MS News That Caught My Eye Last Week: Helper T-cells, PML, WNT9B Gene, New MS Subtypes
Helper T-cells Drive Transition from RRMS to SPMS, Study Suggests
The T-cells referred to in this study, known as CD4+ cells, are believed to play a significant part in central nervous system inflammation. The disease-modifying treatment Lemtrada (alemtuzumab) is designed to destroy these misbehaving T-cells, along with B-cells, so that the body can replace them with normal cells. I’m glad that I was treated with Lemtrada. It seems to have slowed or stopped my MS progression. Too bad it wasn’t available to me sooner.
A group of helper T-cell (Th cells), a type of immune cell, could be responsible for the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS), with important implications for diagnosing and treating SPMS, a new study found.
The study, “Involvement of cytotoxic Eomes-expressing CD4+ T cells in secondary progressive multiple sclerosis,” was published in the journal PNAS by a team of researchers from the National Center of Neurology and Psychiatry in Tokyo.
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Ocrevus Use Linked to PML in Man, 78, With PPMS, Case Report Says
There have been a handful of associations between Ocrevus and PML, but this is the first time the patient wasn’t previously treated with another disease-modifying therapy. Do we need to be concerned about this? I don’t think so. I explained why in a recent column.
A 78-year-old man with multiple sclerosis (MS) developed the brain infection progressive multifocal leukoencephalopathy (PML) after two years of treatment with Ocrevus (ocrelizumab), a recent case report detailed.
Treatment was discontinued and, as the patient’s symptoms worsened, he was moved to off-label treatment with pembrolizumab (a cancer treatment, brand name Keytruda) before he died.
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WNT9B Genetic Variant Linked to Increased Relapse Risk
Many people with MS have wondered whether there might be a genetic link involving the disease. There have been some studies indicating that possibility but nothing definitive. Add this study to the growing evidence file.
A genetic variant in the WNT9B gene and vitamin D response are both associated with a greater risk of relapses in people with multiple sclerosis (MS), a recent study in Belgium has found.
The study, “Genetic variation in WNT9B increases relapse hazard in multiple sclerosis,” was published in the journal Annals of Neurology.
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MS Has 3 Distinct Subtypes, Study of MRI Brain Patterns Using AI Reports
Just when we were getting used to four types of MS (CIS, RRMS, PPMS, and SPMS), here comes a new trio of subtypes. Say hello to cortex-led with early brain shrinkage, normal white matter-led with mid-brain irregularities, and lesion-led with early and extensive brain damage. It’s hoped that recognizing these subtypes will help neurologists do better at matching patients with disease-modifying treatments.
Using artificial intelligence (AI) on imaging data collected from multiple sclerosis (MS) patients, researchers were able to classify these people into three new disease subtypes, each distinct from the current groupings determined by symptoms.
These new subtypes may allow doctors to better determine those patients more likely to have disease progression, and which treatments might best benefit an individual, researchers said.
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Comments
Anthony H
Although its primary target is B-cells, one recent study has found that ocrelizumab (Ocrevus) also targets inflammatory T-cells, perhaps something similar to Lemtrada, which is good news
to me as I am currently receiving ocrelizumab infusions. I also think the approach of characterising MS based on brain imaging and other measurements is a tentative step forward. I often feel that the current clinical groupings of CIS/RRMS/SPMS/PPMS don't adequately capture the variety of MS cases, and may result in unwarranted limitations on medications available to a particular MS patient.
Ed Tobias
Hi Anthony,
Thanks for your comments. I agree with everything you've written. I saw that study about ocrelizumab and T-cells and also found it interesting. I assume that's a good think and I wonder if that might result in a reduction in the frequency of ocrelizumab infusions in the future. (I'm not a scientist, of course, so that's very much conjecture on my part.)
Ed