compound that inhibits the function of specific immune cells that have been implicated in MS. It is related to leflunomide, a drug used to treat arthritis. Aubagio can inhibit a key enzyme required by white blood cells (lymphocytes), reducing the proliferation of T and B immune cells active in MS and also inhibiting the production of immune messenger chemicals by T cells. It is not thought to affect resting immune cells that are not in an activated state. Two doses (7mg and 14 mg) have been approved.
Potential benefits: Three large clinical trials of Aubagio have been completed, and at least two more are ongoing. In the phase III TEMSO study, Aubagio reduced the average number of MS relapses and disease activity on MRI scans significantly more than inactive placebo in 796 people with relapsing forms of MS.
In a recently completed phase III TOWER study involving 1,169 people with relapsing-remitting MS, oral Aubagio reduced relapses compared with placebo over at least 48 weeks, according to a company press release. Of two different doses tested during the TOWER trial (7 mg and 14 mg), the higher dose also slowed progression of disability.
In another study, called TENERE, Aubagio was compared with Rebif® (interferon beta-1a, EMD Serono and Pfizer) in relapsing MS, and did not reach its primary endpoint (the main question posed by the study) -- the “risk of failure,” meaning the first occurrence of a relapse, or permanent discontinuation of the study treatment, whichever came first. There was no significant difference in the numbers of participants who experienced events defined as treatment failure among the Aubagio and Rebif groups.
Potential risks and screenings: In trials to date, Aubagio was generally safe and well tolerated. The most common side effects experienced by participants in clinical trials include diarrhea, abnormal liver tests, nausea, flu, and hair thinning.

The NMSS website also has some FAQs regarding teriflunomid and links to the various studies, the FDA press release, etc.  Be sure to click on the link above to read this valuable information!
This is such exciting news!  As someone who takes a once-daily injection, an oral therapy is extremely enticing!  I have stayed away from Gilenya (the 1st oral therapy) because of the risks for pregnant women/ women who want to become pregnant.  As you all now know, I recently had my first child.  We have not decided whether more children are in our future yet, so I am hesitant to switch to an oral therapy until we are sure that we don't want more children.  But, if I knew that we were done having kids, I would DEFINITELY be talking to my neurologist about possibly switching to one of these exciting oral therapies!  I can't wait to hear more about how people do on the teriflunomid!

Sounds like the little man is waking up - back to MOMMY duty!

While the Baby is Sleeping . . .

Well, I know it has been awhile since I posted, but I have a good reason, I swear!  On June 27th, my son decided to make an early appearance into the world! He came a month early (he was due on July 27th)!  Needless to say, my husband and I were not as prepared as we would have liked to have been.  And even though he still isn't even supposed to be here yet, now that he is here, we could not imagine life without him!  So, I have been just a LITTLE busy the last four weeks and haven't had much time to get on my blog to post.  But, I felt it was time to post at least a little something and in the wake of the news on interferons that broke last week, today seemed to be the perfect day (plus the baby is sleeping right now and I felt as though I had just enough energy to put a little something together).  So, in case you haven't heard, the news on interferons is as follows (from the NMSS website):

In a study looking at more than 2,000 people enrolled in MS clinics in British Columbia, there was no reduction in MS progression in people treated with interferon beta compared to untreated controls. This study did not address the value of interferon beta in reducing MS relapses and the development of lesions (tissue damage) or improving quality of life in people with MS. While the results are at variance with other recent research and need to be confirmed, this carefully conducted study presents some evidence that there is an unmet need for treatments that reduce the likelihood of MS progression. Research also is needed to find more comprehensive and better tools to measure the effectiveness of MS treatments. Afsaneh Shirani, MD, Helen Tremlett, PhD, and colleagues (University of British Columbia, Vancouver, Canada) report the findings in the Journal of the American Medical Association. This study was supported by the Canadian Institutes of Health Research, the National MS Society, the MS Society of Canada and others.
Background: Multiple sclerosis involves immune system attacks against the brain and spinal cord. Several treatments, called disease-modifying therapies (DMDs), are available that can reduce the inflammation associated with the immune attack and reduce disease activity, such as relapses and the development of new lesions. The effect of these therapies on damage to nerve fibers is not well understood, and it is controversial to what extent they reduce the progression of MS, which is associated with nerve fiber damage. Data on MS progression comes largely from what is reported from relatively short-term clinical trials. Some of the difficulties involved in answering this question using traditional, randomized clinical trials include the fact that it would take a long time to observe effects on progression, and that the conditions of a trial do not necessarily reflect the ‘real world’ of treatment and how it might affect disease progression.
The study: The investigators collected information from the British Columbia MS database, which captures about 80% of all people with MS in British Columbia and links the four MS clinics in that province. They observed people with relapsing MS who had registered with a clinic between April 1985 and December 2004 and who were eligible for interferon beta treatment. Within this group, they compared 868 people who were treated with interferon beta, 829 people who were not treated, and 959 historical controls (people who were untreated before approval of interferons for MS). The main outcome measure was time to a confirmed and sustained EDSS (a scale used to measure MS-related disability) score of 6. This score indicates “intermittent or unilateral constant assistance (cane, crutch, brace) required to walk about 100 meters with or without resting.”
The results indicated that those treated with interferon were just as likely to progress to an EDSS of 6 as those who were not treated. The lack of difference among patients persisted whether the controls were contemporary or historical, or whether an EDSS of 4 rather than 6 was considered. However, the authors point out that this study is not capable of discerning a subgroup of patients who might indeed experience reduced progression through interferon use.
Comment: In an accompanying editorial, Tobias Derfuss, MD, and Ludwig Kappos, MD (University Hospital, Basel, Switzerland) point out that the comparison groups used in this study might have tended to underestimate a possible long-term benefit of treatment. They also comment that although this study was methodologically sound, it is subject to the inherent challenges of an “observational” study. In this type of study, researchers infer their conclusions based on observing treated versus untreated patients, as opposed to a randomized, placebo-controlled trial, where the researchers assign patients to either active treatment or a placebo. The results are not likely to stop the debate over the long-term effectiveness of DMDs, including interferons, on MS progression. Recently, Italian researchers using novel study design found that MS treatments were associated with a reduction in MS progression.
The Canadian study’s findings on longer-term benefits of interferons do not negate their proven value for reducing MS relapses, which have been linked to long-term progression, and the development of lesions (tissue damage). Important research is underway to help determine which people may respond best to interferons; success would help guide treatment decisions by people with MS and their health care providers, and pave the way for personalized medicine in multiple sclerosis. Research also is underway to address the need to find more comprehensive and better tools to measure the effectiveness of MS treatments. Novel imaging technology and refined clinical measures may help to capture the full spectrum of MS-related damage, and may improve our understanding of how both currently approved and experimental therapies affect MS progression.

Pretty crazy to think that the Interferon treatments may not be slowing progression!  I would love to hear people's thoughts on this.  I was taking Copaxone before getting pregnant and have been off my meds since last November.  I will go back on the Copaxone as of August 1st.  Since I have not taken one of the interferon treatments, I don't know how to respond to this news, but I can't quite wrap my head around it!  The interferons have been around the longest and I seriously thought about taking Avonex or Rebif until we finally decided on Copaxone.  I think I would be really disappointed right now if I had chosen one of the interferons!  If you take/took an interferon, let me know what you are thinking/feeling about this news.

Back to baby duty.  I will try to post again soon!

Pregnancy & MS

I recently got a comment requesting information on how MS is affecting my pregnancy.  Rather than just reply to that one person, I thought I would share with all who may be curious.

