August 22, 2013 at 12:16pm
With the growth of research into the connection of MS to cerebral blood flow, we've seen an interest in exploring new ways to address hypoperfusion (slowed blood flow), endothelial dysfunction (damaged blood vessels) and brain atrophy (loss of brain tissue).
Why is this? Because MS specialists, neurologists and advocacy groups are much more comfortable designing, testing and recommending a drug for MS, rather than encouraging healthy lifestyles and treating venous malformations. You cannot monetize or patent a diet, exercise and angioplasty. It's impossible to have a placebo-controlled clinical trial for lifestyle. But you can develop a drug and make a lot of money selling it to a population with a chronic and degenerative disease.
Please note that I am not recommending these specific drugs at all, I'm just pointing out how MS research is slowly shifting.
We saw this paradigm change happen with the Vitamin D. Six years ago, Jeff's neuro chuckled when I asked to have his D3 levels tested. But slowly, with independent research funded by patient advocacy groups like Direct MS, the research paradigm has changed. And now, neurologists are testing their new patients' vitamin D levels, and adding supplementation accordingly. I believe we will see this shift continue with drug approaches to reducing hypoperfusion.
This is tacet proof that blood flow matters in MS. But you will not hear that from neurologists-yet. They will discuss cerebral blood flow with their patients when they have a prescription they can write.
Here's some info on a few of these new medications which target blood flow, currently in clinical trials.
Ibudilast (MN-166)
Clinical trials in progressive MS patients to be lead by Dr. Robert Fox and the Cleveland Clinic with the NMSS. Dr. Fox received NMSS money to study CCSVI, and after finding new venous malformations in the jugular veins of people with MS, he has moved on to a clinical trial using a vasodilating and neuroprotective drug. Is this coincidental?
MN-166 has been marketed in Japan and Korea since 1989 to treat cerebrovascular disorders, including post-stroke complications, and bronchial asthma. MediciNova licensed MN-166 (ibudilast), from Kyorin Pharmaceutical for potential utility in MS.
Lisinopril
An inexpensive blood pressure medication and ACE inhibitor which modulates angiotensin. This drug opens up blood vessels and allows blood to flow more easily. This older drug is being developed to treat MS by Dr. Lawrence Steinman of Stanford University School of Medicine. (Dr. Steinman is also one of the inventors of Tysabri--which he has since spoken out against as a first line treatment for MS.)
... angiotensin immediately causes blood vessels to constrict. “That raises your blood pressure so when you stand up to get out of a chair, you don’t fall down and faint,” said Steinman, who is also the George A. Zimmerman Professor in the medical school. But angiotensin overactivity causes chronic hypertension. Lisinopril controls blood pressure by blocking an enzyme that converts angiotensin’s precursor into the active hormone. The drug also appears to have certain anti-inflammatory properties.
Here is info on the current study:
In these studies, lisinopril reduced molecular measures of inflammation that accompany MS, yet it did not inhibit overall immune function.
Statins
Although these cholesterol-lowering drugs failed in earlier trials for RRMS, they are now being brought back to life to address brain atrophy in progressive MS.