Adonis Diaries

Posts Tagged ‘Multiple Sclerosis

Multiple Sclerosis–the vascular connection

From Rindfliesch‘s discovery of the central vessel in the MS lesion in 1863, to CCSVI and the CNS lymphatic discovery. 160 years of research on blood flow, CSF, lymph and perfusion of the central nervous system.

Because the heart and the brain are connected.

Posted by Joan. Wednesday, June 3, 2015

A “Stunning Discovery”

We are living in very exciting times.  During the past few years, researchers have changed what was thought to be known about how the brain cleanses and protects itself. 
Textbooks are being re-written.These discoveries are important for people with neuro-degenerative diseases like MS, Alzheimer’s, Parkinson’s and dementia.

New technologies have allowed researchers to see exactly how the brain cleanses itself while we sleep, via the newly defined “glymphatic” system, which relies on the sleep state to remove toxins, proteins and metabolites from brain tissue.

Before this discovery, it was not known how the lymphatic system functioned in the central nervous system. Researchers had assumed the brain was cleansed with cerebro-spinal fluid, but they really weren’t sure how this took place.

Now it is understood that there is a specialized CSF/lymphatic system in the brain, which has been called the “glymphatic” system because of the importance and reliance on the glial cells.

This discovery was made at the University of Rochester, and is currently rocking the world of sleep specialists.  It explains the link between sleep problems and neurodegenerative disease, and provides some answers as to why sleep is so essential for brain health.
link

I was able to visit Dr. Nedergaard’s lab at the U of R, where this discovery was made,  to see how she and her associates are taking this research forward into translational medicine and potential treatments.

As Dr. Nedergaard told me, good sleep and adequate drainage of the brain are key to brain health.  Nothing can be done to help the brain heal (via stem cells or medications) until these mechanistic systems are functioning adequately.
linkFurther understanding of this discovery has been made at the University of Virginia School of Medicine by Dr. Jonathan Kipnis.

The Kipnis Lab has found previously undetected vessels that carry immune cells in the CNS.  Seeing these vessels was like discovering a new planet in our galaxy.   Researchers thought they understood how the brain’s immune system functioned and how the CNS was “immune privileged”–but in reality, they were completely wrong.

The relationship between the brain and the immune system has long puzzled researchers.

For some time, scientists thought that immune cells only showed up in the brain during an infection.
The brain is considered “immune privileged,” such that when exposed to foreign material, it takes longer to mount an immune response than does the rest of the body. Furthermore, to date, traditional lymphatic vessels had not been found there.
link


This stunning new research shows that the brain and central nervous system is no different from the rest of the body.  We now can study how the immune system works in the brain, and how these lymphatic vessels allow or inhibit immune cells in brain tissue.What do these newly discovered lymphatic cleansing and immunological systems share?

They are lymphatic vessels and rely on veins.

That’s right.  The glymphatic system which cleases our brain utilizes paravenous spaces.  This newly discovered immune system in the CNS drains along the dural sinuses.

In searching for T-cell gateways into and out of the meninges, we discovered functional lymphatic vessels lining the dural sinuses. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes.
link

Kipnis described the newly discovered vessels as “very well hidden” and noted that they follow a major blood vessel down into the sinuses, an area difficult to image. “It’s so close to the blood vessel, you just miss it,” he said. “If you don’t know what you’re after, you just miss it.”
link

Kipnis and his colleagues found that vessels expressing markers of lymphatic vessels elsewhere in the body ran along the dural sinuses, drainage lines in the brain that collect outgoing blood and CSF, emptying these fluids into the jugular vein. They also found that the vessels contained immune cells.  link

Lymphatic ducts drain lymph into veins in the neck (the right and left subclavian veins at their junctures with the internal jugular veins). Valves in the lymphatic ducts at their junctures with the veins prevent the entrance of blood into the lymphatic vessels. link

If lymphatic vessels do not have adequate drainage, due to a stenotic dural sinus,  jugular stenosis, mechanical impingement or venous problems, the brain’s immune system and cleansing system will not function properly.

The venous system which drains the brain is essential for perfusion, cleansing and proper immune function.“Instead of asking, ‘How do we study the  of the brain?’ ‘Why do  patients have the immune attacks?’ 

now we can approach this mechanistically. Because the brain is like every other tissue connected to the peripheral  through meningeal lymphatic vessels,” said Jonathan Kipnis, PhD, professor in the UVA Department of Neuroscience and director of UVA’s Center for Brain Immunology and Glia (BIG). 

