As NDG Tuesday hasn’t happened yet I have posted this and this looks at stem cells therapy which inhibits relapsing disease but the question is does it stop lesions in the CNS At present it is seen as a treatment of last resort to be used when other things have failed but surely it should be offered to people earlier as damage has already accumulated by the time you instigate plan C.
Paramagnetic rings are possibly the rim of macrophages that are generated as lesions around blood vessels eat outwards and have an active Tim and a centre of previous damage. Stem cells transplantation of the immune system halts more attacks in most cases, but what about events already happening.
Lesions were still present 15 months later. HSCT does not aim to kill macrophages and paramagnetic lesions are largely macrophages but suggests that once the lesions are set in motion they continue for many months.
But surely this says that PIRA (progression independent of relapse) is tosh. These lesions will have peripheral inflammation as their central core and are still active 15 months later so evidence of worsening more than 30 days after relapse is progression unrelated to relapse. Many of my colleagues be buy into PIRA as a marker of progression independent of biology related to lesion formation.i suppose many lemmings bought into this…Be careful not to jump off a cliff
Amin M, Nakamura K, Thoomukuntla B, Carlson AK, Planchon SM, Moore S, Lowe MJ, Brunstein C, Ontaneda D, Cohen JA. Paramagnetic rim lesions on 7T MRI after autologous hematopoietic cell transplantation. Mult Scler. 2026 Mar 13:13524585261429371. doi: 10.1177/13524585261429371. Epub ahead of print. PMID: 41821410.
Background: Compared to the potent efficacy of autologous hematopoietic cell transplantation (AutoHCT) on multiple sclerosis (MS) lesion activity, benefit on disability progression is less clear. Paramagnetic rim lesions (PRLs) are imaging biomarkers associated with progression.
Objectives: Evaluate effect of AutoHCT on PRLs using 7T magnetic resonance imaging (MRI).
Methods: A single rater evaluated PRLs before/after AutoHCT on 7T MRI at an MS referral center.
Results: Seven participants were included with mean age 38.9 years and median disease duration 9 years. Median PRL count pre-transplantation was 2. Post-AutoHCT (median 15 months in 5 participants) none of the PRLs resolved.
Conclusion: These results provide low-level evidence that PRLs do not resolve following AutoHCT.
Source: multiple-sclerosis-research.org