1. Honey Bee, Friend or Foe? (bee venom)" (posted: 30/12/2004)
2. Effective Stem Cell Treatment for Incontinence (posted: 30/11/2004)
3. Antegren, renamed Tysabri, gets FDA approval for MS (posted:25/11/2004)
4. Important discovery of Key to Immune System (posted:16/11/2004)
5. Latest on Antegren (natalizumab) Trials (posted:10/11/2004)
6. Should persons with benign MS consider delaying treatment? (posted:28/09/2004)
7. Yoga & Exercise relieve Fatigue in MS (posted:22/06/2004)
8. Patterns of Cannabis Use among Persons with MS (posted:22/06/2004)
9. Small study suggests statins may be effective in reducing MS (posted:25/05/2004)
10. Persons with MS report favourable quality of life> (posted: 25/05/2004)
11. Doubt cast on autoimmune mechanism in MS (posted:05/03/2004)
12. Encouraging news for recently diagnosed (posted: 07/02/2004)
13. Skin cancer in persons with MS (posted:31/01/2004)
14. Vitamin D could help to prevent MS (posted: 14/01/2004)

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Items posted 2004

1. HONEY BEE, FRIEND OR FOE (RE: BEE VENOM)

   Paula Cooke from Norfolk told the BBC that she has had MS for 15 years and has no feeling from her waist to her toes. About three months ago she started a course of bee venom therapy and she believes it has been a success. Ms Cooke said that the bee stings have brought about tiny improvements, providing some feeling in her toes. She receives 12 stings at a time three times a week. The MS Society has warned people that there is no clinical evidence to date to support a belief that bee venom can relieve symptoms of MS and advised that they must consult a doctor before considering this "unproven" therapy.

   Webmaster's comment: There is a long tradition of medicinal use of bee products. Honey bee venom contains a large number of active substances and is used by some people with rheumatoid or osteo-arthritis with some success claimed. Its use in MS is not common but the MS Association of America has grant-aided research by an immunologist to extract venom and study its effect in MS. Currently, the treatment involves the removal of a bee from a jar with a tweezers. It is held over an area of the body which it stings. This is repeated a number of times. The number, sites, and frequency of the stings is decided by the patient. Side effects of bee venom can be very serious. There is a risk of an anaphylactic allergic reaction that can be fatal. This is another reason why medical advice should be obtained before considering the practice.

   
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2. EFFECTIVE STEM CELL TREATMENT FOR INCONTINENCE

   Scientists from the Medical University of Innsbruck in Austria believe they have developed an effective treatment for incontinence which, apparently affects around 15 million people, mainly women, throughout the world, including many persons with MS. The scientists removed the patient's own stem cells from muscle tissue in the arm, cultured it in the lab and injected it into the wall of the urethra and the sphincter muscle. Twenty women aged from 36 to 84 took part in the research. The stem cells yielded about 50 million muscle cells and 50 million connective tissue cells. These were injected into the patient under local or general anesthetic and they began to replace the existing cells. Advanced ultrasound equipment was used to ensure the cells were injected into the correct urethra and sphincter tissue. 18 of the twenty women remained continent one year later. A spokesperson for the scientists said "These are very intelligent cells. Not only do they stay where they are injected, but also they quickly form new muscle tissue and when the muscle mass reaches the appropriate size, the cell growth ceases automatically."

   Webmaster's comment: This is a very small scale research and its impressive outcome will need to be further explored. Even if the results are replicated, its effectiveness in cases of MS related incontinence may be limited. Incontinence among the general population occurs when the urethra, which carries urine from the bladder, narrows or becomes otherwise abnormal, or when the sphincter muscles that help open and close the urethra become weak or diminished. In many MS related cases, the mechanism involved is more complicated as signals from the central nervous system to the muscles may be interrupted at the damaged areas of the nerves. This may contribute to or occur in addition to muscle tone weakness

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3. US FDA APPROVES ANTEGREN (NATALIZUMAB)UNDER NEW NAME TYSABRI FOR MS

   Biogen & Elan announced on 23 November 2004 that the U.S. Food and Drug Administration (FDA) has approved Tysabri (natalizumab), formerly known as Antegren, as treatment for relapsing forms of MS to reduce the frequency of relapses. FDA granted accelerated approval for Tysabri without waiting for the final outcome of the trials because of the very promising progress of both trials. It is suggested that Tysabri works by preventing immune cells from migrating from the bloodstream into the brain where they can cause inflammation and potentially damage nerve fibers and their insulation.

