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Vaccination against immune cells improves disability in progressive MS

This is exciting news for people with progressive MS, for whom there has been little offered in terms of mainstream medical therapy; a randomised controlled trial has shown that vaccination against people's own activated immune cells (T cell vaccination) improves disability and walking in progressive MS

While the methodology of this study may be difficult to follow, it is an extremely important new development for people with MS. MS has long been thought to have a major immune basis, and many of the current therapies operate by modifying the immune response.

Unfortunately, many also therefore affect many other immune responses, and so have side effects that are often found to be unacceptable.

Scientists have been studying the particular immune responses in people with MS and have found that a number of proteins in myelin in the brain seem to trigger this immune response in the immune cells (T cells). Myelin base protein (MBP) and myelin oligodendrocyte glycoprotein (MOG) are the two most widely known culprits.

Given that T cells have been shown to react against these proteins in people with MS, retain the memory of that interaction, and then initiate immune attack on myelin, scientists have sought ways to target just those particular cells involved in this immune reaction, rather than all T-cells.

This potentially could avoid some of the side effects related to more widespread immune suppression. So this piece of research from Israel comes as important confirmation that scientists are on the right track with this approach.

Essentially they recruited 26 people with relapsing-progressive MS, whose T cells were shown to respond to these or other specific proteins known to be involved in the MS immune response. They then grew these cells outside the body, and irradiated them to stop them functioning properly.

At time points of 1 day, 2 months, 3 months and 6 months, they injected these patients' own irradiated cells under their skin as a vaccination.

The idea was that the body would then form an immune response to these cells that were causing the myelin to be destroyed, and reduce their effect, much like we stimulate the body's immune response by vaccinating against particular bacteria. The results indicated that this indeed occurred.

For the group who received only the control injections (salt water rather than the irradiated cells), there was a continuing steady deterioration of half a point on the EDSS scale, and a slight worsening in 10metre walking time.

For the vaccinated group, disability improved by nearly half a point, and there was nearly a one second improvement in 10metre walking time. Further, as these were people with progressive disease but still having relapses, it was possible to compare relapse rates.

There was only one relapse in the vaccinated group over the year of the study, whereas the seven people in the control group had six relapses. Importantly, no-one suffered any significant side effect of the treatment.

This is really important news, particularly for people with progressive MS. Of course, there is still very much work to be done to confirm these findings in a larger group before such therapy might become available clinically, however, this study opens up the potential of highly specific treatments for people with MS that are tailored to their own particular immune response. 

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