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Monday, October 31, 2011

Bye-Bye B Cells, Hello MS Treatment

Multiple sclerosis is a chronic inflammatory disease that affects the brain and spinal cord, or central nervous system (CNS), leading to sensory and motor impairments. MS is more common in women than in men and is typically diagnosed between the ages of 20 and 40. Approximately 400,000 individuals in the United States currently have MS and more than 2.1 million people worldwide live with the disease. MS is diagnosed as one of two forms, either relapsing-remitting (RRMS) or primary progressive (PPMS). The vast majority of patients are initially diagnosed with RRMS, which is characterized by periods of exacerbation, or flare-ups, followed by periods of remission. Patients with PPMS do not experience remissive phases. Most of the medications approved for MS treatment are aimed toward ameliorating the relapsing-remitting disease course. Currently, MS is commonly treated with an interferon beta (IFN beta) drug, which reduces disease activity, in combination with other medications that target the various symptoms experienced by patients (2).
The clinical presentation of MS varies from person to person; however, pathologically, the disease results from an autoimmune attack on myelin sheath (a protective covering around nerve fibers). Immune cells (lymphocytes) become self-reactive against certain proteins that make up myelin and subsequently destroy it. This process is called demyelination. When the myelin sheath is damaged, signaling between nerve cells becomes slowed or prevented altogether. As a result, simple tasks like walking become quite difficult, and patients may experience vision impairments, episodes of numbness and tingling, loss of balance and coordination, as well as other symptoms. Unfortunately, the mechanism through which an individual develops MS is not entirely understood, and therefore, the repertoire of treatment targets is limited. In order to gain a better understanding of the cause and progression of MS, researchers use various animal models of the disease. The most commonly used MS model is experimental autoimmune encephalomyelitis (EAE), which can be induced in a variety of animal species including certain rodents and non-human primates. In the upcoming November issue of the Journal of Neuropathology and Experimental Neurology, a study by Kap and colleagues investigates whether or not B cell depletion (an experimental treatment for MS) is a valid therapeutic target (1). The authors employed an EAE study in the common marmoset (monkey species). Marmosets were first utilized to examine the clinical and pathological features of MS in 1996, and have been found to exhibit a disease course more closely related to human MS than that observed in rodent models. The marmoset EAE model demonstrates widespread demyelination in both white matter and grey matter of the CNS, strongly resembling the conditions of MS in humans. Furthermore, marmosets have similar immune and nervous system genes to humans, establishing another advantage of using this model (3).

