Against multiple sclerosis, “fortunately in recent years with early diagnosis it has been possible to achieve a much more effective and faster result than in the past. We treat the disease from its onset and this is one of the largest progress in the management of the disease “, because” early treatment impacts on evolution and prognosis. Today, from a therapeutic point of view, we have drugs capable of modifying the natural history of multiple sclerosis. Patients diagnosed early, and who immediately follow the therapy, in 80% of cases they can postpone the progression of the disease into more serious forms, including disability, by 15-20 years “. So at Adnkronos Salute Antonio Uccelli, neurologist and scientific director of the Irccs hospital Policlinico San Martino in Genoa, taking stock of the research for multiple sclerosis on the occasion of the World Day which is celebrated on 30 May. “These highly effective drugs – he underlines – are able to make us imagine that people treated early may never reach severe disability, or do so over a very long period of time. Then we also have more effective monitoring with magnetic resonance and new biomarkers. , which will allow us to be able to change the course of therapy by immediately highlighting whether the treatment is going well or if the disease is galloping “. Will it become a chronically managed disease? “Yes – answers Uccelli – it is a pathology that we can imagine managing chronically and increasingly relying on the possibilities of home management, with an increasingly rare request for hospitalization”. But does the network of multiple sclerosis centers work in Italy? “Absolutely yes – assures the specialist – and it is of the highest level throughout the Peninsula. The level of expertise of neurologists is high and this is also thanks to the activities of Aism and scientific societies. There is therefore a capillary network of structures in able to handle patients “. The point on the future and on the way of stem cell transplantation Looking beyond drug therapy, Uccelli takes stock of new frontiers. Regarding the use of mesenchymal stem cells, an approach that has been studied but undergoing a setback, “they are safe, but they do not block the disease”, recalls the neurologist. “In cases where it is necessary to contain the evolution of the pathology, this type of approach is much less effective and impactful. Reparative therapies – highlights Uccelli – are one of the objectives of clinical and translational research. To date, attempts aimed at trying to repairing the damage has not been a success. We are very good at preventing the damage from occurring, but when the disease progresses even the available drugs can go up to a certain point, slowing this ‘rush’ in 20 -30% of cases. This tells us that we are facing an unsatisfactory situation: many researchers are working on the cellular therapies front, however at the moment they have not given the desired results “. Another promising frontier is that of hematopoietic stem cells. “They are a very effective treatment – remarked the specialist – even if the studies that aim to demonstrate an efficacy superior to that of drugs have not yet been definitively published. But I believe that they are the most effective treatment at a preventive level, aimed at killing cells. as bad as it happens in leukemia. The goal is to give back to the body, thanks to autologous stem cells, cells that have less propensity to attack the nervous system. That is, I regenerate an immune system that does not attack my brain. given: it is limited to forms of aggressive sclerosis with important side effects and in very rare cases even fatal. It can be applied in the malignant forms of the disease, which are less than 5% of people with multiple sclerosis. The suggestion is to try the treatment first pharmacological and then, if no results are obtained, try the path of hematopoietic cell transplantation “. According to Uccelli, “in the next few years the way will be combined treatment: on the one hand the drugs we already use, and then help the immune system with the transplant. Then activate an early response and then use the treatments that favor tissue repair. It is conceivable – he concludes – to convey to this frontier also the micromolecules or nanomolecules that intervene with the genes of the nervous system to block degenerative progress “.
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