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- Title
EMERGING TREATMENTS ON THE HORIZON: ANTI-INFLAMMATORY AND NEUROPROTECTIVE THERAPIES FOR MS.
- Authors
Markowitz, Clyde E.
- Abstract
Current options for the treatment of multiple sclerosis (MS) possess important limitations. Firstline disease-modifying agents (interferon β-1α, interferon β-1b, and glatiramer acetate) reduce the rate of relapse by only approximately 30%, require parenteral administration, and can cause adverse effects that are difficult for patients to tolerate. Second-line agents (natalizumab and mitoxantrone) are effective for some patients who do not respond to first-line therapies, but are associated with potentially serious safety concerns. Recent research has suggested several promising new approaches to the treatment of MS, and many novel therapies are now being evaluated in randomized controlled clinical trials. T-cell vaccines use the patient's own myelin-reactive cells to stimulate an immune response against self-reactive T lymphocytes, thereby reducing central nervous system inflammation and demyelination. The synthetic peptide MBP8298 resembles a portion of myelin basic protein and suppresses autoantibody formation. Monoclonal antibodies that target several cell-surface molecules have demonstrated considerable effectiveness in patients with MS, but also produce potentially significant immune-mediated adverse effects. Several oral immunomodulatory compounds are being tested in MS clinical trials, including FTY720 (fingolimod), teriflunomide, laquinimod, cladribine, and fumaric acid esters. Neuroprotective agents are in earlier stages of clinical development. Potential neuroprotection strategies for MS treatment include antagonists of neuronal glutamate and sodium receptors, blockers of inducible nitric oxide or of cell signaling pathways that are important in programmed cell death (eg, calpain and caspases), or restoration of neuronal function with neural stem cell transplantation.
- Publication
Johns Hopkins Advanced Studies in Medicine, 2008, Vol 8, Issue 9, p322
- ISSN
1530-3004
- Publication type
Academic Journal