In the present study, EAE was induced through a single inoculation of recombinant human MOG (myelin oligodendrocyte glycoprotein), a myelin protein that, during MS, becomes incorrectly recognized as foreign antigen. Antigen is an entity that binds to specific receptors on lymphocytes causing lymphocyte activation and a subsequent immune response. Accordingly, when MOG is injected into an animal, the animal’s immune cells are essentially tricked into ‘thinking’ that even self-MOG is foreign, and an immune response is initiated against the myelin protein.
The marmosets in the present study were observed each day for 15 weeks after EAE induction and given a daily clinical score based on a scale ranging from O to 5, where 0 indicates no clinical signs and 5 indicates death due to EAE. At 21 days post-induction, half of the animals were treated with a CD20 antibody (HuMab 7D8), which is an antibody directed against a protein found on the surface of B cells. CD20 antibody treatment provokes a robust and long-lasting depletion of B cells from blood and lymph nodes. The rest of the animals received a placebo treatment. In addition to the data collected from behavioral observation and scoring, MRI was used to detect and analyze the presence of lesions (areas of demyelination) in white and gray matter of the brain. The monkeys were paired according to age and body weight for MRI observation. The first MRI for all marmosets was made at day 18 post-induction and at this point, none of the animals showed detectable brain lesions. A second MRI was taken when at least one marmoset in a pair had demonstrated evident neurological symptoms with a clinical score of 2 or greater (2 = ataxia, optic disease). Data collected from the second MRI demonstrated that B cell depletion effectively prevented white matter lesion development (no significant differences of gray matter lesions were observed at this point), as all marmosets treated with the CD20 antibody had no white matter lesion formation. MRI was additionally taken postmortem; these scans revealed that, when compared with the control animals, CD20 antibody-treated marmosets had significantly smaller white matter lesions, if any, characterized by less myelin damage, and furthermore never developed any gray matter lesions over the course of the study. The CNS of the animals was then examined microscopically (histological analysis) by staining tissue sections of brain, spinal cord, and optic nerve to observe the molecular and cellular characteristics of lesions. This analysis uncovered actively demyelinating white matter lesions in all of the control animals, while none of the CD20 antibody-treated marmosets showed signs of active demyelination. Additionally, the extent of demyelination in spinal cords was substantially lower in the CD20 antibody-treated marmosets than in controls. No demyelination occurred in the optic nerves of any CD20 antibody-treated marmosets. There were no B cells found in the spinal cords of the CD20 antibody-treated marmosets and there was a reduced population of T cells in these animals as well. The presence of macrophages (a type of immune cell involved in inflammation) was greatly reduced in the spinal cords of the CD20 antibody-treated marmosets but not in control animals. IgG antibodies (a subset of antibodies involved in targeting myelin proteins during MS) were not detected in the CNS of CD20 antibody-treated animals, suggesting that antibody-mediated immunity is hindered by B cell depletion. Together, the findings demonstrate that the depletion of B cells decreased demyelination and inflammation in CNS white matter. Histological analysis further revealed that gray matter demyelination in the control animals consisted of macrophages, B cells, and T cells, while no gray matter lesions could be detected in any of the CD20 antibody-treated marmosets.
To summarize, the abovementioned findings together demonstrate that depletion of CD20-postive B cells presents an effective therapy for clinically protecting against EAE, reducing the volume of white matter lesions and the extent of inflammation/demyelination, and most notably, completely preventing gray matter pathology. However, the means by which B cells contribute to the disease course of MS is not fully understood. B cells may play a role in demyelination through the production and secretion of antibodies directed against myelin proteins, or alternatively, by the increased release of cytotoxic cytokines (molecules that directly cause the death of cells), which is observed in MS patients (4). B cells might also act as antigen presenting cells (APCs), resulting in T cell activation. Therefore, with B cell depleting treatment, T cells that would normally attack the myelin sheath do not become activated. This is supported by previous observations where B cell depletion substantially reduced T cell proliferation and cytokine production in a marmoset EAE model (5).
The principal treatments for MS have generally targeted T cells, with the angle that autoreactive T cells propel the immune system into self-destruct mode in the CNS, and therefore must be inhibited somehow. These therapies are only partially effective and often have various adverse effects. In 2008, however, a clinical trial was completed and published in the New England Journal of Medicine that opened a new domain for MS treatment – the B cell (6). The study showed promising results for the treatment of RRMS patients with a CD20 antibody drug called rituximab (commonly under the brand name Rituxan). Rituximab is approved by the FDA for treating rheumatoid arthritis and certain lymphomas, yet its use in treating MS is still considered experimental. Stephen L. Hauser, MD, lead author of the 2008 Rituxan clinical trial explained that B cell targeted treatment “represents a paradigm shift that has profound implications for our understanding of MS” (7). The results from the study by Kap and colleagues offer clear support for the therapeutic benefits of CD20 antibody treatment in EAE, and accordingly strengthen the foundation for clinical use of rituximab in treating MS. Additional successful trials on rituximab will be necessary before it receives approval for use in patients with MS. Future research will hopefully continue to explore and expand upon this new and promising frontier for MS treatment.
Reference:
1. 1. Kap, Y., J. Bauer, N. van Driel, W. Bleeker, P. Parren, E. Kooi, J. Geurts, J. Laman, J. Craigen, E. Blezer, and B. ’t Hart. 2011. B-cell depletion attenuates white and gray matter pathology in marmoset experimental autoimmune encephalomyelitis. J Neropathol Exp Neurol. 70: 992-1005.
Other References:
2. 2. What we know about MS. National Multiple Sclerosis Society http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/index.aspx.
4. 4. Bar-Or, A., L. Fawaz, B. Fan, P. Darlington, A. Rieger, C. Ghorayeb, P. Calabresi, E. Waubant, S. Hauser, J. Zhang, and C. Smith. 2010. Abnormal B-cell cytokine responses a trigger of T-cell—mediated disease in MS? Ann Neurol. 67:452-461.
5. 5. Kap, Y., N. van Driel, E. Blezer, P. Parren, W. Bleeker, J. Laman, J. Craigen, and B. ‘t Hart. 2010. Late B cell depletion with a human anti-human CD20 IgG1kappa monoclonal antibody halts the development of experimental autoimmune encephalomyelitis in marmosets. J Immunol. 185: 3990—4003.
6. 6. Hauser, S., E. Waubant, D. Arnold, T. Vollmer, J. Antel, R. Fox, A. Bar-Or, M. Panzara, N. Sarkar, S. Agarwal, A. Langer-Gould, and C. Smith. 2008. B-cell depletion with rituximab in relapsing-remitting multiple sclerosis. N Engl J Med. 358: 676-688.
7. 7. Boyles, S. (2008, February 13). Rituxan shows promise for MS. WebMD Health News. http://www.webmd.com/multiple-sclerosis/news/20080213/rituximab-shows-promise-for-ms.