I have been very lucky.  I have had a fairly "easy" pregnancy and my MS has been very manageable and almost non-existent.  By "easy" pregnancy, I mean that I got lucky and didn't really have any morning sickness and aside from not sleeping well and minor aches and pains, I haven't had any real complaints.  Regarding my MS, I stopped taking my MS medications when I learned I was pregnant, so I have been off treatments for approximately 30 weeks now.  I have barely even thought about my MS throughout this pregnancy because my focus has been on having a healthy baby.  The only time I am really reminded of my MS is when we take our dog for walks (since I no longer take daily shots, I am not reminded quite as frequently).  On our walks, I do fine until we stop walking.  At that point, I generally have some sort of numbness or tingling in my lower back, buttocks and/or legs.  It is nothing debilitating, more annoying than anything else.  It is my understanding that these are just "residual" symptoms, meaning these are not new symptoms or relapses, just my old symptoms recurring.  Some of my first and most prominent symptoms have consistently been numbness and tingling in those areas and, to my knowledge, I have not experienced any new symptoms since I got pregnant.  I have spoken with my neurologist about getting an updated MRI done after the baby is born so that we can see if any new lesions have formed, but I am not sure how telling that will be regarding the pregnancy considering my last brain MRI was 4 months prior to my diagnosis (April 2010). 

That is an overview of how everything has been.  In my research, I have read that it is common for MS to go into remission during pregnancy because the immune system is suppressed during pregnancy and, therefore, not attacking itself.  I think this has been my experience just based on how I have felt physically throughout my pregnancy. 

As I am sure all of you know, MS varies so much from person to person and I was lucky enough to have been diagnosed very early on (when I only had 2 or 3 lesions).  Also, I had been doing very well before getting pregnant.  I had been on treatments for over a year and had been essentially symptom-free since January 2011 (about 10 months before getting pregnant). 

I hope this helps anyone who has/had questions.     

WORLD MS DAY 2012

Today is World MS Day - a day to advocate and spread the word about MS.  My goal since my diagnosis has been to educate people about MS in any way that I can in hopes that, once people understand what MS is and how devastating it can be, more people will want to get involved in helping find an end to MS.  World MS Day is designed to spur people to do just that.  Today, I received my newest MSF emailer and in it was some VERY exciting news - more progress in MS research.  Below is a few excerpts from the emailer.

Neutralizing Enzyme May Hold Key to Staving Off MS

Researchers studying MS have long been looking for the specific molecules in the body that cause lesions in myelin, the fatty, insulating cells that sheathe the nerves. Nearly a decade ago, a group at Mayo Clinic found a new enzyme, called Kallikrein 6, that is present in abundance in MS lesions and blood samples and is associated with inflammation and demyelination in other neurodegenerative diseases. In a study published in Brain Pathology, the same group found that an antibody that neutralizes Kallikrein 6 is capable of staving off MS in mice. 

"We were able to slow the course of disease through early chronic stages, both in the brain and spinal cord," says lead author Isobel Scarisbrick, Ph.D., of the Mayo Clinic Department of Physical Medicine and Rehabilitation.
Researchers looked at mice representing a viral model of MS. The model is based on the theory that a viral infection early in life results in an eventual abnormal immune response in the brain and spinal cord. One week after being infected with a virus, the mice showed elevated levels of Kallikrein 6 enzyme in the brain and spinal cord. However, when researchers treated mice to produce an antibody capable of blocking and neutralizing the enzyme, they saw a decrease in diseases effecting the brain and spinal cord, including demyelination. The Kallikrein 6 neutralizing antibody had reduced inflammatory white blood cells and slowed the depletion of myelin basic protein, a key component of the myelin sheath.
"These findings suggest Kallikrein 6 plays a role in the inflammatory and demyelinating processes that accompany many types of neurological conditions," says Dr. Scarisbrick. "In the early chronic stages of some neurological diseases, Kallikrein 6 may represent a good molecule to target with drugs capable of neutralizing its effects."

It is so exciting that researchers continue to find new ways to attack MS so that it stops attacking us!  It would be great if they could get a medication formed and start testing this theory out - sounds very promising.

Adult Stem Cells from Bone Marrow Repair Myelin in Mice

A recent study reports that human mesenchymal stem cells (MSCs) have been used in animal models of MS to not only successfully block the autoimmune MS response, but also to repair myelin. Researchers say this demonstrates an innovative potential myelin repair treatment for MS. The human MSCs used in this study were culled from adult stem cells derived from the bone marrow.

The Myelin Repair Foundation (MRF) announced the results of a new peer-reviewed research study published in Nature Neuroscience. Funded by the MRF, this research was conducted by Case Western Reserve University scientists.

Compared to the controls, this research study showed fewer and smaller lesions found on the nerves in the MSC treatment group.

Research by others and results of their own work indicated hepatocyte growth factor, which is secreted by mesenchymal stem cells, was a likely instigator.
The scientists injected animals with 50 or 100 nanograms of the growth factor every other day for five days. The level of signaling molecules that promote inflammation decreased while the level of signaling molecules that counter inflammation increased. Neural cells grew and nerves laid bare by MS were rewrapped with myelin. The 100-nanogram injections appeared to provide slightly better recovery. 

To test the system further, researchers tied up cell-surface receptors, in this case cMet receptors that are known to work with the growth factor. 
When they jammed the receptors with a function-blocking cMet antibody, neither the mesenchymal stem cell medium nor the hepatocyte growth factor injections had any effect on the disease. In another test, injections of an anti-hepatocyte growth factor also blocked recovery. 
The researchers will continue their studies, to determine if they can screen mesenchymal stem cells for those that produce the higher amounts of hepatocyte growth factor needed for effective treatment. That could lead to a more precise cell therapy. 
"Could we now take away the mesenchymal stem cells and treat only with hepatocyte growth factor?" Miller asked. "We've shown we can do that in an animal but it's not clear if we can do that in a patient." 
They also plan to test whether other factors may be used to stimulate the cMet receptors and induce recovery.

 This is more great news in MS research!  I love the continuing research regarding stem cells and how they can be used to help with so many problems, including MS!  This is great to learn that something may actually be able to REPAIR myelin - something I thought was probably beyond the realm of possibility!

Stem cell research and CCSVI all in one blog!  Oh my!

FDA Alerts on Potential Dangers of “Liberation Therapy” for CCSVI

The U.S. Food and Drug Administration (FDA) is alerting people with MS to the risks of serious injuries and death associated with certain procedures to treat chronic cerebrospinal venous insufficiency (CCSVI). The benefits of these experimental procedures, commonly known as “liberation therapy” or the “liberation procedure” have not been proven, says the FDA, and their promotion as a treatment for MS may lead people with the disease to make treatment decisions without being aware of the serious risks involved. 

The FDA’s announcement is also intended to notify physicians and clinical investigators planning or conducting clinical trials using medical devices to treat CCSVI that they must comply with FDA regulations for investigational devices.

The “liberation procedure” uses balloon angioplasty devices or stents to widen narrowed veins in the chest and neck. However, the FDA has learned of cases involving death, stroke, detachment, and migration of the stents, as well as damage to the treated vein, blood clots, cranial nerve damage and abdominal bleeding associated with the experimental procedure. Balloon angioplasty devices and stents have not been approved by the FDA for use in treating CCSVI.

Some researchers believe that CCSVI, which is characterized by a narrowing (stenosis) of veins in the neck and chest, may cause MS or may contribute to the progression of the disease by impairing blood drainage from the brain and upper spinal cord. However, studies exploring a link between MS and CCSVI are inconclusive, and the criteria used to diagnose CCSVI have not been adequately established, according to the FDA.

The FDA gave the following reasons for issuing the warning:

There is no clear diagnostic evidence that CCSVI exists as a distinct clinical disorder or is linked to MS.

Venous stenoses seen on imaging tests may be normal variants that do not cause any symptoms or disease, since they are sometimes seen in healthy people.

The safety and effectiveness of using balloon angioplasty devices or stents in the internal jugular or azygos veins have not been established for any clinical condition; nor has the FDA approved the use of these devices in these veins.

There is no clear scientific evidence that the treatment of internal jugular or azygos venous stenosis is safe in MS patients, impacts the symptoms of MS, changes the overall course of MS, or improves the quality of life for MS patients.

It is possible that stent placement can worsen any venous narrowing. This is because further narrowing has been shown to sometimes occur within stents placed in veins, due to the body’s response to the implant.

“Because there is no reliable evidence from controlled clinical trials that this procedure is effective in treating MS, FDA encourages rigorously-conducted, properly-targeted research to evaluate the relationship between CCSVI and MS,” said William Maisel, M.D., M.P.H., chief scientist and deputy director for science in the FDA’s Center for Devices and Radiological Health. “Patients are encouraged to discuss the potential risks and benefits of this procedure with a neurologist or other physician who is familiar with MS and CCSVI, including the CCSVI procedures and their outcomes.”

