Lancet neurology
-
Multiple sclerosis (MS) has been classically regarded as a white matter disease. However, recent histopathological studies have convincingly shown that grey matter regions are also heavily affected. Grey matter damage starts early in the disease and substantially affects clinico-cognitive functioning. ⋯ At present, the causes of grey matter damage are unclear. We review several exciting new hypotheses on grey matter pathogenesis, including meningeal inflammation as a cause of subpial cortical damage, but also selective vulnerability of neuronal subpopulations, growth factor dysregulation, glutamate excitotoxicity, mitochondrial abnormalities, and the "use-it-and-lose-it" principle. These hypotheses remain to be validated over the coming years, and could substantially affect our current views on MS pathogenesis.
-
Randomized Controlled Trial Multicenter Study
Safety, efficacy, and biomarker findings of PBT2 in targeting Abeta as a modifying therapy for Alzheimer's disease: a phase IIa, double-blind, randomised, placebo-controlled trial.
PBT2 is a metal-protein attenuating compound (MPAC) that affects the Cu2(+)-mediated and Zn2(+)-mediated toxic oligomerisation of Abeta seen in Alzheimer's disease (AD). Strong preclinical efficacy data and the completion of early, clinical safety studies have preceded this phase IIa study, the aim of which was to assess the effects of PBT2 on safety, efficacy, and biomarkers of AD. ⋯ The safety profile is favourable for the ongoing development of PBT2. The effect on putative biomarkers for AD in CSF but not in plasma is suggestive of a central effect of the drug on Abeta metabolism. Cognitive efficacy was restricted to two measures of executive function. Future trials that are larger and longer will establish if the effects of PBT2 on biomarkers and cognition that are reported here translate into clinical effectiveness.
-
Randomized Controlled Trial Multicenter Study
Repeated subcutaneous injections of IL12/23 p40 neutralising antibody, ustekinumab, in patients with relapsing-remitting multiple sclerosis: a phase II, double-blind, placebo-controlled, randomised, dose-ranging study.
Repeated subcutaneous injections of a monoclonal antibody against the p40 subunit of interleukins 12 and 23, ustekinumab, were used to treat patients with relapsing-remitting multiple sclerosis (RRMS) to assess the drug's safety, efficacy, and pharmacokinetics. ⋯ Ustekinumab is generally well tolerated but does not show efficacy in reducing the cumulative number of gadolinium-enhancing T1-weighted lesions in multiple sclerosis.