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4. IMPORTANT DEVELOPMENT - KEY TO IMMUNE SYSTEM DISCOVERED

   MS is an autoimmune disease in which the body's immune system attacks the myelin covering nerves in the central nervous system. The mechanisms involved are not sufficiently understood to facilitate the development of protective treatments.

   Now a multidisciplinary team of scientist from around the world has discovered a key to how the body controls its immune response. The research centered on special cells called natural killer T-cells, which act as switches in the body, determining how aggressive the immune response will be. The scientists have now identified the key that controls the killer T-cell switches of the immune response. It is an antigen. Most antigens to date have consisted of small pieces of protein that may be from chemicals, bacteria, viruses etc or from the body's own tissue cells. This newly discovered antigen key is made up of sugars and a fatty molecule and belongs to a group known as glycolipids.

   Autoimmune diseases like multiple sclerosis or rheumatoid arthritis, where the body attacks itself with an inflammatory response, could be due to a lack of natural killer T cells, which in turn could be caused by a lack of the antigen key. A spokesman for the group said, "Now we know what the real key is so we can start asking where that key is made, how it's regulated, and that will allow us to understand how these responses are regulated. We can start to manipulate the natural killer T cells into doing what we want - treat disease."

   The study was published last week in "Science Express," the online version of the American journal, "Science". The lead authors on the paper are Dapeng Zhou and Albert Bendelac at the University of Chicago. Coauthors are at the Brigham Young University, the Scripps Research Institute, National Institutes of Health, Goteborg University in Sweden, the Chinese Academy of Sciences and the University of New Hampshire.

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5. ANTEGREN (NATALIZUMAB) TRIALS PROMISING

   Biogen & Elan announced very positive interim results of the Affirm trial on Monday, 08/11/2004.

   Antegren (natalizumab) is one of a new type of drug that acts to reduce inflammation by preventing migration of inflammatory cells from blood vessels to sites of inflammation.

   Elan Corporation and Biogen are collaborating on the development, manufacture and marketing of antegren for use in inflammatory conditions such as Crohn's disease and multiple sclerosis (MS). They report that earlier phase 1 and phase 2 studies have been very promising. They are now collaborating on two phase 3 trials in MS. The AFFIRM (Antegren safety and efficacy in relapsing-remitting MS) trial is a two year, randomized, double blind study of approximately 900 patients, designed to determine whether Antegren is effective in slowing the rate of clinical relapses.

   The second trial, known as SENTINEL (safety and efficacy of Antegren in combination with Avonex® (interferon beta-1a) in subjects with relapsing-remitting MS), is a two year, randomized, double blind study of approximately 1,200 patients. The SENTINEL trial, which will be one of the largest conducted in MS, is designed to determine whether the treatment of MS with Antegren in combination with Avonex is more effective than Avonex treatment alone in slowing the rate of disability in MS and in reducing the rate of clinical relapses.

   According to the statement, interim one year results showed that natalizumab reduced the rate of relapses by 66 percent compared to a placebo, a statistically significant result. Adverse events occurring in at least 5 percent of natalizumab-treated patients that were 2 percent more common than in placebo-treated patients included headache, fatigue and arthralgia (joint pains). The overall incidence of infection was similar between the groups. Serious infections occurred in 1 percent of placebo-treated patients and 2 percent of natalizumab-treated patients. Serious hypersensitivity-like reactions occurred in approximately 1 percent of natalizumab-treated patients. Both companies believe antegren has the potential to make a significant difference in the treatment of MS. The final outcome of the trial is expected to be available in the 1st half of 2005.

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6. SHOULD PERSONS WITH BENIGN MS DELAY DRUG TREATMENT?

   The doctors from the renowned Mayo Clinic in the US who carried out research into how MS progresses over time have suggested (Annals of Neurology, August 2004) that persons with benign MS might want to wait for five or even ten years before deciding to undergo treatments with drugs such as beta interferon. Their research suggested that persons whose MS remains benign after five years are unlikely to progress to significant disability and might prefer to forego treatment at least until the progress of their disease becomes clear rather than to expose themselves to the side effects of the drugs. The doctors used a measurement of disability called the expanded disability status score (EDSS) and described persons with a score of 2 or less as having minimal disability. They estimated that this applies to about 17% of persons with MS. The doctors advise that decisions should only be taken in consultation with a person's own doctor or consultant.

