Mom's Story, A Child Learns About MS

Mom's Story, A Child Learns About MS
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Friday, May 13, 2022

Promising Vaccine for 'Mono' Virus, Cancers, and MS

 

By Dennis Thompson
HealthDay Reporter

THURSDAY, May 5, 2022 (HealthDay News) -- Two experimental vaccines show promise in protecting against infection with the "mono" virus, which also causes cancer and has been implicated as a potential trigger of multiple sclerosis, a new paper reports.

Tested only in animals so far, the vaccines block two pathways by which the Epstein-Barr virus (EBV) takes root inside the body, said senior researcher Dr. Gary Nabel, president and CEO of ModeX Therapeutics, a small biotech startup in Natick, Mass.

Epstein-Barr is tricky to prevent because it takes up residence in two types of cells, Nabel said — B immune cells that produce antibodies, and epithelial cells that line the internal and external surfaces of the body.

These new vaccines are genetically engineered to induce an immune response that would block infection of both cell types, Nabel said.

"That gives us an opportunity to really damp down any foothold the virus may be able to take in establishing itself in the body," Nabel said. "That's why we think that this is a worthwhile approach, because we've essentially isolated two critical entry proteins for the virus, and can block its ability to enter cells and cause infection."

Currently, there's no approved vaccine that protects against Epstein-Barr virus, which has infected more than 95% of adults worldwide, researchers said in background notes.

Epstein-Barr is primarily known as the cause of mononucleosis.

"It infects B cells in the body, your antibody-producing cells, and it causes those cells to proliferate abnormally," Nabel said. "You get a lot of inflammation, and you get a lot of immune dysregulation. And that's why people feel lousy. That's why it takes several months to get over. That's why you get super infection with these sore throats and upper respiratory symptoms, and these systemic symptoms that give rise to infectious mono."

But EBV also was the first human virus associated with cancers, primarily lymphomas and gastric cancers, Nabel said. The virus causes more than 200,000 cases of cancer every year.

More recently, researchers also have learned that a person's risk of multiple sclerosis (MS) skyrockets 32-fold if they've been infected with Epstein-Barr, according to a study published in Science in January.

It's believed that EBV triggers MS in some people by tricking the immune system into attacking the body's own nerve cells, according to another January study published in Nature.

The experimental vaccines work by genetically fusing two different attachment proteins — the keys that allow EBV to enter B cells and epithelial cells — onto a common particle called ferritin, Nabel said.

Ferritin's regular job is to carry iron in the bloodstream, but the genetic engineering gives it an extra purpose, Nabel said.

"It serves as a carrier, where we can essentially decorate the outside of the particle with the viral proteins," Nabel said. The immune system sees the viral infection proteins and mounts a response that theoretically would protect against future infection by the real virus.

The vaccines prompted strong antibody responses in mice, ferrets and monkeys, according to a new report published May 4 in Science Translational Medicine.

The vaccines also appeared to block development of lymphomas in "humanized" mice — rodents grafted with human stem cells.

The researchers hope to start human clinical trials for the vaccines within a year, Nabel said. However, it's important to note that results obtained from animal studies aren't always replicated in humans.

Effective EBV vaccines will be the key to ultimately proving the link between the virus and MS, said Bruce Bebo, executive vice president of research programs for the National MS Society.

"In order to prove causation, there's one experiment left to do. That experiment is to have a vaccine and deploy the vaccine, and then observe over a period of time whether it can prevent MS," Bebo said. "We have everything we need to know now to justify an investment in that type of experiment, once we have a safe and effective vaccine."

This study was funded by Sanofi, one of the pharmaceutical companies developing the vaccine.

More information

The U.S. National Institutes of Health has more about Epstein-Barr virus and multiple sclerosis.

SOURCES: Gary Nabel, MD, PhD, president and CEO, ModeX Therapeutics, Natick, Mass.; Bruce Bebo, PhD, executive vice president of research programs, National MS Society; Science Translational Medicine, May 4, 2022

 

Saturday, May 7, 2022

Are Off-Label Drugs Safe for Treating MS?

 

When your doctor suggests a drug to treat your multiple sclerosis (MS), your first move may be to search the internet to learn more about it. You may be surprised to find that the medicine is "off-label," which means it isn't approved to treat MS.

Is that a good idea, you wonder? The answer: It can be. A lot depends on how the medicine works and whether the benefits outweigh the risks.

Over the years, doctors have prescribed everything from cancer drugs to acne medicine to help with MS. So you have a lot of options.

When Would I Try One?

Your doctor might suggest going off-label if approved drugs aren't safe for you. You might have allergies to some medicines or find that side effects hit you too hard. Or you might have another condition that means you need to avoid certain medications.

In other cases, you might have tried the standard medications and found they didn't get the job done.

What Are the Risks?

The FDA approves drugs to treat specific conditions. Then, doctors get guidelines on when to use them, how much to give, and what side effects to look for.

When you go off-label, you're in a gray area. A cancer drug doesn't get tested in someone with MS to see if it acts any differently or to check which dose works best. So there's some extra risk there.

That said, many off-label meds for MS often have at least some research behind them. When studies show off-label drugs work for MS, they tend to have fewer risks.

Your best bet is to talk it through carefully with your doctor. Ask questions like:

  • What studies show the drug works for MS?
  • What are the side effects and risks for someone with MS?
  • Are there clinical trials I could join?

How Long Can I Use Them?

It depends on a lot of things like the dose, other conditions you have, and other medicines you take. For some drugs, there may not be enough research to know. New studies come out all the time, so check with your doctor.

Which Off-Label Drugs Treat MS?

You have a lot of choices. Some medicines your doctor may suggest are:

Amantadine (Osmolex ER). It's used to treat the flu and Parkinson's disease, but it may help with fatigue from MS. It generally has few side effects and seems safe.

Azathioprine (Imuran). Doctors have prescribed this drug to treat MS for over 40 years. It can cut the number of relapses you get and keep your MS from getting worse. If you use it for more than 10 years or take more than 600 grams over your lifetime, it may raise your risk of cancer.

Cyclophosphamide.Doctors sometimes recommend it for progressive forms of MS, but results have been mixed. It may slow down your disease and help with symptoms, but it can also come with side effects like nausea and vomiting that can be tough for some people.

Duloxetine (Cymbalta, Irenka). Your doctor may suggest it to treat pain and depression from MS. It seems generally safe and without too many side effects.

Methotrexate. It can slow down progressive forms of MS and may put off problems in your shoulders, arms, and hands. One study showed that it was safe to use for at least 3 to 6 years.

Minocycline. An antibiotic originally used for acne, this drug's been around for 50 years. It looks to be helpful in slowing down relapsing-remitting MS in people who recently had their first symptoms.

Mycophenolate mofetil (CellCept). This drug may cut down on your relapses and slow down the disease. It may raise your chances of getting cancer or an infection. More research is needed to see if it's safe to take long term.

Pregabalin (Lyrica). This is another option for treating pain from MS. It looks to be safe with few side effects.

Rituximab (Rituxan). It can slow down relapsing-remitting MS and cut back on relapses. For most people, it doesn't seem to cause any major issues.

Simvastatin (Zocor). It's typically used for high cholesterol, but it shows promise in slowing brain shrinkage from secondary progressive MS. And it's considered safe with few side effects.

 https://www.webmd.com/multiple-sclerosis/off-label-drugs-treat-multiple-sclerosis?ecd=wnl_mls_050622&ctr=wnl-mls-050622_lead_cta&mb=q80%2F%40kIeuyYKtyaYzOxdbc6RVoMqf%400VkpmvpK5yEEQ%3D