Albuterol add on therapy

[Cvfactor]

Nice find Suebee,

Apollo posted a study on the first page of this link that shows that those using another asthma treatment (also a beta 2 adrenergic receptor agonist) had a reduced prevalence of MS.

As far as the Albuterol I have been on it for a week and have no side effects. I think it is pretty inert at this dosage, at least this is my experience.

If it keeps me stable I think this is a good option for me, but I will post back if I have a relapse or side effects.

Take care

[Cvfactor]

The Hypothesis

The hypothesis behind this treatment is that the nervous system has control over the immune system and the immune system does not function in isolation.

Here is a review article about this:

"Hypothesis 3: prolonged treatment with adrenergic agonists might rescue immune control

Despite the insensitivity of peripheral immune cells to acute adrenergic stimulation, prolonged treatment with adrenergic agonists might induce a potentially beneficial shift in cytokine patterns. In a study with SPMS patients, Makhlouf et al. [60] showed that, after 14 days of treatment with salbutamol, the in vitro IL-12 production of monocytes and dendritic cells was decreased significantly compared to baseline, with persisting effects for at least one week post-treatment. Furthermore, they reported an increase of Th2 cytokines [61]. Based on these findings, a randomized trial of add-on treatment of salbutamol to glatiramer acetate is under progress (see http://www.clinicaltrials.gov).
To date, it is unclear how this reinstitution of adrenergic signal transduction is achieved. Future studies should examine b-adrenergic receptor expression and intracellular signalling cascades under b-agonist treatment in MS patients."

http://www.sciencedirect.com/science...71490605002449

[Cvfactor]

Astrocytes

The more I dig into this there intriguing it is becoming.

It seems that a certain type of cell in the central nervous system (the astrocyte) lacks the beta 2 adrenergic receptor. But this seems to be only the case for people with ms.

At any rate it is suspected that because of this, the features of ms (inflamation followed by neurodegeneration) may be explained by this lack of receptor:

http://www.ncbi.nlm.nih.gov/pubmed/15102491

This is probably the most logical explanation of what MS is in my opinion.

More intriguing, this same group seems to think that beta2 adrenergic receptor agonists (which is what Albuterol is) may actually normalize the astrocytes through induction of a newly discovered t cell line (double negative t cells or DNT).

http://www.jneuroinflammation.com/content/11/1/21

"We previously reported that β2-adrenergic receptors are selectively downregulated in astrocytes in MS [54]. This downregulation might play a role in the neurodegenerative aspect of the disease [2], but it remains unclear how it can explain the inflammatory aspect of MS. A decrease in immunoregulatory DNT cells may be a component linking downregulation of astrocytic β2-adrenergic receptors with neuroinflammation in MS."

[Suebee]

CV factor, I have been looking for research on effect of overstimulation or too much up regulation of beneficial T cells with albuterol.
This led me to a very dense and esoteric paper on T cells. Struggling through it I found that The paper has nice diagrams of T cells. (Pictures!) although I lack a science background, I thought if share my glib review to save someone else the trouble. The paper suggested that Different T cells may regulate different region-specific localization of inflammation in the CNS. I thought that was really interesting. Also, it discussed roll of B with T cells : "B cells may exert an immunoregulatory influence on CNS autoimmunity. B cells have been reported to facilitate the recruitment of regulatory T (TReg) cells to the CNS during EAE142, and interleukin-10 (
...In contrast to a pathogenic role for B cells, several studies indicate that B cells may exert an immunoregulatory influence on CNS autoimmunity. ...
Interestingly, B cells from patients with multiple sclerosis produce less IL-10 than B cells from healthy controls, and B cells that emerge following treatment with rituximab (an antibody specific for CD20, which is expressed on the surface of B cells) secrete higher levels of IL-10 than B cells before treatment145. This finding, together with the observations that rituximab does not deplete plasma cells and that autoantibody titres did not change during treatment, suggests that the benefit of this treatment was not simply a result of inhibiting pathogenic antibody activity."

At around pg 133 of paper it discusses the possible role of viruses, esp. Epstein Barr virus with T cells and inflammatory response. At around pg 178 it briefly mentions copaxone and it's affect on up regulation .

I hope you find this interesting. Let me know if you come across anything on the affects of triggering too much beneficial T cells. I was wondering if causing a significant anti inflammatory Benefical T cell upregulation with Copaxone and albuterol would allow for possibility of tumor growth. Copaxone warns of causing tumors in theory but I've never been able to find a descriptive explanation of why. I'm guessing it would take a significant amt of both drugs to cause negative effect, but I am curious as to how it would take before the benefits diminish.
Suebee
http://www.ncbi.nlm.nih.gov/pmc/arti...1/#!po=58.5809

[Cvfactor]

Suebee,

I don't actually know if this add on therapy increases the chance of cancer. This is a good question.