Complications following CCSVI treatment can be reported through MedWatch, the FDA Safety Information and Adverse Event Reporting program. For more information visit www.fda.gov/Safety/MedWatch/HowToReport.    

In February 2012, the FDA sent a warning letter to a sponsor/investigator who was conducting a clinical study of CCSVI treatment without the necessary approval. The sponsor/investigator voluntarily closed the study.

The FDA says it will continue to monitor reports of adverse events associated with “liberation therapy” or the “liberation procedure” and keep the public informed as new safety information becomes available.

Not surprising that the FDA is warning us about CCSVI; I think it was pretty clear that CCSVI treatment has not been proven to help MS patients - it seems to be very helpful for some but not helpful for others.  It is always important to research different "treatments" and "procedures" before diving right in.  It is nice that the FDA is recognizing this and looking into it though.

Finally, the emailer reports that Tovaxin has undergone a name change and will now be referred to as Tcelna (pronounced Te-SELL-nuh).  Tcelna is being researched as a treatment for secondary progressive MS.

Happy World MS Day! 

Last Year of my 20s

I turned 29 last week and officially entered the last year of my 20s.  I hope that this year is a great end to an era :)  I will have my first child, entering motherhood is sure to be amazing in more ways than one!  I will mark my 2nd anniversary of my diagnoses with MS in September and I will hopefully have an opportunity to get a new MRI and see if I have developed new lesions - I will keep my fingers crossed that I have not!  I am optimistic that this will be a good year!

In news, I just read a blurb that a study was done to see if there is a link between cell phone use and MS - lucky for all of us living in the technology-rich world, "no significant evidence for a pronounced association between mobile phone use and risk of MS or mortality rate among people with MS" was found.

Want to be involved in a clinical trial?  Check out one of these:

What Triggers MS in Kids? –

Investigators nationwide are recruiting 640 children with early relapsing-remitting MS or CIS (clinically isolated syndrome, a single episode of MS-like symptoms) and 1280 children without MS or CIS for a four-year study to determine environmental and genetic risk factors that make children susceptible to developing MS. The study, funded by the National Institutes of Health, leverages the National MS Society’s support of the Promise: 2010 Pediatric Network of Centers of Excellence.

Those under age 18 who had disease onset (MS or CIS) in the last two years may enroll in this study with the consent of their parents. Children without MS or CIS can enroll if they are 19 or younger and don’t have a demyelinating disease or an autoimmune disorder (except asthma). 

Participants are providing blood samples to test for genetic and environmental risk factors that may be associated with pediatric MS. Next, all participants are completing questionnaires about relevant environmental factors. Investigators also will draw information from participants’ medical records.

For further information, please contact Janace Hart (University of California, San Francisco) at (415) 514-2476.

Participate in a Trial of Vitamin D Supplementation –

Investigators at several centers nationwide are recruiting 172 people with relapsing-remitting MS to compare the effectiveness of the current recommended amount of vitamin D supplementation versus high dose vitamin D supplementation at reducing MS disease activity, when added to standard therapy with glatiramer acetate (Copaxone®, Teva Pharmaceutical Industries).

To learn more about the enrollment criteria for this study, and to find out if you are eligible to participate, please see: http://click.icptrack.com/icp/relay.php?r=28288047&msgid=425901&act=X8WI&c=263560&destination=http://www.clinicaltrials.gov/ct2/show/NCT01490502, or e-mail vitamindtrialms@jhmi.edu. 

Pregnancy & MS

Well, life has been pretty overwhelming lately.  I am now into my 6th month of my pregnancy and although I am very excited to welcome my baby boy into the world, I am definitely not ready/prepared.  Good thing we have 3 more months!  My husband and I are trying to get our basement finished before our little one arrives because right now we don't have an empty room for the nursery.  Due to my "condition," I have not been much help in the basement project.  I feel a little helpless, but I am trying to help in any way that I can.  Unfortunately, this pregnancy (or this pregnancy plus my MS) have me pretty tired!  I seem to make it through the work day ok, but when I get home, all I want to do is sit and/or sleep.  I know that my body is working really hard and it is normal to be tired, but we have SO much to do and SO much going on right now that being tired is not really an option right now during daylight hours.  I have been going to sleep around 9pm each night which helps, but the problem is I feel ready for bed around 7pm (some days even earlier).  Anyway, I just wish I had a little more energy to get everything done that needs to be done.

Speaking of pregnancy, this article was in my last emailer from MSF:

Pregnancy May Cut Risk of Developing MS

New research suggests that pregnancy may decrease women's risk of developing multiple sclerosis.

In an Australian study of 282 people with MS symptoms, having one pregnancy was associated with nearly halving the risk of developing MS symptoms compared to those who were never pregnant. Risk decreased even more with additional pregnancies, according to the study.

Study author Anne-Louise Ponsonby, head of the environmental and genetic epidemiology and research group at Murdoch Children's Research Institute in Melbourne, Australia, and her research team reported they found an association between pregnancy and a lower risk of MS symptoms, not a direct cause-and-effect link.

Previous research has found that pregnancy in women who already have MS is linked with lower rates of relapse. The researchers say this association may help explain why the incidence of MS in women has inched up over the past few decades, as more women delay pregnancy or have fewer babies or none at all.

“In our study, the risk went down with each pregnancy and the benefit was permanent,” said Ponsonby.

Researchers reviewed information about 282 Australian men and women between the ages of 18 and 59 who had a first diagnosis of central nervous system demyelination, which means they had their first symptoms similar to MS but had not yet been diagnosed with the disease. They were compared to 542 men and women with no MS symptoms. For women, the number of pregnancies lasting at least 20 weeks and the number of live births were recorded. For men, the number of children born was recorded.

The study found that women who were pregnant two or more times had a quarter of the risk of developing MS symptoms and women who had five or more pregnancies had one-twentieth the risk of developing symptoms than women who were never pregnant. There was no association between the amount of children and risk of MS symptoms in men.

“The rate of MS cases has been increasing in women over the last few decades, and our research suggests that this may be due to mothers having children later in life and having fewer children than they have in past years,” said Ponsonby.

The researchers couldn't say exactly why pregnancy may lower MS risk, but they speculated it could be the increase in estrogen during pregnancy or the effect pregnancy has on inflammatory genes involved in MS.

The information may lead to future studies looking into hormonal treatment or other treatments that may alter the disease course.

The study was published online in the journal Neurology.

This article really made me wish that I had gotten pregnant earlier on in my life.  I am 28 now, will be 29 when this baby is born (god willing he doesn't come THAT early), and it would appear that had I gotten pregnant in my early 20s or even earlier, maybe I would have significantly decreased my risk of developing MS.  I guess there is no point in dwelling on what might have happened had I gotten pregnant earlier, but it does make me wonder if I ever would have been diagnosed had I had a baby earlier.  I wouldn't have been ready to be a mom in my early 20s, so really it is best that I didn't have a baby then, but sure would be nice to not have MS.  Makes me think of a Shel Siverstien poem called Woulda-Coulda-Shoulda:

All the Woulda-Coulda-Shouldas
Layin' in the sun,
Talkin' bout the things
They woulda-coulda-shoulda done...
But those Woulda-Coulda-Shouldas
All ran away and hid
From one little did.

 We all have woulda-coulda-shouldas, but we have to learn to live with the way things are (the "dids").  Don't get me wrong - I am very happy with the way my life has turned out.  I love my husband, my family, my job, my unborn baby boy, etc.  But who doesn't wonder and who doesn't wish certain aspects of their life was different?

100th Post!

This is my 100th post!  What a milestone!