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7. YOGA & EXERCISE BOTH RELIEVE FATIGUE IN MS

   Researchers from the Department of Neurology, Oregon Health & Science University, Portland, USA, concluded that persons with MS who participated in either a 6-month yoga class or an exercise class showed significant improvement in measures of fatigue compared to a control group. Sixty-nine participants were randomly assigned to one of three groups. One group attended a weekly yoga class and also practiced at home; a second group exercised weekly on an exercise bike and also exercised at home; the control group did not engage in either activity. Twelve persons did not complete the six weeks. The participants were subjected to a range of measures of fatigue at the start and the end of the randomized controlled trial . The study was reported in the June 8 2004 edition of the journal Neurology.

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8. PATTERNS OF CANNABIS USE AMONG PERSONS WITH MS

   Researchers from the Dalhousie University, Halifax, Nova Scotia, Canada, surveyed 220 persons with MS. 36% reported never having used cannabis for any purpose; 14% reported continuing use of cannabis for symptom treatment. The symptoms reported by users to be most effectively relieved were stress, sleep, mood, stiffness/spasm, and pain. Those using cannabis for medicinal purposes tended to be predominately male tobacco users and recreational users of cannabis. The study was reported in the June 8 2004 edition of the journal Neurology.

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9. SMALL STUDY SUGGESTS STATINS MAY BE EFFECTIVE IN REDUCING MS

   A small study reported in The Lancet (Vollmer T, Key L, Durkalski V et al. Oral simvastatin treatment in relapsing-remitting multiple sclerosis. Lancet. 2004 May 15;363(9421):1607-8) suggests that statins might be effective in reducing the effect of MS. 30 persons with relapsing-remitting MS were given 80mg daily dose of simvastatin (Zocor) over a period of 6 months. The number of brain lesions as revealed by MRI scans reduced by 44 % and the volume reduced by 41%. There was no significant evidence of side effects. The study was too small to provide proper evaluation of effectiveness and possible side effects. Large, controlled, studies will be required before definitive effects can be determined.

   Webmaster's comment: Many of the approved drugs for relapse remitting MS such as interferon are very expensive and are administered by injection. Statins are much cheaper and are usually taken as a single oral dose in the evenings. They are a relatively new group of drugs used to lower blood cholesterol levels. A high cholesterol level increases a person's risk of having a heart attack or stroke. The long-term use of statins reduces the risk of such an event and can increase the life expectancy of people with a history of heart disease. The best known statins are simvastatin (Zocor) and pravastatin (Lipostat).

   The statins can cause headaches, insomnia, liver problems and digestive tract problems like abdominal pain, wind, diarrhoea, and feeling and being sick. Rarely, they can cause hepatitis, a skin rash, and a serious Top

   Items posted 2004

   muscle problem, with symptoms of muscular pain, tenderness and weakness. One statin, cerivastatin (Baycol), has been withdrawn from the market in America because of concern over a number of deaths resulting from its use.
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10. MOST PERSONS WITH MS REPORT A FAVOURABLE QUALITY OF LIFE

    Although persons with MS experience physical impairment to a greater or lesser degree, in a recent study of 185 persons in Olmstead County, Minnesota, most (77%) reported a favourable quality of life. The study was conducted by researchers from the Mayo Clinic ( Pittock SJ, Mayr WT, McClelland RL et al. Quality of Life Is Favorable for Most Patients With Multiple Sclerosis: A Population-based Cohort Study. Arch Neurol. 2004 May;61(5):679-686.)

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11. DOUBT CAST ON AUTOIMMUNE MECHANISM IN MS

    A recent study by Michael H. Barnett, MBBS & John W. Prineas, MBBS Institute of Clinical Neurosciences, Department of Medicine, University of Sydney, Australia, raises doubt about the common view of the mechanism involved in MS (see Webmaster's comment below). The study was reported in the February 23rd online issue of the Annals of Neurology (Ann Neurol 2004;55:000-000) , the Journal of the American Neurological Association. The results are based on clinical and pathologic findings in 12 patients with relapsing and remitting MS who died during or soon after a relapse episode. In seven of the twelve cases they observed changes that had not been previously observed in newly formed lesions. They observed extensive evidence that oligodendrycites had died first and that the immune cells then arrived to dispose of the dead oligodendrycites and their myelin. The authors believe that the current findings could have a big impact on MS research, which is largely focused on determining why the immune system attacks myelin. The research suggests that attention should be directed at the mechanism whereby the myelin producing cells die.

