Quote from Bob
I will say that when I was reading through your last posting it did flash through my mind that this might have something to do with whatever is behind the relapsing/remitting aspect.
The name relapsing remitting describes the nature of the disease. I usually refer to the action of RRMS, as waxing and waning, like the phases of the moon. You can think of the full noon as an attack and a moonless night as a remission.
SPMS no longer have moonless nights. I assume the MRTCs still wax and wane, but they never sufficiently decrease in number to the point where the body’s repair mechanism can provide enough restoration for the patient to regain some of what had been lost during an attack.
The body’s does not seem to have any defense against autoimmune diseases. With self-reactive cells, the body produces them and is not able to realize that they are destructive. In the case of MS, the oligodendrocytes, which repair myelin damage, are what bring back some lost function. Their action is an important part of the remission in RRMS. If you can bring the number of MRTCs down to near zero, the body will try to repair itself.
The CRAB drugs are an immunosuppressant. Tysabri is a monoclonal antibody that blocks most if not all WBCs from passing through the BBB, essentially leaving the brain defenseless and open to opportunistic diseases like PML. If I had an aggressive form of MS and was not able to control the advance of disease disability, I would consider Tysabri as a viable option. Anyone contemplating that would have to weigh the risks verses the benefits, and also decide how long to stay on it.
Quote from Lars
That varying stages of progression, remission or neutrality dictate the MRTC level.
Every time the body is triggered, the memory WBCs respond by producing MRTCs. Corresponding to the increased number of times that a patient’s memory WBCs are stimulated to produce MRTCs, the body will respond by making more memory WBCs to defend against this repeated threat. It is with repeated expose to chickenpox that the body maintains a sufficient number of chickenpox memory WBCs to prevent another case of the pox. Without repeated exposure to stimulate the memory WBCs, they will slowly dwindle in number.
I believe that everyone who has MS has MRTCs circulating, whether they can be detected or not. I pointed out one time that a good trivial pursuit question would be to ask how long do memory WBCs last without re-exposure to the enemy they are waiting to defend against. The answer is 72 years. The mechanism to produce MRTCs remains even if we are able to eliminate them as they are produced.
Quote from Lars
With that theory in mind, it would be impossible to judge every positive or negative test without interviewing every patient as to their condition at the time of blood retrieval.
An attack may occur when the number of MRTCs reaches a disease threshold or when the body is triggered to produce extra MRTCs. Many times in the past, I though I was having an attack, but it turned out to be a case of heightened symptoms, thus the 4-day rule.
I think a questionnaire would be useful, but difficult to design so that the responses would differentiate between an attack and increased symptoms. With Tovaxin, the patient will need to be monitored regularly. The interval between blood tests and a bag of blood for new vaccine will probably be as individualized as the vaccine.
If someone waited until they were having an attack to get some vaccine. The vaccine would arrive after the attack was over. First there would be the test for the presence of MRTCs. Then a bag of blood would be drawn, and from start to vaccine would probably be 14 weeks.
The temperature has cooled down enough for me to do some things outside. I am getting ready to go to Wisconsin with my brother on Friday. We get one TV station and no Internet. I may pop into a place with WiFi, but I will be mostly gone until after the 4th of July.
Well that eases my mind that the little buggers have an enjoyable trip to the lab!
) but that is what I would surmise.