Last Saturday was my local Walk MS - we had a great turnout and I was, again, reminded of just how blessed I am.  My husband, my parents, my boss, 2 co-workers/friends, and a high school friend all walked with me!  In addition, my high school friend, who is now a high school teacher and coach brought her varsity softball team out to walk AND they made t-shirts for our team!  It was so great to have so many friends/family supporting me by walking beside me!  I am constantly amazed at the incredible people in my life!  I have such a great family, great co-workers, and great friends who are always so supportive; I am truly blessed!  Also, my sister made a HUGE donation this year helping me reach my lofty $3000 fundraising goal!  Even though she lives too far away to walk with me, she is always super supportive of my efforts!  I also had a number of other great friends donate, helping me reach my goal - I am always overwhelmed at all of the support I get.  Sometimes I probably don't seem a appreciative as I am.  I am always trying to get people involved and raise as much as I can, and sometimes I don't always realize how burdensome that can be.  But, when I really reflect, I could not ask for more supportive friends and family.  Thank you to all who walked and thank you to all who donated!  I was able to surpass my personal fundraising goal and I think we will surpass our team fundraising goal (the totals are not final yet, but I am very confident)!  It means so much to me to raise money for research.  As all of my friends, family, and readers know, the ultimate goal is to end MS - to find a cure!  And we can do that, I really believe that!  I just hope that the cure comes within my lifetime!

Thanks to all who have supported me in all of the ways that you have!

Walk MS

My local Walk MS is less than a week away!  Next Saturday, my friends and family (& thousands more) will gather to walk to create a world free of MS!  I am only about $500 shy of meeting my fundraising goal this year!  I hope that I can still reach my mark, although I am pretty happy with the $2500+ I have raised so far!

Visit my personal page!

Wish me luck!

MS Awareness Week

This week is MS AWARENESS WEEK!  Plus, all of March is MS Awareness Month, so spread the word - the more people know, the more likely we can work together to find a cure.

Here is more from my MSF email:

Research Investigates MS Lesion Impact on Brain and Behavior
Researchers at Wayne State University are taking a closer look at MS damage in the brain to better understand how lesions create certain symptoms, including cognitive, emotional, and behavioral changes. Their hope is that one day this information can be used to develop treatments that can be used to alleviate these symptoms more effectively than those being used today.
Treating MS patients with drugs used for typical behavioral disorders such as schizophrenia and depression can have terrible side effects and can be ineffective because the drugs are attempting to rectify nonexistent imbalances in brain neurochemicals, according to Alexander Gow, Ph.D., professor in Wayne State University's Center for Molecular Medicine and Genetics and School of Medicine's departments of pediatrics and neurology.
While not everyone with MS has cognitive problems, over time some people can lose their ability to focus mentally, forget what they want to do, or have difficulty following conversations. They also can become extremely depressed or frustrated at their inability to perform daily mental functions.
Gow believes the immune system attacks that damage or destroy white matter brain cells (oligodendrocytes) and cause the more catastrophic symptoms of MS also destroy cells in the brain's gray matter cells (neurons), where auditory, visual and cognitive functions are based.
"Changes in gray matter could well be associated with emotional outbursts," Gow said. "Cells involved in memory and learning are also being destroyed. Whenever those sorts of changes occur, you almost always see frustration in patients as they try to grapple with the resultant loss in mental capacity.
"That causes them to be upset about not being able to do things, even if they don't know that's what's going on physically. This can also lead to them withdrawing from social settings with family and friends, which deepens the impact of MS."
MS patients' more severe symptoms result when the immune system attacks the myelin that surrounds white matter cells, causing lesions that are visible in magnetic resonance imaging scans. Gow said if viewed the right way, lesions also can be seen in gray matter, indicating that neurons and not just oligodendrocytes are being destroyed.
"That then gives us an anatomical basis for memory loss and patients' inability to focus," Gow said.
Researchers will examine white matter for specific changes indicating the presence of biomarker substances that cause MS-like symptoms. If those substances are found, researchers then can try to administer drugs to reverse the effects of the myelin attacks.
"Using different classes of existing drugs," Gow said, "novel therapies can be developed with shorter delays in moving from the bench to the bedside."

High Resolution Images Reveal Receptor Action Key to MS
A team of scientists from The Scripps Research Institute, collaborating with members of the drug discovery company Receptos, created the first high-resolution virtual image of cellular structures known as S1P1 receptors, which are critical in controlling the onset and progression of MS and other diseases.
The new study used the technique of x-ray crystallography to reveal the high-resolution 3D image of the S1P1 receptor. The results provide scientists with new details about the receptor’s mechanism of action.
One aspect of the receptor structure that is of particular interest is the binding pocket for the natural ligand or potential drugs that activate the receptor responses. The structure revealed how the binding pocket shifts to activate signaling. Understanding how that occurs makes it easier to identify additional compounds that might have effects in controlling the receptors.
With the structural information in hand, the scientists say they can advance efforts to understand the specific chemical transformations that drive the cellular responses tied to MS and other diseases.
Researchers have long known that S1P1 receptors play critical roles in controlling multiple sclerosis and other diseases. One way the receptors do this is by regulating the flow of certain white blood cells, or lymphocytes, out of lymph nodes.
This is critical because in patients with multiple sclerosis, auto-reactive lymphocytes attack the protective sheaths of nerve cells in the brain, causing malfunctions in the way the central nervous system transmits signals through the body. The S1P1 receptors are also involved in the progression of harmful scarring and swelling in response to lymphocyte damages in the brain.
The research was reported in the journal Science.

Implanted Microchip Delivers Injections on Demand
The first successful test has been reported for a programmable, wirelessly-controlled microchip that delivers drugs after being implanted in a patient’s body. Though the microchip in this study was administering daily doses of an osteoporosis drug normally given by injection, researchers project that the technology may one day also be applied to treatments for diseases such as MS.
In the new study, funded and overseen by MicroCHIPS, scientists used the programmable implants to deliver an osteoporosis drug called teriparatide to seven women aged 65 to 70. The study found that the device delivered dosages comparable to injections, and there were no adverse side effects.
The drug-delivering microchip is the brainchild of MIT professors Robert Langer and Michael Cima. The results of their study, published in the online edition of Science Translational Medicine, could help usher in a new era of telemedicine – delivering health care over a distance, Langer says.
"You could literally have a pharmacy on a chip," says Langer, the David H. Koch Institute Professor at MIT. "You can do remote control delivery, you can do pulsatile drug delivery, and you can deliver multiple drugs."
"Patients with chronic diseases, regular pain-management needs or other conditions that require frequent or daily injections could benefit from this technology," says Robert Farra, president and chief operating officer at MicroCHIPS and lead author of the paper.
"Compliance is very important in a lot of drug regimens, and it can be very difficult to get patients to accept a drug regimen where they have to give themselves injections," says Cima, the David H. Koch Professor of Engineering at MIT. "This avoids the compliance issue completely, and points to a future where you have fully automated drug regimens."
Once a version of the implant that can carry a larger number of doses is ready, MicroCHIPS plans to seek approval for further clinical trials, Farra says.

Brain Exercises Help Improve Cognition Skills
Functional magnetic resonance imaging (fMRI) shows that cognitive rehabilitation changes brain function and improves cognitive performance in people with relapsing-remitting MS, according to a new study from Italy.
"These results prompt the use of specific computer-based rehabilitation programs to treat deficits in selected neuropsychological domains in patients with relapsing-remitting MS," said the study's lead author, Massimo Filippi, M.D., professor of neurology at the San Raffaele Vita-Salute University and director of the "BrainMap" interdepartmental research program and the Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute San Raffaele, Milan, Italy. "They also suggest that fMRI might provide useful metrics to monitor the effects of rehab in MS."
For the study, Dr. Filippi and colleagues recruited 20 patients with relapsing-remitting MS. Patients were randomized into two groups of 10. The first group received a 12-week program of computer-assisted cognitive rehabilitation of attention and information processing and executive functions, and the second (control) group received no cognitive rehabilitation.
Aspects of the rehabilitation program included a day-planning task, which employed realistic simulations of a set of scheduled dates and duties to address the patient's ability to organize, plan and develop solution strategies; and an attention task requiring the patient to simulate driving a train, carefully observing the control panel of the train and the countryside while encountering several distractions at increasing levels of difficulty.
All of the patients underwent neuropsychological assessment and MRI exams at baseline and after 12 weeks. As compared to their performance at baseline, the patients in the treatment group improved in tests of attention and information processing and executive functions. The fMRI results showed modifications in activity in several brain regions in the rehabilitation group, compared to the non-rehabilitation group. These fMRI modifications were correlated with cognitive improvement.
Analysis after cognitive rehabilitation found no structural changes in the gray matter or normal-appearing white matter of the brain in the treatment group.
"The findings demonstrated that computer-assisted cognitive rehabilitation in patients with MS results in an improvement of the trained cognitive functions," Dr. Filippi said. "However, the structural integrity of the brain's gray matter and white matter showed no modifications in these patients, suggesting an impairment of structural plasticity."