144 comments:

  1. I really enjoyed your post, Rachel. It’s amazing how far science has come toward understanding autoimmune diseases (and MS in particular) yet we still have so much more to learn. This is an exciting step in the right direction. Keep blogging

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  2. Has anyone looked into whether or not Rituxan can be used to treat the primary progressive form of MS?

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  3. Very interesting blog post, Rachel. Do you think that this study will promote the next phases of the Rituxan trial toward completion? It seems like this research serves as strong substantiation for the therapeutic benefit of CD20 antibody treatment in MS patients. Looking forward to reading your next post

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  4. This is a really exciting blog post, great job finding this article!

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  5. Your post was inspiring! It’s so cool that this study hasn’t even really come out yet and I am able to read about it now. Seems like research in MS is getting closer to finding successful treatments for the disease.

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  6. It's interesting that they can use monkeys for studying MS... It definitely makes more sense to use a primate for studying human diseases, so why are mice and other rodents ever used for EAE studies?

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  7. This was a great blog post! It’s awesome that you were able to find such an exciting article to write about. Everything you wrote was interesting and easy to understand. MS is such a debilitating disease and for so many people the available treatment options fail. I hope that the final phase of the clinical trial you mentioned is completed in the near future so that this promising therapy can be accessible for MS patients.

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  8. I really hope that the final phases of the rituximab clinical trial are successful, this seems like it could be a major step in the right direction towards effectively treating MS.

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  9. Great post! This is extremely interesting to me because I have a friend whose mother has MS, so I’ll be sure to tell him about this new research and your blog.

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  10. I have a family friend who was diagnosed with MS years ago, and she has not had very successful responses to the available drug treatments… so this is really encouraging to read. You did an excellent job making this study clear and understandable for non-science students who are otherwise unfamiliar with research in the field

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  11. You did a great job of explaining the pathology of MS. I didn’t really understand how the disease occurs before reading this, so thanks for making it all so clear and interesting! Keep blogging!

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  12. This is very interesting. I did a little research to learn more about the possibility that CD20 antibody treatment for MS will be approved anytime soon and I found this information: http://clinicaltrials.gov/ct2/show/NCT01457924?term=Rituximab&cond=Multiple+Sclerosis&rank=4 ... I couldn’t find anything about a phase III trial for Rituxan, though. Why wouldn’t that study be completed first before trying a different CD20 antibody drug?

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  13. The results from this study seem pretty encouraging. Hopefully this will set the wheels in motion for additional research on B cells as targets for MS drug treatment, as well as in helping to pinpoint the exact mechanism of MS onset

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  14. Why is rituximab not approved for treating MS yet? The clinical trial study you cited was from 2008, and it seems like the results were pretty promising…

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  15. I really enjoyed reading this post. You did a phenomenal job at making scientific research readable. Keep us updated on any future advancements with Rituxan treatment in MS!

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  16. Is there any indication as to when the final phase of the Rituxan clinical trial will be completed? Have you read anywhere that it’s in progress now?