    Webmaster's comment: The common view among medical professionals and researchers is that MS occurs when the body's own immune system attacks the myelin coating that surrounds the nerves of the central nervous system. This is why it is described as an autoimmune disease. Myelin is formed by cells called oligodendrycites and they are involved in remyelinating exposed nerve cells. Some remyelination occurs in persons with MS but not to a degree that completely repairs the damage.

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12. ENCOURAGING NEWS FOR RECENTLY DIAGNOSED

    MS is generally thought of as a severely debilitating disease that progresses quickly and, unfortunately, in many cases, so it is. It is therefore useful to get scientific information about rates of progression. The results of a comprehensive study over ten years were published in a recent edition of the journal Neurology (NEUROLOGY 2004;62:51-59) and they provide encouraging news particularly for recently diagnosed persons. The researchers from the renowned Mayo Clinic in Minnesota carried out a series of tests on 162 patients from Olmsted County in 1991. They reassessed this cohort in 2001 and were able to follow up 161 of the original cohort. Only 15% had received immunomodulatory therapy. Of 66 persons who could walk unaided in 1991, 83% retained that ability in 2001. Of 33 who could walk unaided but experienced a degree of disability in 1991, 51% required a cane to walk in 2001. Of 39 persons who required the assistance of at least a cane in 1991, 51% required a wheelchair in 2001. Overall the authors concluded that, although 30% of persons progressed to needing a cane or wheelchair, the majority remained stable or minimally progressed.

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13. SKIN CANCER IN PERSONS WITH MS

    According to a report in the Journal of Epidemiology and Community Health. 2004 Feb; 58(2): 142-4, skin cancer was significantly less common among a cohort of persons with MS than among cohorts of persons with other diseases and than among the general population of those studied. The study was carried out by M J Goldacre, V Seagroatt, D Yeates of the Unit of Health-Care Epidemiology, Department of Public Health, Institute of Health Sciences, Oxford University and E D Acheson of the Department of Epidemiology, Public Health, University College London, Medical School. They analysed a database of linked hospital records and death certificates in the Oxford region of the NHS. They found that although skin cancer was significantly less common in persons with MS, there was no deficit of other cancer in the MS cohort, and no deficit of skin cancer in cohorts of persons with other autoimmune or neurological diseases. Their conclusion was that the findings support the hypothesis that solar radiation may have a protective influence on the development of MS.

    Webmaster's comment: This study adds to the growing body of evidence that exposure to sun, especially in early childhood may have a preventative effect against MS. See the item posted here on 25/09/2003 regarding childhood exposure to sun and the one posted on 14/01/2004 suggesting that intake of vitamin D, a vitamin produced naturally when the body is exposed to sunlight,could help in the prevention of MS. Members of the Foyle branch participated recently in a Northern Ireland study of the levels of vitamin D in persons with MS. The outcome is awaited with interest.

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14. VITAMIN D COULD HELP TO PREVENT MS

    There is a report in the January 2004 issue of the journal Neurology (Neurology 2004;62:60-65 © 2004 American Academy of Neurology ) of findings of research that suggest that vitamin D may help to prevent multiple sclerosis. The research was led by Ms. K.L. Munger, Department of Nutrition, Harvard School of Public Health. The team investigated the incidence of MS among two large groups of nurses involved in studies of nurses' health over 20 years. 173 nurses developed MS. The nurses with the highest intake of vitamin D from supplements -- 400 IU (10 μg ) or more a day -- were 40 percent less likely to develop MS than those who used no supplements. The women who only got vitamin D from food such as fortified milk did not lower their risk of MS.

    Webmaster's comment: Vitamin D is produced in the body when exposed to sunlight. This is the main natural source. Foods rich in vitamin D include cod liver oil and fish with a high fat content, such as sardines, salmon, herring and mackerel. Some cereals and margarines are fortified with vitamin D. The RDA (recommended daily allowance) is 5 μg. Further research is required for any definitive link to be established. If confirmed, it could account in some part for the low incidence of MS in countries nearer the equator.