Don't do well with Betaseron?

[jensequitur]

Turns out there's two different kinds of MS - those that don't have the flu-like response to Betaseron, and those that do.  

http://pagingdrgupta.blogs.cnn.com/2010/03/29/scientists-find-there-may-be-two-forms-of-multiple-sclerosis/?hpt=T2

[daisy.girl]

University of Alabama at Birmingham, Stanford researchers announce major discovery on multiple sclerosis
By Jeff Hansen -- The Birmingham News
March 28, 2010, 12:00PM
A groundbreaking study by UAB and Stanford University researchers has revealed that the incurable neurological disease multiple sclerosis has two distinct forms.
One form appears to respond to the common drug used to try to slow the progression of the disease, beta-interferon. The other does not, or may actually be worsened by the drug.
In the future, a simple blood test should be able to distinguish these two groups of patients. About a third of multiple sclerosis patients now given beta-interferon do not respond to the drug.
"We have found the first bio-marker that allows us to predict the outcome of therapy," said Chander Raman, an associate professor in clinical immunology and rheumatology at the University of Alabama at Birmingham.
Since beta-interferon treatment can cost $25,000 a year and causes uncomfortable flu-like side effects, knowing who will benefit from the drug and who will not would be valuable. About 400,000 Americans have multiple sclerosis.
The study was published today in Nature Medicine

[shoshin]

Here's another take from Medical News Today http://www.medicalnewstoday.com/articles/183841.php which does mention two types of MS, although I think it's hard to say if that's all there are or whether they're two types or two stages or whether two dimensions is all there is or is this only relevant for RRMS or what. I don't put too much stock in EAE results in mice--researchers cure EAE all the time. Biomarkers are good. A biomarker for beta-interferon susceptibility is good, but maybe not as good as one that says whether someone has MS or that tracks progression.

Here also is a video interview with the lead researcher who, at least as he comes off in the interview, seem pretty confident in his results with the twenty-six humans. http://www.scientificamerican.com/video.cfm?id=74470522001

The Medical News Today article at least mentions the need for confirmation. "In a statement, Steinman said that if the findings are confirmed by other labs doing larger studies in humans, people with multiple sclerosis might one day be able to take a simple blood test to find out whether they are likely to respond to the standard treatment."

The other interesting implication seems to be that if there is a way to separate out the non-responders and then analyze the effect only on the responders, the effectiveness of the drug would presumably go up and beta-interferon maybe turn out to be a better drug than currently thought.

I agree with Tiredofbeingnumb that a lot of these press releases are way overblown and misleading.

sho

[essdipity]

Thank you. This makes MUCH more sense (and doesn't mention interferon side effects at all).

ess

[Tiredofbeingnumb]

Here is the link from the National MS Society that makes a bit more sense:

http://www.nationalmssociety.org/research/research-news/news-detail/index.aspx?nid=2958

How I read it is it isn't so much that there are 2 types of MS but rather that there are two subsets of T cells (part of your immune system that fights infection but the current theory is they are the culprits that attack the myelin sheath). Each subset produces a different cytokine (an immune system chemical messenger), and from what they are finding, the type of cytokine that is being produced seems to be a predictor of how responsive/unresponsive a patient is to an interferon drug.

This is what the MS society article states:

They transferred two different types of disease-causing immune T cells into mice, and both were able to produce the MS-like disease EAE. (The two types of T cells are called T helper 1 cells and T helper 17 cells, and each type causes a different pattern of cytokines to become activated.)

Then they tested whether there was any difference in the response of the mice to interferon. They found that interferon reduced EAE symptoms in mice whose disease had been induced by T helper 1 cells, but it worsened disease that had been induced by T helper 17 cells. They also identified which immune messengers were influencing the different responses.

This is what jensequitur's article states:

In this study, published in the current issue of Nature Medicine, researchers established animal models of multiple sclerosis by injecting mice with myelin into their immune systems, causing it to attack the animals' own myelin nerve-cell coatings, much as MS attacks a human being’s. By looking at these animals and treating them with beta-interferon and then testing their blood the researcher found there were actually two different types of MS, caused by different patterns of T cells in the body. So what works for one, doesn't necessarily work for the other.

I believe these articles are talking about the same study (they both quoted Nature Medicine) but they are saying two different things. I, for one, would be more likely to believe the article from the MS society.

So, from what I gather from the MS society's article, it isn't really two TYPES of MS, more that there are two subtypes of T cells, each producing a different cytokine. It sounds like the type of cytokine you produce can predict how responsive you'd be to an interferon. It is exciting in that potentially, a simple blood test can determine what the best drug option is, instead of randomly picking one, and having to wait 6 months to see if the drug works. Betaseron didn't work for me, and it would have been nice to know that going in! Would have saved 6 months of more symptoms, potentially.

My PSA for the day is: be very careful what you read on the internet. Make sure what you read is from a valid site. Not that paging dr gupta would be spouting total misinformation, I just think a more accurate site of information would be the MS society.I believe they have medical correspondents that help edit that kind of stuff. It is just interesting to compare these two articles, because I believe they are quoting the same study, but they read very differently. The MS society article doesn't even mention the interferon flu like effects being a predictor to interferon effectiveness.

[jensequitur]

What I got from it was:

• Two kinds of MS
• One is caused by gamma-interferon-secreting T cells - people with this kind of MS can tolerate Betaseron without any flu-like symptoms.
• The other is cause by IL-17-secreting T cells, and people with this kind of MS have the flu-like symptoms.  

The article seemed to indicate that the people without the flu-like symptoms did better on Betaseron, but like you, ess, I have to wonder - I know a lot of other people who do well even with the flu-like symptoms.

I think at this point it's too early to tell how the disease progresses, or how well the beta interferon works on the gamma-interferon-secreting T cell MS.  Only 26 blood samples tested so far, remember!

I am curious to see what they come up with, though.

[essdipity]

I didn't take this article to mean that patients could be differentiated by whether or not interferon caused flu-like effects, although its wording is certainly confusing.

Rather, it seems to say that two different kinds of cells may cause MS demyelination. For one type, interferons seem to work, and for the other, no deal. I don't see a connection between that and whether or not interferon is reasonably tolerated.

The article also says that 1/3 of those on an interferon do have flu effects. I'm thinking it must be a lot more than that. But what that has to do with disease progression I don't know. I am one person who does get the side effects, though they are well-controlled, and I also feel that Avonex is helping me. After the first year, my MRI showed no disease progression, the first and only time that has occurred. My situation is just one anecdote, of course, and not scientific proof.

If I am misreading this article, I hope one of you will point this out. My brain has been a bit fuzzy lately.

ess

[jensequitur]

Very true!

The reason I posted this particular article is because of the idea that a simple blood test could tell you whether or not you should take betaseron - that's pretty cool.  

26 blood samples from human patients is certainly not enough to base a theory on - but before they used human blood, they tested the theory on animal models of multiple sclerosis. "beta-interferon improved the condition of animals who had MS caused by gamma-interferon-secreting T cells, but made the symptoms worse in those mice whose MS was caused by IL-17-secreting T cells."

[Ginosmommy]

That is a great article, thanks for sharing. I have just started my injections so I am still on the titration schedule (and the fact that I take 800mg twice a day of ibuprofen) I have never gotten the flu-like symptoms, maybe it's just because of the T-cells!

[sllowe]

Please be careful gleaning information from articles based on study that involved 26 patients.

Not posting my thoughts here to discredit what they have learned. Just pointing out the size and scope of this initial study.