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  17. I'm not sure about the trial referred to in the blog: here is a link to the U.S. government clinical trials database, showing all of the current and completed clinical trials (that use U.S. gov't funding) regarding rituximab (Rituxan) and MS.

    http://clinicaltrials.gov/ct2/results?term=rituximab+and+multiple+sclerosis

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  18. Rachel, great post... the video link for demyelination was really helpful and gave a good visual for what happens during the disease course of MS. I have a question about CD20 antibody treatment though, if you deplete an individual's B cells, how do they fight against infections afterwards?

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  19. As someone who's interested in pharmacy, it would be very interesting to find a drug that would lead to such stimulation of the vagus nerve.

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  20. I enjoyed reading your post. Your explanation of MS pathology was very educational and the research you focused on seems really exciting. Hope you keep us updated in the future on any new findings with this type of treatment!

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  21. Excellent post, Rachel. I know someone who was treated with Rituxan for lymphoma, so it is interesting to see its promising applicability for patients with MS. Thank you for explaining these novel findings in such an understandable way.

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  22. I also know someone who has been treated with Rituxan for non-Hodgkin's lymphoma; I had no understanding of how the drug worked before reading this, so it is really great that you were able to make the science behind this type of treatment so tangible for your readers.

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  23. Rachel - your post is absolutely fascinating. I know several individuals with RRMS and they will be very interested to hear about this study! Are MS patients being treated with Rituxan off-label at all?

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  24. This looks interesting to me, I would like to learn more about this type of treatment.

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  25. Exciting research to blog about, Rachel. You clarify each detail of MS, the study's results, and future implications perfectly. I'd probably find the actual article difficult to read and understand, so its wonderful that you're able to put it into words that make sense to everyone. Looking forward to reading more from you!

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  26. I just found this information regarding treating PPMS patients with rituximab:

    http://clinicalstudyresults.gene.com/u2786g.pdf

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  27. Hey Rachel, great blog post! That is so interesting that scientists can create a model of MS in monkeys. I hope their findings provide enough support to stimulate further research in B cell depleting therapies for the treatment of MS!

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  28. Great blog post Rachel! This is so interesting-- it's great that you found such a new and exciting study on MS treatment. Your post is really well-written and clear!

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  29. This is so cool that you're doing this for one of your classes. Your blog post is really interesting, Rachel. I especially liked how you highlighted the clinical relevance of the animal study at the end. Keep up your blogging!

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  30. Awesome post! Some of my friends are taking an Immunology course right now at University of Arizona, and I showed them your blog! You did such a good job at explaining the results and the significance of the results of the study. I also have a family friend who was recently diagnosed with MS so I'm sure she'll be interested to hear about CD20 antibody treatment. I'm looking forward to reading your future posts!

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  31. Please disregard the previous message....wrong post

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  32. Also, I just went through some of the links you provided to some of the more complex terms, and they are so helpful. It's awesome that you made sure everything can be further explained through the external websites and videos!

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  33. I just read that the third phase of the trial is unlikely to be funded because Rituxan loses its US patent in 2015... but hopefully trials with other CD20 antibody drugs will be done.

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  34. Rachel, great blog post. Very interesting topic, you explained everything well. Looking forward to reading more from you in the future

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  35. I told some people about your blog, Rachel. I'm sure they'll find your post just as interesting as I do!

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  36. I read that, too. Here's a link to where I found that: http://neuroimmunology.wordpress.com/2011/03/27/the-shameful-story-of-rituximab-in-multiple-sclerosis/
    but the alternative anti-CD20 drug that this author was talking about looks like the same one that ben posted about yesterday. Unfortunately that was still a phase II trial so additional research will still be needed before it would be approved to treat MS

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  37. Your blog post is excellent, Rachel. I found the research that you focused on to be really exciting! Looks like many of your readers agree!

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  38. Great post! You did such a terrific job at making all of this information so accessible for all types of readers. I hope that this research sparks more MS treatments to be uncovered!

