Are we closer to a ‘cure’ of Multiple Sclerosis? : Treatment of Multiple Sclerosis in Dubai
Just a decade ago, most people with newly diagnosed multiple sclerosis faced the dreadful prospect of having to depend on walkers and wheelchairs or be limited to their bed within 15 years of diagnosis. Today, the epoch-making advances in early diagnosis, development of new biomarkers , high-efficacy treatments, and most importantly ubiquitous awareness among public are keeping millions with MS healthier for longer – many disability-free.
MS is a disease of the brain, spinal cord and the immune system. Our brains contain a network of billions of neurons, nerve cells that send messages for initiation, coordination and overall supervision of all the body movements from head-to-toe including speech, typing on a keyboard, walking unassisted , balancing on a bicycle ,fine tuning of acceleration and applying breaks on an automobile etc. Central nervous system is also responsible for perceiving sensations including special senses like vision, tactility, feeling pain and others .Lately, the awareness of cognitive impairment in people with MS (pwMS) is expanding among clinicians and caregivers. Each neuron is wrapped in myelin, a protective coating like the plastic sheath around a copper electrical wire. But in people with MS, the immune system – which ought to protect us against germs – mistakes myelin for a foreign invader. This case of mistaken identity prompts an all-out , forceful, destructive assault by the immune system on the central nervous system. The immune system attacks the myelin, short-circuiting the neurons (nerve fibres) like frayed electric cables.
With passage of inexorable time, the connections between nerves are irretrievably lost, nerve cells and their connecting nerve fibres die. MS snatches away from people of basic functions we take for granted – vision, sensation, motor strength … and sometimes even the ability to speak, eat or breathe independly.
Enemy at the Gates
Initially for several decades, researchers in the field of MS believed that T-cells – a type of white blood cell that acts like the immune system’s detectives to identify intruders – were behind the myelin attacks. However, currently there is a body of burgeoning evidence that another immune soldier, B-cells, are the real culprits.
Brain and nervous system are protected from infections, by a proverbial city wall or ramparts of a fort , the “blood-brain barrier” that is made up of cells and some immune chemicals manning the gates. In MS, T-cells disrupt this barrier, opening the proverbial city gates, but it is the B-cells and the proteins they manufacture that attack the myelin coatings of the nerve cells and thus short-circuiting the brain’s network of neurons.
This understanding has led to an extensive study of monoclonal antibodies (corrective police personnel that confront and neutralize the rogue B-cell antibodies).These lab-manufactured ,bioengineered are replicas of the inimical antibodies working on biological principles, and hence they are also called “biosimilars.”
Some of the currently approved and widely prescribed B-cell monoclonal antibodies for treatment of MS are Rituximab, Alemtuzumab, Ocrelizumab, Daclizumab, Ofatumumab, and the latest cop on the block Ublituximab.
Other high efficacy treatments ,also called Immune Reconstitution Therapy (IRT) are Cladribine and Autologous Haematopoietic Stem Cell Therapy (AHSCT) are also available and approved by FDA.
Drugs in pipeline to repair the damaged myelin (neuroprotective agents)
In 2013, physician-scientist Ari Green, MD, and neuroscientist Jonah Chan, PhD, made a startling discovery: The over-the-counter antihistamine clemastine repaired damaged myelin in laboratory tests. But could it prove to be useful in healing the human brain in people with MS and prevent further damage? A decade later, they had their answer: Yes. It has established the boilerplate for future research into remyelinating therapies and hope for recovery of some of the neurological deficits considered to be irreversible until now.
There is a significant genetic pre-determinant in deciding the evolution or progression in the course of MS. Some patients are in wheelchair after 15 years of diagnosis and others are running marathon after having had MS for 20 years. Identification of these genetic markers will eventually lead to precision-guided medications contributing to cure of multiple sclerosis.
Summing up, The battle is not yet won, but all of the soldiers and the pieces of armamentarium are poised to soon reach the finish line – a cure for MS.
