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Clinical trials in Alzheimer’s disease: three recent setbacks

…ties, including lymphopenia, elevated cholesterol and elevated urinary pH. Comment Dr. Yves Bacher: The negative scans for amyloid in 36% of ApoE4 non-carriers at baseline in the bapineuzumab trial raise questions about the importance of amyloid pathology in Alzheimer’s disease and/or the value of our diagnostic criteria in relation to the clinical syndrome. Is it a question of the right target (i.e. fibrillar vs. soluble amyloid)? Or a question o…

Alemtuzumab receives Health Canada approval

…ls, dendritic cells, macrophages), which may preserve some degree of immunocompetence (Freedman et al. J Clin Cell Immunol 2013;4; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3869402/). However, the risk of herpesvirus infection or reactivation appears to be high, with an incidence of 16% in both CARE-MS trials (vs. 2-4% with IFNb) despite antiviral prophylaxis. The risk of PML is not known. There have been no PML cases in MS trials of…

Fingolimod: impact on beta-amyloid neurotoxicity?

…2013;8:e6; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC3625222/pdf/pone.0061988.pdf). Cortical neurons were shown to express all S1P subtypes. Treatment with fingolimod-P 100 pM three hours prior to administration of beta-amyloid protected neurons from severe beta-amyloid-induced neurotoxicity. Subsequent experiments indicated that this neuroprotective effect was due to fingolimod-P-induced production of brain-derived neurotrophic fact…

MS treatment failure: who is at risk?

…:1616-1623; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC2881858/pdf/7121.pdf). This suggests that there is a limited time window to potentially alter the disease course with the current immunomodulatory therapies. The times to EDSS 6 or 7 in the Brazilian study are similar to those reported by the Lyons group (23.1 years for EDSS 6, 33.1 years for EDSS 7) (Confavreux et al. N Engl J Med 2000;343:1430-1438), indicating that the natural h…

Neurodegenerative disease and high-voltage power lines

…ing >600 m from a power line (Huss et al. Am J Epidemiol 2009;169:167-175; free full text at http://aje.oxfordjournals.org/content/169/2/167.full.pdf+html). AD risk increased with increasing duration of exposure of >5 years (HR 1.51), >10 years (HR 1.78) and >15 years (HR 2.00). There was little evidence of an association between exposure to high-voltage power lines and PD, MS or amyotrophic lateral sclerosis. A previous review of 10 epidemiologic…