 If you'd like to make a donation to my Walk MS team, visit our team page!

Hello, Again

I know it has been awhile, but there is a reason, I promise!  Mostly exhaustion!  I am pregnant and off my meds so I have pregnancy exhaustion plus MS fatigue.  Overall, however, I have been feeling great!  I have to go to bed earlier, but I, luckily, bypassed most of the early-pregnancy nausea and my MS flare-ups have been minor and few and far between.  I feel very blessed!  I am 19 weeks along now and my husband and I couldn't be more excited to welcome our baby boy to this world sometime around the end of July!  I feel like all I do lately is eat, sleep and work, but it is good! 

We've had a lot going on at the society lately too - we had a booth set up at our local Women's Fair in February, which I worked.  We lost an amazing staff member, which was really sad, but we all understood her reasons for leaving and we wish her the best!  Our Walk MS event is less than a month away - March 31st!  So I have that going on as well.  If you are interested in donating, visit my personal page!  I have a fairly lofty goal this year and am starting to worry that I won't reach it.  I have 5 other team members - my faithful husband, my loving parents, and two great co-workers!  I am hoping that I can rope a few more people into participating, but we'll see. 

And now, MS news from my most recent MSF email:

BG-12 New Drug Application Submitted

Biogen has announced it has submitted a New Drug Application to the U.S. Food and Drug Administration (FDA) for marketing approval of BG-12 (dimethyl fumarate), an investigational oral therapy in late-stage clinical development for the treatment of relapsing-remitting MS. The regulatory submission was based on research in which BG-12 demonstrated significant reductions in MS disease activity coupled with favorable safety and tolerability – the Phase 3 DEFINE and CONFIRM studies.

In 2011, Biogen Idec announced positive data from DEFINE and CONFIRM, two global, placebo-controlled phase III clinical trials that evaluated 240 mg of BG-12, administered either twice a day or three times a day, for two years.
Biogen Idec says there are also plans to submit a Marketing Authorisation Application for BG-12 to the European Medicines Agency (EMA) within the coming days.

“The rapid submissions of our BG-12 regulatory packages, which integrated one of the largest placebo-controlled data sets for a filing in MS, reflect our commitment to bringing additional therapies to patients in need as quickly as possible,” says Douglas E. Williams, Ph.D., Biogen Idec’s executive vice president of Research and Development. “We anticipate hearing from regulatory authorities regarding the status and acceptance of our submissions within the next couple of months.”

 

 

Scientists Dismiss One Hypothesis on How MS Develops
One current hypothesis on how MS develops has recently been refuted by neuroimmunologists who studied myelin damage that was created in a new mouse model of the disease. They concluded that the death of oligodendrocytes (the cells that produce the myelin sheath) does not trigger MS.
With their research, the scientists say they have disproved the so-called "neurodegenerative hypothesis." This was based on their observations that certain patients exhibited characteristic myelin damage without a discernable immune attack. In their new hypothesis, the scientists assume that MS-triggering myelin damage occurs without the involvement of the immune system. In this scenario, the immune response against myelin would be the result – and not the cause – of this pathogenic process.
Using genetic tricks, the scientists induced myelin defects without alerting the immune defense. "At the beginning of our study, we found myelin damage that strongly resembled the previous observations in MS patients," explains Burkhard Becher, a professor at the University of Zurich. "However, not once were we able to observe an MS-like autoimmune disease."
To ascertain whether an active immune defense causes the disease based on a combination of an infection and myelin damage, the researchers conducted a variety of further experiments – without success. "We were unable to detect an MS-like disease – no matter how intensely we stimulated the immune system," says Ari Waisman, a professor from the University Medical Center Mainz. "We therefore consider the neurodegenerative hypothesis obsolete."
The teams involved in the study want to continue researching the cause and origins of MS. "In light of these and other new findings, research on the pathogenesis of MS is bound to concentrate less on the brain and more on the immune system in future," says Professor Thorsten Buch from the Technischen Universität München.

Thanks for reading!  

From Epstein-Barr to Gilenya Guidelines

News from my latest email from MSF:

Evidence Mounts Regarding Role of Epstein-Barr Virus in MS

New research conducted in the United Kingdom strengthens the hypothesis that the Epstein-Barr virus (EBV) plays a role in MS. Researchers at Queen Mary, University of London, examined the post-mortem brains of people who had MS and found that even though the virus was latent, it had been sending out chemical signals in the form of RNA.

Those signals caused inflammation and turned on the immune system leading to the symptoms of MS, the researchers reported. Previous research has not successfully shown the connection, but that may be due to the fact that the virus hides in immune system cells when not replicating.

While more studies need to be conducted, researchers are optimistic that learning more will lead to better MS treatments. The anticancer drug Rituximab kills the cells EBV uses to hide and is being used in clinical trials.

“We have to be careful and have to study more MS brains but this is potentially very exciting research. Now we understand how EBV gets smuggled into the brain by cells of the immune system and that it is found at the crime scene, right where the attack on our nervous system occurs. Now we know this, we may have a number of new ways of treating or even preventing the disease,”

the researchers noted.

 

Reversing Remyelination in Mice

A new study in mice shows that the age-associated decline in the regeneration of the nerve's myelin sheath, or remyelination, is reversible. The study demonstrates that when old mice are exposed to the inflammatory cells (called monocytes) from young mice, the ageing remyelination process can be reversed.

"For individuals with MS, this means that in theory regenerative therapies will work throughout the duration of the disease. Specifically, it means that remyelination therapies do not need to be based on stem cell transplantation since the stem cells already present in the brain and spinal cord can be made to regenerate myelin -- regardless of the patient's age," says Professor Robin Franklin, Director of the MS Society's Cambridge Centre for Myelin Repair at the University of Cambridge. Researchers at Harvard University also participated in the study.

The study was published in the journal Cell Stem Cell.

 

Looking at MS from a Different Perspective

While the current consensus among scientists is that MS is an auto-immune disease, one researcher from New York has proposed a very different theory: that MS may result from problems with the way the body metabolizes lipids, or fats in the blood. This in turn would cause the inflammation and spark a series of damaging events. 

Angelique Corthals, a forensic anthropologist at the John Jay College of Criminal Justice in New York, conducted a lengthy review and analysis of existing research. She notes that MS shares that underlying mechanism with atherosclerosis. (“Sclerosis” refers to hardening or scarring such as the build-up of plaque in arteries and the development of plaques in the brain associated with MS.)

She concludes that viewing MS in this light helps explain many mysteries that the autoimmune model leaves unanswered, including the role genetics play in MS risk, the environmental elements or pathogens that may trigger disease onset, and the reasons MS strikes twice as many women as men. (Atherosclerosis affects men more commonly than women; Carthals suggests gender differences in lipid metabolism may play a big role in determining who gets which condition.)

Because anti-inflammatory drugs such as statins commonly used to fight cardiovascular disease have also been used to treat symptoms of MS, she writes, such drugs may become part of more comprehensive and effective MS treatments than currently exist.

Carthals’ recently presented her theory in The Quarterly Review of Biology.

 

Vitamin D Levels Linked to Depression

Low levels of vitamin D have been linked to depression, according to UT Southwestern Medical Center psychiatrists working with the Cooper Center Longitudinal Study. It is believed to be the largest such investigation ever undertaken.

UT Southwestern researchers examined the results of almost 12,600 participants from late 2006 to late 2010. Dr. Brown and colleagues from The Cooper Institute found that higher vitamin D levels were associated with a significantly decreased risk of current depression, particularly among people with a prior history of depression.