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  40. Just to update everyone, last week a news article was published in Science Daily about the completion of a phase 2 clinical trial involving the experimental drug, Ocrelizumab, in treating RRMS. Ocrelizumab is a CD20 antibody drug and the results of the study are very promising! Phase 3 trials have already begun as well:

    http://www.sciencedaily.com/releases/2011/11/111101173638.htm

    And here is a link to the actual journal article published on the study:

    http://www.sciencedirect.com/science/article/pii/S0140673611616498

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  41. This post was really informative, great job!

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  42. I had no idea what t and b cells were, or how they related to MS until I read this post. Very clearly explained. Good job!

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  43. My mom has MS and although hers is pretty benign she's always interested in reading about new research and treatments. I'll send her a copy of your blog!

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  45. This post was informative and easy to understand. Great job!

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  46. For a kid that hasn't taken a science class since high-school this post was extremely informative and easy to understand. I never really knew much about MS, but this post has definitely given me a better understanding of both the disease and potential treatments. Well done girl.

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  47. Really enjoyed your post. Super interesting. Great job Rach

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  48. Awesome article, Rachel! My aunt has MS and always complains how nothing can help her. Can't wait to show her this. Glad to see college is treating you well!

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  49. My friend's grandfather has MS so I found this article really interesting. Great job Rachel!

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  50. Great post, Rachel. Such an interesting and relevant topic for many people in the world.

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  51. Very nicely written and incredibly informative. I am curious to see how this develops over the next couple years. Keep us up to date!

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  52. Great blog post rachel! Interesting post, I learned alot!

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  53. Awesome job Rachel, I'm really impressed.

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  54. I did not know a lot about MS, and this really helped me learn more! Great job!

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  55. Not only was this informative, but extremely well written as well. Incredible work by an exceptional student. Keep it up.

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  56. What an excellent job at explaining such a complicated disease. So proud of you Rachel!!!!

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  57. This is really interesting, Rachel! I'd love to hear more about your blog. Can we meet for coffee sometime so you can tell me more about your MS research?

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  58. Great post Rachel. Very interesting, well-written,and knowledge inducing.

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  59. Such an interesting post! Very informative and easy to understand. Rituxan seems like an exciting step in the right direction.

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  60. Great post, it's nice to hear initiative being taken on helping with this unfortunate disease.

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  61. Great blog post, Rachel! It was so interesting and I learned a lot. Very well-written. You did a fantastic job explaining such a complicated disease, especially to someone like me who isn't a science person.

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  62. What a great post! Yay, Rachel!

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  63. Very informative blog post Rachel, you did a great job on covering all the important aspects of the disease, and it was extremely easy to understand.

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  64. It is very exciting to hear that a new treatment for MS is on the way. Good job on this insightful and hopeful post!

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  65. Tremendously informative post Rachel! It is exciting to hear important developments in the field, keep up the good work!

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  66. Wow I learned a lot about MS that I never knew before. It's fascinating to see the potential treatments that are out there and you do a really good job of explaining them in simple terms.

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  67. This is really cool stuff. Hopefully this sort of research will help lead to a break through in treatment soon. Great job on this post.

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  68. Unbelievable post Rach! I learned so much. Really interesting stuff!

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  69. WOW, i really learned alot from this blog. AWESOME

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  71. Shifting treatment options for MS that focus on rituximub, which targets a person's B cells, is really the future of MS research. For years, T cells really have been the hope for MS patients, but with more clinical work there really is hope for effectively treating MS victims from multiple directions. It will be exciting to see what the trials focusing on B cells will bring, and I look forward to reading more in the future!!

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  72. Awesome work Rachel! I learned so much on the topic, really interesting stuff.

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  73. It’s great to see another treatment be developed to combat MS. This is clearly a step in the right direction and I'll be eager to see when the final phase of testing is complete or if other drugs with the CD20 antibodies are developed.

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  74. Very well written. I will continue reading about this treatment now thanks to your interest!

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  75. Wow! Intense research, thanks for sharing this with everyone!

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  76. For someone who has MS, I have read a lot on the topic and your article is one of the best I have read. You were able to explain the technical aspects so they were easy to understand. Great work, Rachel!

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  77. Great article. I wonder if MS is like cancer and can be found in clusters. we have a lot of cases in buffalo Grove Il.

