in this video I'm going to explain to
you how the LS disease-modifying
therapies work all of them using simple
language and easy to understand
analogies if you'd like to better
understand how these meds work stay
tuned because I'll start explaining
right now
howdy thanks for learning about MS with
me Aaron Boster. I started this YouTube
channel to help my own MS clinic
patients learn between visits and it's
my hope that through these videos I can
help you learn to today's topic disease
modifying therapies the medicines that
we use to slow or delay multiple
sclerosis in 2019 there are literally 17
different FDA formulations of these
medicines and they're weird in the way
that they work because what we're trying
to do is alter the immune response which
is no easy task it's very easy to get
lost and how these medicines work and
over the years I've come up with ways of
trying to help people understand what
the medicine they take does I've made
several videos on this channel on each
one of these drugs but I thought I would
take a few moments and pull them all
together to give you the highlights of
how these meds work using simple
easy-to-understand analogies and
everyday language so let's jump in
number one Copaxone go TL or acetate
these are injections they're one of the
first line medicines and they work by
tricking the immune response Copaxone is
four amino acids in a random chain these
four amino acids look like a certain
protein specifically they look like
myelin the coating on the nerves that
you're naughty immune system is trying
to attack when you take Copaxone you
literally show your immune system its
target you say hey look look at this and
then a couple days later you reject hey
look at it again and then a couple days
later try to look at it again and you
literally keep shoving the target in the
immune systems face and over time the
immune system becomes bored when the
immune system later sees the real myelin
the real target in the brain it's a sort
of yesterday
happens is instead of launching a
pro-inflammatory raw campaign to try to
attack the myelin this is their I saw
that I'm not interested and it moves
away
number two interferon beta there are
multiple injectable medicines for MS
including trade names such as readeth
beta C R on Expedia Avonex plugger II
these medicines work by tightening the
blood-brain barrier
the naughty autoreactive cells that will
attack you live in the bloodstream and
they cross the blood-brain barrier where
they gain access to the brain and spinal
cord the interferon class medicines try
to create a better barrier so I think of
the analogy of the Three Little Pigs if
the natural blood-brain barrier is the
straw house in the Three Little Pigs
analogy when you screw it in a ferrule
on top of it it becomes the stick house
it's a better house so the cells can't
cross as easily number three a Biagio or
tear fluid amide this medicine for MS is
a daily pill and it works differently
than the interferons
or Copaxone it works by preventing the
cell's ability to rapidly reproduce when
you have a white blood cell it lives its
life and as long as it doesn't have much
to do it will just plot along and then
make a copy of itself before it dies and
then that next I'll make a copy of
itself before it dies and that way you
can maintain the white blood cells which
aren't really do much but if there's
suddenly a war or a battle that's about
to be fought or your immune system gets
activated that one white blood cell sort
of turns on and it will make a bunch of
a bunch of copies which reminds me of
the Clone Wars if you're familiar with
the story of Star Wars where they make a
bunch of stormtroopers now when you take
the Biagio it doesn't kill the cells but
it freezes the cells so that they can't
make multiple copies you can still
maintain the style lines it doesn't kill
them it just prevents them from rapidly
reproducing so you can build a bunch of
stormtroopers to go attack your brain
when you stop a Biagio that circuitry is
no longer interrupted and now your cells
can start to behave more normally number
four dimethyl fumarate or tecfidera this
twice of a pill is rather unique in its
mechanism
it works by tricking the cells in
thinking that they're under oxidative
stress even though they're not that
forces themselves to then respond with
an antioxidant cascade which slows down
multiple sclerosis a rather unique
mechanism of action
number five finger mod or jelenia a
once-a-day pill for MS that again has a
rather unique mechanism of action now to
understand this I like to set up a brief
analogy think of the white blood cell as
a car the blood stream as a road in the
lift mode as a garage car drives down
the road enters in the garage now
getting in the garage is free you just
go in but leaving a garage requires a
hey tag you have to show you hang tag to
exit the garage when you take Junia it
causes us to lose the Hang tag so the
car goes down the road and drives into
the garage no big deal but it can't get
out because it doesn't have a hang tag
as long as you take Junia when the white
blood cells in the bloodstream and it
goes into the lymph nodes it becomes
trapped it reminds me of that old song
from the Eagles Hotel California even
though it anytime you want but you can
never leave as long as you continue to
take to linea those cells are
sequestered or trapped in the lift nodes
they can't leave when you stop to linea
then the cell can reexpress his exit
hang tag and you can once again leave
the lymphatics
that's how journey works to slow a mess
because if the cells can't enter in the
bloodstream they can't cross the
blood-brain barrier into the brain so
keeping them trapped in the lymph nodes
accomplishes that in a rather unique way
number six Tysabri or natalizumab it's
an infused agent taken once every month
and it works to tighten up the
blood-brain barrier in a way that we
haven't seen before remember when I use
the analogy of the Three Little Pigs and
I said that the normal blood-brain
barrier is like the straw house when you
squirt interferon beta on that it
becomes this thick house when you give
someone Tysabri it becomes the brick
house then of course you have to sing
"She's a brick...HOUSE!"
Tysabri recreates literally the Great Wall
of China
and so that blood-brain barrier is
impermeable and literally cells cannot
cross as long as you stay on Tysabri
that Great Wall of China stays intact
when you stop Tysabri the Great Wall
goes back to being a straw house number
seven
Ocrelizumab, or Ocrevus,  it's a infused
drug taking through the vein given twice
a year so every six months and it works
in a rather creative way
it kills adult b-cells now allow me to
explain think about high school I
remember in high school if two young men
bumped into each other in the hallway
there was only one way to settle that
dispute they met behind the building at
3:30 and they beat the crap out of each
other now I noticed when I would attend
some of these events that young men
never showed up to fight by themselves
they always came with six of their very
closest friends and those friends would
egg them on go ahead with this but I got
you all your bookbag now using this
analogy the t-cell is the cell that's
going to attack your brain spinal cord
but the t-cell can't do it without
stimulation from his friends the b-cells
with okra vus we literally murder all of
your friends and so there are no adult
b-cells therefore they can't get that
t-cell riled up to fight and in the
absence of adequate co-stimulation from
the B cells that t-cell doesn't attack
and so why do we give otra vez every six
months because six months later you
start to make more b-cells you start to
make more friends soon every one of
those guys - and every six months we
knock out adult b-cells
which prevents the t-cell from becoming
adequately stimulated which prevents it
from attacking you
and lastly Allen - slab or limb trata
it's also in monoclonal antibody infused
through IV in the vein and as you recall
it's taken for five days in a row and
then you wait a year and then three days
and then you don't take it again unless
you have new disease activity obviously
this drug works very differently and
it's a style of induction therapy
essentially what you're doing is you
target a
B and T cells and you murder them and
then you force the young ones to go back
more well-behaved I like to think of it
as a reboot of the immune response so
instead of trying to block a cell you
retraining the cell lines to knock it
off so they don't behave the way they
used to there you have it my rendition
of how the MS medicines work using
easy-to-understand analogies and
straightforward language my name is Erin
Bhaskar and thank you for learning about
ms with me today if you enjoyed this
video and think you'd like to see future
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until my next video and take care