Low vitamin D levels were associated with depressive symptoms, particularly those with a history of depression, so primary care patients with a history of depression may be an important target for assessing vitamin D levels. The study did not address whether increasing vitamin D levels reduced depressive symptoms.

The scientists have not determined the exact relationship -- whether low vitamin D contributes to symptoms of depression, whether depression itself contributes to lower vitamin D levels, or chemically how that happens. But vitamin D may affect neurotransmitters, inflammatory markers and other factors, which could help explain the relationship with depression, said Dr. E. Sherwood Brown, who leads the psychoneuroendocrine research program at UT Southwestern.

"Our findings suggest that screening for vitamin D levels in depressed patients -- and perhaps screening for depression in people with low vitamin D levels -- might be useful," said Dr. Brown, professor of psychiatry and senior author of the study, done in conjunction with The Cooper Institute in Dallas. "But we don't have enough information yet to recommend going out and taking supplements."

European Medicines Agency Strengthens Gilenya Guidelines While Review Underway

The European Medicines Agency, the agency responsible for the scientific evaluation of medicines for use in the European Union, has undertaken a review of Gilenya following cases of serious cardiac events and death in people who had recently started the medicine. As yet, there is not enough information to determine if Gilenya was the cause of these cases, which is why a review is underway. During the review, the agency has strengthened its recommendations for monitoring patients who receive the drug.

The new guidelines are as follows:

Before starting treatment with Gilenya, all patients should have their heart checked by ECG, a test that measures the electrical activity of the heart.

After receiving the first dose of Gilenya, all patients should have their heart function continuously monitored by ECG for six hours.

All patients should also have their blood pressure and heart rate checked every hour for six hours after the first dose.

If patients develop any clinically relevant heart problem (such as bradycardia or atrioventricular block), doctors are advised to consider extending the monitoring period until it is resolved.

These guidelines apply only within the European Union. FDA guidelines within the U.S. remain unchanged. Those being treated or planning to begin treatment who have questions can call Novartis, the drug's manufacturer, at 1-888-NOW-NOVA.

 

As always, new and exciting research is ongoing!  The most interesting thing here, in my opinion, is looking at MS from a new perspective.  The most exciting thing here is that remyelination is possible!  Hope all is well!

More on CCSVI

The following information on CCSVI research is published on the NMSS website:

Reports from seven multi-disciplinary teams investigating CCSVI (chronic cerebrospinal venous insufficiency) in MS indicate that they are making good progress toward providing essential data and critical analysis as these two-year projects move toward their completion. The studies were launched on July 1, 2010 with a more than $ 2.4 million commitment from the MS Society of Canada and the National MS Society (USA). The ongoing work by the seven teams will help inform the design of an early-phase clinical trial that is expected to launch in late spring 2012 with funding from the MS Society of Canada and the Canadian Institutes of Health Research (CIHR).
The research teams have recruited and scanned a broad spectrum of people with MS and others to build understanding of who may be affected by CCSVI. In addition they are refining CCSVI imaging methods for accuracy and consistency to reliably validate the occurrence of CCSVI and understand its implications in the MS disease process. All of the seven teams are working under approvals from the required Institutional Review Boards in the U.S. or the Research Ethics Board in Canada, a first step established by regulatory authorities to protect human subjects involved in research projects.
Already more than 800 people have undergone scanning with various imaging technologies being used by the studies, including the Doppler ultrasound technology used by Dr. Paolo Zamboni and his collaborators, as well as magnetic resonance studies of the veins (MR venography), catheter venography, MRI scans of the brain, and clinical measures.
Representatives of each of the seven funded teams are part of the CIHR’s Scientific Expert Working Group. In November 2011 the Canadian Institutes of Health Research (CIHR) announced the release of a Request for Proposals seeking grant applications from researchers to conduct an early-phase clinical trial in Canada to test the ability of a surgical procedure called balloon venoplasty to improve blood drainage in individuals with MS who have been identified as having CCSVI. The request for research proposals is a collaborative initiative between the CIHR and the MS Society of Canada. The working group will provide leadership and advice concerning the clinical trial, and will continue to monitor and analyze the data from the seven studies and other studies related to CCSVI and MS around the world.
Several teams have presented, or are planning to present, preliminary results at medical meetings. Because the studies employ rigorous blinding and controls designed to collect objective and comprehensive data, the full results of the ongoing research will be available only after completion of the studies which will involve more than 1300 people representing a spectrum of MS types, severities and durations, as well as individuals with other disease types and healthy controls.
“The research underway is significantly advancing our understanding of CCSVI and what its relationship might be to MS disease process,” notes Dr. Tim Coetzee, chief research officer at the National MS Society. Dr. Karen Lee, Vice President Research at the Canada MS Society, concurs, “We are pleased that our collaborations with the National MS Society and CIHR are moving us closer to the answers that people with MS need about CCSVI and MS.”
Details of Progress
The funded investigators, who are drawn from a broad range of disciplines ranging from MS neurology, vascular surgery and interventional radiology, report progress in establishing standardized protocols, recruiting and scanning participants and in the development of plans for sharing their findings, as summarized below.
• Dr. Brenda Banwell, The Hospital for Sick Children, Toronto, Ontario
Dr. Banwell’s team is seeking confirmation for findings that Cerebrospinal Venous Insufficiency is a cause for MS. If impaired venous drainage occurs as a key part of the beginnings of the MS process, then venous abnormalities should be present even in the youngest MS patients. The team is now studying children and teenagers with MS to determine whether the venous system is abnormal in a population where the disease process is at a very early stage. Unlike adult MS patients, children are very unlikely to have any age-related changes in blood vessels, and do not have any of the adult-onset health conditions (such as high blood pressure, heart disease, use of medications) that might complicate the ability to determine whether blood flow patterns are due to MS or other causes. Their ultrasound team has received training from Dr. Zivadinov’s group in Buffalo, and has created ultrasound and brain imaging procedures suited to explore venous drainage in children. They plan to assess 30 children with MS, 30 healthy children of the same age, and 30 “graduates” (young adults who experienced the onset of MS during childhood and who received care and prior brain imaging studies at the Hospital for Sick Children). Enrollment began in December 2010 and Dr. Banwell’s team has reported that it is going well. To ensure the highest standards of scientific accuracy, they intend to analyze their findings once all 90 participants have undergone the testing; which will help to determine whether impaired venous drainage is indeed a core component of MS.
• Dr. Fiona Costello, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
The University of Calgary team has initiated a prospective cross-sectional study to determine the association between ultrasonography (US) and magnetic resonance venography (MRV) measures of venous outflow in MS patients. This study will evaluate 120 people with MS (including 65 with relapsing-remitting MS, 20 with secondary-progressive MS, 10 with primary-progressive MS, 10 with neuromyelitis optica, and 15 with pediatric MS) and 60 age- and sex-matched healthy control subjects. To date, 98 participants have been recruited. The main outcome measure will be the proportion of cases and controls with US and MRV evidence of extracranial venous outflow obstruction. Secondary outcomes will include MRI measures of brain inflammation, Expanded Disability Status Scale (EDSS) scores, and extracranial US measures of venous wall thickening and jugular valve competence.
The team published a paper based on the cases of five people who had experienced medical complications after undergoing procedures focused on treatment of venous abnormalities: “Complications in MS Patients after CCSVI Procedures Abroad.” Burton JM, Alikhani K, Goyal M, Costello F, White C, Patry D, Bell R, Hill M. (Calgary, AB).