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  78. Great job, Rachel. We just talked about MS in one of my Bio classes so I was especially interested to read this!

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  79. siiick post!!! Great job on all your research

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  80. Fascinating post. The advancements being made in medical science are incredible, thank you for the information

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  81. Great article, subject hits close to home for me so its much appreciated.

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  82. Great job on all of your research! This article was very informative.

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  83. Great post, Rachel. My uncle has MS, but I really know nothing about it so it was pretty fascinating to read a post about it. Hits home in a coincidental way. Glad I got to read this!

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  84. This is a really interesting blog post, Rachel. I'm amazed at how many of your readers have a personal connection to this debilitating disease. Thank you for making this research understandable and accessible to so many people!

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  85. Rachel, well done! I found your blog post quite interesting and informative. Keep up the good work!

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  86. Is there any news on how clinical research with this antibody therapy is going?

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  87. Really Interesting post Rachel. Very impressed by your scope of knowledge on topic and I look forward to reading about and enjoying the benefits of your future clinical research.

    - Evan

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  88. In response to LesliAnn, I found this article that might be useful:

    http://neuroimmunology.wordpress.com/2011/11/03/rituximab-vs-ocrelizumab-in-multiple-sclerosis/

    What are people's thoughts? Seems like a frustrating challenge to overcome...

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  89. Why would they start all over with the same type of drug when the original (Rituxan) showed such promising results? Not to mention ocrelizumab is less successful considering the possible association with the death of one of the trial participants...

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  90. Rituxan will lose its patent in 2015, so despite the fact that it is a safe and effective treatment option for RRMS patients, the drug isnt going to be as profitable as ocrelizumab would be, but now ocrelizumab will have to overcome its safety issues. this of course further forestalls the progress towards a phase III trial and FDA approval.

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  91. This is crazy:
    http://bmartinmd.com/2008/02/rituxan-in-ms-positive-phase-2.html

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  92. Your knowledge on MS is quite impressive Rachel. I would love to further discuss the disease with you in the future. It seems as though MS impacts the brain similar to a stroke. It would be interesting to investigate the differences and similarities between the two. But anyways, keep up the good work!

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  93. Really great post Rachel! keep blogging!

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  94. Wow! Thank you for this post, Rachel. I did not know too much about MS before your post and now I am interested in learning more about it and charities dedicated to helping people with this disease. Good job!

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  95. I did not know anything about MS either, and it is so impressive that you are able to convey such a complex topic in an understandable manner. Great post!

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  96. Well written, interesting article. Its great to see that you are making science and medical research something that a broader population can understand and find interest in!

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  97. Nice job, Rachel! I enjoyed reading your blog post and learned so much about MS and the hopeful new direction in treatment.

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  98. This was extremely interesting and well written and you made it really easy to understand such a tough subject to grasp. The in depth explanations were really intriguing and this article has sparked a new topic of interest for me. Great job Rachel!

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  99. I agree with Benjamin... It's shocking that these types of competing interests hinder the progress of new and promising drugs being approved for treatment. Especially in a disease like MS where the available options are so limited

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  100. I really liked your blog post, Rachel! This was really clearly written and definitely easy to understand. I think it's great that you chose to write about an article on MS treatment, considering so many of us know someone who suffers from this disease. Looking forward to reading more from you

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  101. Your blog post is really informative! Great work, Rachel!

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  102. Clever title, great read. Thanks for sharing!

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  103. Rachel - really well-written blog post. I'm so impressed with your ability to discuss a complicated topic in a tangible way. Good job!

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  104. Thanks for such an interesting blog post, Rachel!

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  105. Rachel--what a fantastic post. Thanks for teaching me so much about this disease. All hail.

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  106. Really interesting and well written, good job!

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  107. Great blog post, Rachel! I particularly liked how simple you made everything and the links you provided were quite useful. Way to go!

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  108. Excellent job, Rachel. My aunt has MS and she will be really interested to read your blog. I'll show this to her! keep up the interesting work

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  109. Really great blog post, Rachel. I learned so much about MS from reading this. I had no idea of the complexity involved in finding treatments for autoimmune diseases, particularly this one.