The brain is like every other tissue in our body.  It needs adequate venous drainage, so that lymphatic drainage can occur.

The images below show normal venous structure on the left, contrasted to Jeff’s stenotic jugular veins, pinched off dural sinus and inefficient, curly collateral veins on the right, as they looked on MRV prior to his venoplasty treatment.
Jeff has had no MS progression and a healing of most of his MS symptoms after successful stenting of his veins six years ago.

Endovascular stenting of the venous sinus is an approved treatment for intracranial hypertension, and a recent review shows the benefits.  link

Italian doctor may have found surprisingly simple cure for Multiple Sclerosis

A simple surgery for incurable Multiple Sclerosis?

Unblocking a blood flow in brain?

April 20, 2016

An Italian doctor has been getting dramatic results with a new type of treatment for Multiple Sclerosis, or MS, which affects up to 2.5 million people worldwide.

In an initial study, Dr. Paolo Zamboni took 65 patients with relapsing-remitting MS, performed a simple operation to unblock restricted bloodflow out of the brain – and two years after the surgery, 73% of the patients had no symptoms. Dr. Zamboni’s thinking could turn the current understanding of MS on its head, and offer many sufferers a complete cure.

Multiple sclerosis, or MS, has long been regarded as a life sentence of debilitating nerve degeneration. More common in females, the disease affects an estimated 2.5 million people around the world, causing physical and mental disabilities that can gradually destroy a patient’s quality of life.

It’s generally accepted that there’s no cure for MS, only treatments that mitigate the symptoms – but a new way of looking at the disease has opened the door to a simple treatment that is causing radical improvements in a small sample of sufferers.

Italian Dr. Paolo Zamboni has put forward the idea that many types of MS are actually caused by a blockage of the pathways that remove excess iron from the brain – and by simply clearing out a couple of major veins to reopen the blood flow, the root cause of the disease can be eliminated.

Dr. Zamboni’s revelations came as part of a very personal mission – to cure his wife as she began a downward spiral after diagnosis.

Reading everything he could on the subject, Dr. Zamboni found a number of century-old sources citing excess iron as a possible cause of MS.

It happened to dovetail with some research he had been doing previously on how a buildup of iron can damage blood vessels in the legs – could it be that a buildup of iron was somehow damaging blood vessels in the brain?

He immediately took to the ultrasound machine to see if the idea had any merit – and made a staggering discovery. More than 90% of people with MS have some sort of malformation or blockage in the veins that drain blood from the brain. Including, as it turned out, his wife.

He formed a hypothesis on how this could lead to MS: iron builds up in the brain, blocking and damaging these crucial blood vessels. As the vessels rupture, they allow both the iron itself, and immune cells from the bloodstream, to cross the blood-brain barrier into the cerebro-spinal fluid.

Once the immune cells have direct access to the immune system, they begin to attack the myelin sheathing of the cerebral nerves – Multiple Sclerosis develops.

He named the problem Chronic Cerebro-Spinal Venous Insufficiency, or CCSVI.

Zamboni immediately scheduled his wife for a simple operation to unblock the veins – a catheter was threaded up through blood vessels in the groin area, all the way up to the effected area, and then a small balloon was inflated to clear out the blockage.

It’s a standard and relatively risk-free operation – and the results were immediate. In the three years since the surgery, Dr. Zamboni’s wife has not had an attack.

Widening out his study, Dr. Zamboni then tried the same operation on a group of 65 MS-sufferers, identifying blood drainage blockages in the brain and unblocking them – and more than 73% of the patients are completely free of the symptoms of MS, two years after the operation.

In some cases, a balloon is not enough to fully open the vein channel, which collapses either as soon as the balloon is removed, or sometime later. In these cases, a metal stent can easily be used, which remains in place holding the vein open permanently.

Dr. Zamboni’s lucky find is yet to be accepted by the medical community, which is traditionally slow to accept revolutionary ideas. Still, most agree that while further study needs to be undertaken before this is looked upon as a cure for MS, the results thus far have been very positive.

Naturally, support groups for MS sufferers are buzzing with the news that a simple operation could free patients from what they have always been told would be a lifelong affliction, and further studies are being undertaken by researchers around the world hoping to confirm the link between CCSVI and MS, and open the door for the treatment to become available for sufferers worldwide.

It’s certainly a very exciting find for MS sufferers, as it represents a possible complete cure, as opposed to an ongoing treatment of symptoms. We wish Dr. Zamboni and the various teams looking further into this issue the best of luck.


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