This video discusses remyelination, a process of repairing the myelin sheath in the brain and spinal cord damaged by multiple sclerosis (MS). Dr. Aaron Boster explains the process, explores potential therapies like cladribine and metformin, and discusses the challenges and hurdles in MS remyelination research.
The four steps in the remyelination process are: 1) Damaged myelin sends a distress signal; 2) Oligodendrocyte precursor cells (OPCs) are activated and migrate to the damaged area; 3) OPCs transform into oligodendrocytes; 4) Oligodendrocytes produce myelin, wrapping it around the nerve sheath.
Potential therapies mentioned include cladribine fumerate, metformin, P307 (targeting M1 receptors), and anti-LINGO-1. A combination of cladribine and metformin is also being investigated.
The main challenges are: translating animal research to humans; the presence of chronic lesions and scar tissue creating physical barriers; OPC depletion with age; and the need for extensive safety and long-term testing of new therapies.
Dr. Boster explains that remyelination only repairs existing damage; it doesn't prevent future damage. He suggests a complete "cure" would require three types of therapies: remyelination, neuroprotective agents, and potent anti-inflammatories.
The video mentions the following drugs and related information:
Cladribine Fumerate: An over-the-counter antihistamine (related to Bedaquiline), studied in the "Rebuild" trial for its ability to help remyelinate and improve visual signals in people with relapsing MS. Also studied in the "TRAPP MS" trial for progressive MS, but this trial was stopped early due to the surprising progression of disability in participants.
Metformin: A common diabetes medication currently being explored for its potential to rejuvenate cells and possibly assist with myelin repair. It's being investigated in combination with cladribine to see if it amplifies the repair mechanism.
P307: An oral medication that targets M1 receptors. Early investigations show it's safe, and ongoing trials are exploring its potential for remyelination in MS patients.
Anti-LINGO-1: A therapy aiming to block a protein that inhibits myelin repair. Early investigations have yielded mixed results, but ongoing trials are refining its potential.