• Dr. Aaron Field, University of Wisconsin School of Medicine and Public Health, Madison
Official approval of this study protocol was issued on June 28, 2011. The team continues to actively recruit study subjects from a database of approximately 100 MS patients who had contacted them since the study was first announced, as well as from the patient population seen regularly in their MS clinic. Thus far, 17 people with MS and 12 healthy controls have undergone both MRI/MRV and ultrasound imaging. No results are yet available as the study is blinded.
Since the previous progress report, Dr. Field was awarded a $27,000 grant from his institution to further investigate the novel MRI components of this study in healthy controls, particularly with regard to reliability and reproducibility. Specifically, they investigated (1) the use of a novel method to adjust venous flow measurements for variations related to breathing and heartbeat, (2) the use of a novel MRI method for measuring the iron content in brain tissue, and (3) the use of a relatively new, FDA-approved MRI contrast agent (a drug administered intravenously to enhance the visibility of blood vessels on MRI) that can enhance the visibility of head/neck veins and enable the measurement of blood flow through brain tissue. Ten healthy subjects underwent these components of the team’s CCSVI protocol twice, on separate days. Progress made in these studies includes:
• The team’s novel approach to measuring venous flow with MRI is able to detect clear differences in venous flow between inspiration and expiration, and demonstrates evidence of expiration-related reflux (backwards flow) in the jugular veins of healthy subjects.
• The team’s system of rating the degree of venous narrowing on MR images of the azygous and jugular veins yields comparable results when performed by different individuals.
• Their novel MRI method for measuring iron content in brain tissue provides reproducible results that are comparable to previously described methods of iron measurement, with fewer technical pitfalls.
• A single dose of a relatively new MRI contrast agent is sufficient to enhance the visibility of head/neck veins and generate reproducible maps of blood flow through the brain. (It would normally require two separate doses of a conventional contrast agent to accomplish both of these objectives.)
These investigations have yielded two abstracts presented or to be presented at national/international imaging meetings:
“Comprehensive assessment of cerebral venous return with MRA: preliminary results.” Wieben O, Johnson K, Schrauben E, Reeder S, Field A. 23rd annual meeting of the “MRA Club” (International Magnetic Resonance Angiography Workshop), Calgary, Alberta, Canada, September 25-28, 2011.
“The importance of the sonographer in the investigation of chronic cerebrospinal venous insufficiency.” Kohn S, Kliewer K, Field AS. American Institute of Ultrasound in Medicine (AIUM) Annual Convention, Phoenix, AZ, March 29-April 1, 2012.
In addition, three abstracts have been submitted for consideration for the American Society of Neuroradiology (ASNR) 50th Annual Meeting, New York, NY, April 21-26, 2012, and two have been submitted for the International Society of Magnetic Resonance in Medicine (ISMRM) 20th Annual Meeting & Exhibition, Melbourne, Victoria, Australia, May 5-11, 2012.
• Dr. Robert Fox, Cleveland Clinic Foundation, Cleveland
Dr. Fox’s team continues to use MR venography, ultrasound, MRI and clinical measures in people with MS or who are at risk for MS (CIS) and comparison groups to evaluate vein drainage. The ultrasound team, which underwent training in the technique originally used by Dr. Zamboni, found several aspects of the published methodology ambiguous, and they have standardized the protocol and analysis to achieve consistent results.
Early on they identified physiological and technical factors that can complicate screening for vein blockages using ultrasound, including that heartbeat irregularities, stages of breathing, head position and pressure applied by the operator could alter results; and that the state of hydration of the subject (whether they drank adequate amounts of fluids) might impact results of several of the criteria used to determine CCSVI.
The team reported at the international ECTRIMS/ACTRIMS congress in October 2011 preliminary results of ultrasound assessments. Pooling the results of the ongoing, blinded study of CCSVI in MS and non-MS controls, they reported results from the first 20 subjects, finding that 6 (30%) met criteria for CCSVI, four subjects met no criteria, and none met criteria for reverted postural control of cerebral venous outflow. Nine subjects (45%) had a flap and/or septum/abnormal valve. Identifi¬cation of deep cerebral vein reflux depended upon the ultrasound technique. They noted that this finding highlights the importance of ultrasound methodology in performing and interpreting deep cerebral vein assessments. (P1104 – “Ultrasound assessment of chronic cerebrospinal venous insufficiency.” R. Fox, L. Baus, C. Diaconu, A. Grattan, I. Katzan, S. Kim, M. Lu, L. Raber, A. Rae-Grant)
At the same ECTRIMS/ACTRIMS meeting, the team shared preliminary results from an ongoing study of vein structure in autopsy specimens from seven people who had MS in their lifetimes, compared to six people who did not have MS. In this unblinded study, they identified abnormalities inside the vein tubes (lumen) that drain the brain and found a variety of structural abnormalities and anatomic variations in both groups. However, they reported higher frequency of abnormalities in those who had MS (2 abnormalities in 2 out of 6 controls versus 9 abnormalities in 6 out of 7 MS patients). They noted that MR venography may be less effective than ultrasound for identifying these venous abnormalities, and that ultrasound that examines only vein wall circumference may miss some intraluminal abnormalities. (Abstract 134 – “Anatomical and histological analysis of venous structures associated with chronic cerebro-spinal venous insufficiency.” C. Diaconu, S. Staugaitis, J. McBride, C. Schwanger, A. Rae-Grant, R. Fox)
• Dr. Carlos Torres, The Ottawa Hospital, University of Ottawa, Ontario
The team began phase 1 of their project which consists of imaging with MRI the veins of the head and neck of 100 people without MS. MR venography is also being performed to obtain normative data that will allow the team to better understand the normal anatomy and variants of the veins before they begin to examine the veins of the subjects and controls.
So far, they have performed this additional sequence in 85 people and expect to complete the target of 100 within the next 2 weeks. Further, they have gathered MRI studies of 30 people with a specific sequence that allows them to measure the amount of iron in the brain. The iron deposits are being quantified by an MR Physicist.
In order to perform the ultrasound studies of the veins in the head and neck the same way they were done as described by Dr. Zamboni, the team received training in Vancouver from an experienced group who received training in Italy. Two sonographers and a radiologist traveled to Vancouver and received appropriate training on the technique in mid-May.
In early September, the team reported that they successfully started phase 2 of the study recruiting subjects and controls through the Ottawa Hospital MS Research Unit. Since then, they have recruited a total of 30 people with MS (with relapsing-remitting, primary-progressive or secondary-progressive MS) and 30 controls (60 total), who have undergone both a contrast enhanced MRI and an ultrasound of the veins of the head and neck. The team is currently scanning approximately 4 people with MS and 4 controls per week. They expect to complete recruitment and begin analysis of the data by mid February 2012.
• Dr. Anthony Traboulsee, UBC Hospital MS Clinic, UBC Faculty of Medicine and Dr. Katherine Knox, Saskatoon MS Clinic, University of Saskatchewan
This team is conducting their study at two centers (UBC Hospital, Vancouver, BC and Saskatoon City Hospital, Saskatoon, Sask.) and the goal is to recruit up to 200 subjects. Imaging protocols have been both developed and tested and the group is very satisfied with the quality of their results. Their ultrasound technologists were trained by Dr. Zamboni to perform the ultrasound testing in a similar way. There is no previous standardized venography protocol for looking at neck veins.
Recruitment is now closed at the University of British Columbia site, and will be closing soon at the Saskatoon site. All investigations are expected to be completed in March 2012. The team plans to do the preliminary analysis by April 2012. Analysis will occur in stages, starting with the catheter venography and ultrasound data, then the MR venography results will be reviewed.
The team reported that the level of interest and response rate remained high throughout recruitment. The UBC site recruited 110. At the Saskatoon site, 70 subjects have been recruited and are at various stages of the protocol. All investigators remain blinded to the status of the subjects and do not have any preliminary results to report at this time.
• Dr. Jerry Wolinsky, University of Texas Health Science Center at Houston
The team reports that they have recruited about 82% of the expected study cohort. The cumulative number of volunteers recruited from study inception includes: 10 Healthy Volunteers; 34 Other Neurological Diseases; 22 Stroke/TIA; 12 CIS; 112 relapsing-remitting MS; 44 secondary-progressive MS; 1 progressive-relapsing MS; 15 primary-progressive MS. Of people with MS or CIS, 45 have undergone MR venography with advance MRI. In addition, to date 10 people with MS have consented to transluminal venography, 2 are scheduled for study and 4 have completed the procedure without complications. No therapeutic interventions are considered in these investigations.
Dr. Wolinsky and the team’s MR vascular expert, Dr. Larry Kramer, are members of the MS Scientific Expert Working Group established by the Canadian Institutes of Health Research (CIHR), in collaboration with the Multiple Sclerosis (MS) Society of Canada, and additional team members have participated in the meetings and provided advice to the CIHR as requested.
A summary of the team’s preliminary work was presented as a poster at the international ECTRIMS/ACTRIMS congress in October 2011. They used Doppler technology to evaluate venous drainage in a blinded fashion. They reported that of all participants, 48/162 fulfilled at least one of five criteria for anomalous venous outflow proposed by Dr. Zamboni; 10/48 fulfilled two criteria consistent with CCSVI; none fulfilled more than 2 criteria. There was no significant difference between people with MS and non-MS, or within MS subgroups. They also found no significant differences between MS and non-MS subjects for measures of cross-sectional areas of the internal jugular veins or for venous flow rates. The team concluded that thus far they find less CCSVI than previously reported by other groups. They are now focusing on whether ultrasound can be complemented or supplanted by MRV and/or transluminal venography. (P1108 -- “Prospective, case‐control study of CCSVI with imaging‐blinded assessment: progress report focused on neurosonography.” Barreto AD, Brod SA, Bui T, Jamelka J, Kramer LA, Ton K, Cohen AM, Lindsey JW, Nelson F, Narayana PA, Wolinsky JS (2011).
In addition, two abstracts have been submitted for consideration for the 64th Annual Meeting of the American Academy of Neurology to be held in late April 2012.
Going Forward
These seven teams were chosen by an international panel of experts that included specialists drawn from all key relevant disciplines including radiology, vascular surgery and neurology. The projects were selected for having the greatest potential to quickly and comprehensively determine the significance of CCSVI in the MS disease process.