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  110. You did an excellent job explaining the results from this study. Its great that people without a science background can now understand at least one direction that novel research in MS is headed. I'm looking forward to reading more from you, Rachel.

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  111. I enjoyed reading your post, Rachel. It was quite informative and I found the otherwise difficult and complicated subject matter rather easy to understand. Great job!

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  112. It's awesome that you are doing something like this for one of your classes. Being able to convey this type of information at a level that the general public is able to understand is going to be extremely valuable in whatever field you go into. Well done, Rachel.

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  113. Rachel, I am very impressed with your work. Your blog post is well-written, interesting, and informative. I hope that this research stimulates advancements in the clinical phase of drug development/approval so that MS patients gain access to this promising treatment.

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  114. Nice blog post, Rachel. Such a relevant topic for so many people. I have a close friend whose mother has MS and she has had so many challenges with the available treatments. I'm sure that this information will give her some hope!

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  115. This is a phenomenal blog post, Rachel. Pretty frustrating that there have been so many challenges in the clinical trial process for these types of drugs, though.

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  116. Great work, your post is so interesting! I can't believe how well you explained MS and the findings from the study you were writing about. Can't wait to read more from you!

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  117. It's clear that you put a lot of thought into this blog post, Rachel. You did a wonderful job making research in MS more accessible to people without a science background. Keep blogging!

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  118. Great work, Rachel. This seems like exciting research!

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  119. It's so cool that you were able to share this information with us! Your blog post is so interesting. I cant believe that they use monkeys to research multiple sclerosis!

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  120. This is such an interesting blog post! We recently covered some of the details of MS pathology in a course I am taking, and I found the material to be rather complicated. So needless to say, this was really helpful for me to read. Great job!

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  121. well-written and informative blog post, Rachel. I did not know anything about MS before reading this, so I found your work particularly interesting

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  122. Awesome post, Rachel. Looking forward to reading more from you!

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  123. Rachel - Why do you think that MS pathology can be prevented or ameliorated so drastically with CD20 mAb therapy considering that plasma cells are not being eliminated? Wouldnt that leave the potential for these cells to still produce anti-MOG antibodies?

    Your blog post is terrific, by the way. This study, along with related research looking into the role of B cells in MS, may ultimately revolutionize our understanding of this disease. Keep up the good work in all your studies!

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  124. I thought you did a great job with this blog post. You explained a complex disease in an understandable way, discussed an exciting study that is extremely relevant to so many people, and placed the findings into a clinical context that gives hope for a new treatment in MS. Well done!

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  125. That video on demyelination is so helpful! great blog post, Rachel!

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  126. fascinating work, Rachel! I really enjoyed reading your post.

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  127. Wow! what an interesting blog post, Rachel! great work

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  128. You seem very well-versed on this topic. Your blog post is great, I learned a lot from reading it!

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  129. My aunt has MS, so this post was so relevant for me. She reads a lot about the latest research so I'll show her your blog. Nice work

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  130. I'm very impressed with your knowledge on MS! This is really cool that you are writing these blog posts, they're so interesting

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  131. You did a very good job with this blog post. I learned so much about MS, thanks for sharing!

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  132. Great post, Rachel! The research you discussed was so interesting!

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  133. I cant believe how prevalent MS is amongst your readers! So many people have a connection to this disease.

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  134. I can’t believe the politics of the pharmaceutical industry.

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  135. It’s awesome that your blog post helps so many people to better understand MS and moreover to find out information regarding new potential treatment options!

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  136. I wish that it were more important to develop medications that will benefit individuals with difficult-to-treat diseases than to figure out a way to make more money.

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  137. Nice post, Rachel! such interesting stuff... I'm going to show this to my friend, her mom has MS and I'm sure she'll be excited to read this!

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  138. It's wonderful that you posted about novel research in MS. I know that this disease is particularly difficult to treat effectively, as much of the pathology and underlying causes remain to be fully understood. There is still a long way to go, but this seems to mark an important step in the right direction. Hope to read more from you in the future!

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  139. Great job, Rachel, I am so impressed with your work! Looking forward to reading more blog posts from you

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