July 25, 2010

MS: Vascular or Neurological?

As I have mentioned previously, Multiple Sclerosis has always been defined as a neurological autoimmune disease that affects the central nervous system. Well, there is now reason to speculate that MS is actually (at least partially) induced by attenuated veins in the neck and chest that block the proper drainage of blood from the brain. Dr. Paolo Zamboni, an Italian vascular surgeon who has been accredited with this vascular theory of MS, has been advocating the usage of a "liberation procedure" in which a balloon is inserted into one of these narrowed veins and inflated, with the intent of thickening the blood passageway and ameliorating blood flow from the brain.

This idea is particularly intriguing to me, considering the study is taking place in the Jacobs Neurological Institute at Buffalo General Hospital, steps away from where I worked this Summer. We even discussed the possible ethical dilemmas associated with the study in a staff meeting last week. Although I tend to steer clear of the New York Times for science updates, this one article does a great job of explaining what is happening in Buffalo and what issues some people have with the experimentation.

Personally, I think this study is a great idea. I understand the risk behind the surgical procedure, but all the patients involved have consented, and understand the risk behind undergoing the surgery. Although the study is double-blind, and some patients will undergo a sham surgery (balloon is inserted but taken out without being inflated in the target vein), patients were notified prior to consenting that they could be undergoing a sham surgery in which they would not be receiving the potential therapy. To be honest, a lot of the research happening at the JNI is focused on how we can reduce the side-effects of the already existing MS therapies. Antigenicity of Copaxone, Rebif and Interferon-beta have been worrisome, and, Tysabri - although effective - has been associated with increased risk for PML, an incurable, untreatable and sometimes fatal brain infection. I think patients who have been diagnosed with MS and are suffering are for the most part unopposed to a potential new treatment, that most likely does not have any more risks than any other surgical procedure might have. Furthermore, the experimental phase of the study has not even begun yet. Right now, doctors are simply performing the procedures and monitoring patients to make sure that the surgery itself is not harming them. I believe the first procedures took place about a month ago, and it will be a few months until the experimental phase of the study begins.

I myself do not know if I believe MS is a vascular disease, but I do not see any harm in finding out more. Should this study be successful in targeting the narrowing of blood passageways as a direct cause or exacerbating factor of MS, it will lead to a wide array of new (and most likely less risky) therapeutic options. From a genomics point of view, it will help us identify new genes and loci that might be vital on the pharmacogenomics side of things. I do not know whether or not this is included in the study - but I do hope that after the conclusion of the study, patients who had unknowingly received the sham procedure are entitled to the actual liberation surgery if they so choose.

Now, I don't consider myself anywhere close to an MS expert, but based on what I do know, I would expect to find an association between severity of symptoms/relapses and vein narrowing. However, I think there is too much evidence to point to MS as a neurologically-driven autoimmune disease. All in all, if you couldn't tell by the frenzied state of my writing in this post, I'm pretty freakin' excited by the potential of the study.

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