My personal feeling is that Albuterol has been in use for decades in asthma treatment so I think a lot of doctors have experience with it. This is why I talked to my PCP since my neurologist has no history with this drug.

The group from Harvard has a background paper that describes this as a posible option prior to the Phase 2 trial :

http://www.ncbi.nlm.nih.gov/pubmed/11772115

I'm not condoning that anyone should try this therapy, I'm just explaining what I am doing and the reasoning behind it.

I would run this by your doctor (s) to get their opinion.

Best of luck.

[Suebee]

CVFactor, I totally understand this is an approach you are taking with dr. I got excited because the science you cited looks promising. When I was diagnosed years ago I did not think I would see a cure or meaningful treatment in my lifetime. But there are so many discoveries I get hopeful. The stakes feel high for me. My last attack was aggressive, but I had lengthy recovery and quite functional now. Not perfect. But I'll take functional. My mother had progressive MS, which shortened her life. So I've seen first hand what the disease is capable of so I am willing to try novel ideas. Because of my clinical history and family history doctors are usually quite supportive of things I want to try. So glad some mysteries about MS are being discovered !

[Cvfactor]

Suebee,

Yes this disease is very scary. After my first attack I lost the ability to walk for 6 months and have permanent urinary retention that requires me to self cath.

I try to understand something before I jump into it and this to me seems to have promise. I don't think anyone can argue about the effects seen on relapse rate, but as far as progression this is an unknown as well as other things like cancer risk as you suggested.

What ever you decide best of luck.

[Cvfactor]

Cancer

Suebee,

Here is a paper that describes the role of the immune system on cancer surveilance:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228931/

I think researchers are not exactly sure what factors are involved in the development but it seems the immune system plays a role.

[Suebee]

Thanks CVfactor. I'm going to raise another potential issue to consider. In asthma , albuterol and inhaled cortosteroids are used to control disease. This protocol is effective for most, but it's been documented that in some severe asthma patients, those on high doses of drugs or long duration, "pro-inflammatory actions of short acting B agonists counterbalance the benefits of inhaled cortosteroids". By loose analogy, and based on theoretical principals, I'm thinking that one should have ongoing evaluation of the effectiveness of adding on albuterol to copaxone if IV steroids or prednisone is needed for treatment of a MS flare.
Best of luck to you too. Thanks for posting.

[Suebee]

Link for quote above http://www.ncbi.nlm.nih.gov/pmc/arti...v055p00595.pdf

[Cvfactor]

Suebee,

Good point. I think if you need Corticosteroids to treat relapses, it probably is not effective.

But looking at the relapse data it seems that after 20 weeks, relapses were halted (at least in this group of people).

So if I have another relapse next winter (my most common time) I would conclude the Albuterol is not working for me.

On the other hand if I have a relapse before twenty weeks I think I would stick with it for a longer period of time.

[Suebee]

CVfactor. I think that is good plan. My time is summer. I have speculated that my allergy to grass pollen etc may be triggering an immune response after undiagnosed sinus infections started. I became more vigilant about sinus issues. Using a medi pot and massage of face, and antibiotics if needed. Unclear if this helps my MS but certainly helps my overall health. If you are allergic to winter allergens (mold dust etc) it might be beneficial to try to eliminate exposure and treat allergy. Also, winter flares as probably know raise issue of whether there is vitamin d def And less vit c and omega 3 s in your diet. It's been helpful to connect with you about such issues. I often feel I'm on a solo journey with no road map. Hearing your approach and experience with MS was a good boost to keep searching and advocating for myself. Peace. Suebee.

[Cvfactor]

First Month

I have been on the Albuterol add on therapy for a month and I don't have any side effects. One thing I have noticed is that my legs seem to feel good.

Ever since I recovered from my first attack I've had residual chronic aching in my legs. The further I walk the worse the feeling gets. Now my legs feel normal. I can't say that this is not my imagination but I'm happy either way.

So far so good.

[havingfun]

The medi pot has helped preventing my sinus infections. I did learn to use purified water to prevent organisms in tap water from causing sinus infections. I buy a cheap gallon and add my own non-iodized salt and baking soda. Much less expensive than the little salt packets.

[Cvfactor]

Thanks Havingfun,

I'll have to give this a try. I think there is a strong connection between infections and MS activity so your idea has merit.