Medical Hypothesis – NO in pathology of MS – Louis Ignarro Giovannoni – nitric oxide metabolites in CSF MS patients Cross et al – nitrotyrosine in MS lesions Nobel Prize NO in Heart Disease Louis Ignarro Nitric Oxide in MS Animal studies showed ONOO damaged nerve cells and produced MS type lesions 1988 2001 1998 1992
Danilov – nitric oxide products in progressive and RRMS Increased amounts during relapse Redjak et al Calabrese – iNOS in MS patients CSF Nitrotyrosine in CSF Nitric Oxide in MS 2002 2004 2003
ONOO in acute and chronic MS Lui – nitrotyrosine in lesions ONOO production brain cells ONOO damaging but not NO Nitric Oxide in MS 2006 2008 2007
Rejdak et al Neurology 2004 Examined NO metabolites in CSF Correlates to MRI scan lesions Greater levels in those with less disability Correlation NO levels and severity of disability/MRI appearance at 3 yrs 2008 – nitrosative stress assoc with sustained disability in MS
Tyscore Measuring disease activity Increased Tyscore in absence of clinical signs 25% of progressive MS patients have raised levels Treatment with steroids/co paxone/LDN may reduce levels and disability 25%
Tyscore – Measuring Nitrotyrosine New test for MS patients Highlights increased immune activity Progressive forms of MS Key to unlock treatment
New Paradym In MS Treatment 75% of all MS patients have progressive disease Majority are not in active treatment Tyscore can help identify the periods of increased immune activity. Active treatment at these times has potential to reduce/prevent disability.
Does LDN work soley through endorphin increase ? Does LDN/other Rx reduce the Tyscore? How do we respond to a raised Tyscore? Cost implications of treating more MS ? Unanswered Questions?
Crohns Disease 60 year old male patient Severe crohns – nine bloody motions daily Recent blood transfusion 19 colonoscopys Started LDN 2007
Crohns Disease Review August 2008 Normal motions for one year Complete remission of disease Single dose LDN Tyscore negative
Psoriasis Guttate Psoriasis several years Plamoplantar pustulosis 2008 Commenced LDN 1mg Sept 2008 Marked Clinical Improvement Autoimmune Disorder