At this 18-month milepost, the investigators are making significant progress on their overall two-year study goals. Some of the teams are presenting preliminary results at medical meetings, and all have shared technical advice so that the projects can move forward as smoothly and quickly as possible. Their results will help guide the development of an early-phase clinical trial to test whether treating vein blockages may be safe and effective in treating people with MS. The trial should launch in late spring 2012 with funding from the MS Society of Canada and the Canadian Institutes of Health Research (CIHR).
The next update on the work of the seven grantees will be reported in six months.

Blog Anniversary!

Today is my blog's one year anniversary!  It has been a great ride so far and I hope to continue giving updates and reporting on the ongoing research.  Things are going well for me right now - I have been in remission for about a year now (with a few slight flare ups here and there).  I am very pleased with my condition at this point and hope that I can continue feeling this well.

I have signed up for Walk MS which will occur in March - click here to visit my personal page.  I hope to surpass my fundraising goal from last year - I hope that I make it (I am fearful that my goal is too lofty). My local MS Society chapter has already had two events this year and both have been really great!  I am excited about what this year will bring!

And now, MORE news on Vitamin D from the NMSS website:

Researchers and clinicians from around the globe gathered recently in Chicago to develop strategies for testing whether vitamin D supplements can prevent the development of MS. Participants discussed the latest findings relevant to vitamin D and MS and potential clinical trial designs, taking the first steps to making these exciting studies a reality. “Vitamin D and MS Prevention: An International Workshop,” was chaired by Colleen E. Hayes, PhD (University of Wisconsin-Madison) and Anne-Louise Ponsonby, PhD (Murdoch Children’s Research Institute, Canberra Australia), and was funded by the National MS Society.
Background: Research is increasingly pointing to a reduced level of vitamin D in the blood as a risk factor for developing MS. Years ago, MS researchers wondered why MS occurs less often in regions of the world where exposure to sunlight is high. Dr. Hayes – a professor of biochemistry and microbiology – and colleagues suggested that vitamin D, which is made by cells in the skin in response to sunlight, may suppress the immune response involved in MS. She and others have since shown that in lab mice, vitamin D can reduce the effects of EAE, an MS-like disease.
Epidemiologic studies (studies of who gets MS) have backed up laboratory studies. Dr. Ponsonby – an epidemiologist and public health physician – was a co-author of the Ausimmune Study, a comprehensive Australian study that showed that higher levels of sun exposure and higher blood levels of vitamin D were both associated with decreased risk of having a first demyelinating event, often the first indicator of subsequent MS.
The National MS Society has led the way in pursuing this avenue of MS research, funding much of Dr. Hayes’ work, first funding the Ausimmune study, and now, a new clinical trial testing whether vitamin D can reduce disease activity in people who have MS. Read more on clinicaltrials.gov.
The Meeting: Participants included experts in vitamin D studies, immunology, statistics, epidemiology, clinical MS research, pediatric MS, and MS biomarkers. The group began by bringing its vast experience to bear in discussing the promise and potential pitfalls of conducting “primary prevention studies” using vitamin D to potentially prevent MS before it occurs.
“We are people from all over the world and we have one common purpose – to stop this disease,” noted Dr. Hayes. “The research that has been done by the people in this room and others provides us with strong evidence that vitamin D may help.”
Alberto Ascherio, MD, DrPH (Harvard School of Public Health) and colleagues have published pivotal studies relating to several MS risk factors. His 2006 study  – supported by the Society – compared levels of vitamin D in blood serum stored from military personnel during their service, and found that those with higher levels of vitamin D were at lower risk for later developing multiple sclerosis. Dr. Ascherio noted a major concern about designing vitamin D studies, based on his research. “Compliance is likely to be a major obstacle,” he said. “You have to worry about people in the placebo group that might take vitamin D anyway, and make the study powerful enough to account for that.”
George Ebers, MD, FRCP(C) (University of Oxford) reported on findings “hot off the press” – his team recently confirmed an association between MS and a gene linked to vitamin D. Dr. Ebers cautioned that before beginning a study, “You absolutely need to know what the rate of MS is in your country,” noting that the reported rates of MS is increasing in some areas.
Dr. Hayes reviewed basic research that could have a strong impact on planned studies. For example, female mice treated with vitamin D are protected from MS-like disease, but not male mice. “Normal estrogen may be essential for vitamin D benefits,” she said. Also, her research points to the immune messenger protein interleukin-10 as being essential for vitamin D protection from MS-like disease in mice. “Anything that destroys that pathway may undermine a treatment trial,” said Dr. Hayes.
Jorge Correale, MD (Raul Carrea Institute for Neurological Research Argentina) discussed his research on the immune response and vitamin D. “Vitamin D is particularly reduced during relapses in people with MS,” he said, noting that administering vitamin D to cells isolated from people with MS resulted in modulation of immune “T cells” which have been previously implicated in MS activity. He noted that cells that reduce inflammation are activated by vitamin D and those that promote inflammation are suppressed.
Reinhold Vieth, PhD, FCACB (University of Toronto) has been studying vitamin D for decades. His team’s findings show that this vitamin is associated with decreased PSA (a marker for prostate cancer), and a decreased risk of breast cancer. His experience provided numerous important considerations for conducting vitamin D prevention trials in MS. “Vitamin D binding protein [a protein that helps to transport the vitamin within the body] acts as a safety buffer to prevent toxicity,” he said. “It protects the body from having too much vitamin D.” Dr. Vieth works with the team that found vitamin D supplements to be safe in small, early study of people with MS.
Co-chair Dr. Ponsonby encouraged participants with her review of similar efforts undertaken to combat other diseases such as folate supplementation to mothers in pregnancy to prevent spina bifida. “I remember being at a primary prevention meeting in the early 1990’s ,like this one, to talk about sudden infant death syndrome prevention, which was taking one in 250 children in Tasmania at that time,” she said. “I thought, ‘How are we going to get this done?’ Five years later, it felt so good to be at another meeting, talking about how, after changes in health recommendation, the rate of SIDS had decreased by up to 70% in several countries.”
Future Steps: After reviewing data and hearing from statisticians and clinicians about the feasibility and expense of primary prevention studies, participants agreed to look at three study designs. The next steps are to submit a report based on the summit to a peer reviewed journal, and to begin the process of designing and seeking funding for the proposed prevention trials.
Timothy Coetzee, PhD, chief research officer of the National MS Society, complimented Drs. Hayes, Ponsonby, and colleagues on the “audaciousness” of their efforts. “Can we end MS by something as simple as vitamin D supplementation? This goal is as big as they come, but it fits right into the Society’s bold commitment to do everything possible to free the world of MS.”

 Always amazed at all of the Vitamin D correlations and continued research.  Guess I will continue taking Vitamin D supplements!