- It was 1995 and her husband, Paolo Zamboni, a professor
of medicine at the University of Ferrara in Italy, set out to help. He
was determined to solve the mystery of MS an illness that strikes
people in the prime of their lives but whose causes are unknown and whose
effective treatments are few.
-
- What he learned in his medical detective work, scouring
dusty old books and using ultra-modern imaging techniques, could well turn
what we know about MS on its head: Dr. Zamboni's research suggests that
MS is not, as widely believed, an autoimmune condition, but a vascular
disease.
-
- More radical still, the experimental surgery he performed
on his wife offers hope that MS, which afflicts 2.5 million people worldwide,
can be cured and even largely prevented.
-
- "I am confident that this could be a revolution
for the research and diagnosis of multiple sclerosis," Dr. Zamboni
said in an interview.
-
- Not everyone is so bullish: Skeptics warn the evidence
is too scant and speculative to start rewriting medical textbooks. Even
those intrigued by the theory caution that MS sufferers should not rush
off to get the surgery nicknamed the "liberation procedure"
until more research is done.
-
- U.S. and Canadian researchers are trying to test Dr.
Zamboni's premise.
-
- For the Italian professor, however, the quest was both
personal and professional and the results were stunning.
-
- Fighting for his wife's health, Dr. Zamboni looked for
answers in the medical literature. He found repeated references, dating
back a century, to excess iron as a possible cause of MS. The heavy metal
can cause inflammation and cell death, hallmarks of the disease. The vascular
surgeon was intrigued coincidentally, he had been researching how
iron buildup damages blood vessels in the legs, and wondered if there could
be a similar problem in the blood vessels of the brain.
-
- Using ultrasound to examine the vessels leading in and
out of the brain, Dr. Zamboni made a startling find: In more than 90 per
cent of people with multiple sclerosis, including his spouse, the veins
draining blood from the brain were malformed or blocked. In people without
MS, they were not.
-
- He hypothesized that iron was damaging the blood vessels
and allowing the heavy metal, along with other unwelcome cells, to cross
the crucial brain-blood barrier. (The barrier keeps blood and cerebrospinal
fluid separate. In MS, immune cells cross the blood-brain barrier, where
they destroy myelin, a crucial sheathing on nerves.)
-
- More striking still was that, when Dr. Zamboni performed
a simple operation to unclog veins and get blood flowing normally again,
many of the symptoms of MS disappeared. The procedure is similar to angioplasty,
in which a catheter is threaded into the groin and up into the arteries,
where a balloon is inflated to clear the blockages. His wife, who had the
surgery three years ago, has not had an attack since.
-
- The researcher's theory is simple: that the underlying
cause of MS is a condition he has dubbed "chronic cerebrospinal venous
insufficiency." If you tackle CCSVI by repairing the drainage problems
from the brain, you can successfully treat, or better still prevent, the
disease.
-
- "If this is proven correct, it will be a very, very
big discovery because we'll completely change the way we think about MS,
and how we'll treat it," said Bianca Weinstock-Guttman, an associate
professor of neurology at the State University of New York at Buffalo.
-
- The initial studies done in Italy were small but the
outcomes were dramatic. In a group of 65 patients with relapsing-remitting
MS (the most common form) who underwent surgery, the number of active lesions
in the brain fell sharply, to 12 per cent from 50 per cent; in the two
years after surgery, 73 per cent of patients had no symptoms.
-
- "I am confident that this could be a revolution
for the research and diagnosis of multiple sclerosis" - Dr. Paolo
Zamboni
-
- Augusto Zeppi, a 40-year-old resident of the northern
Italian city of Ferrara, was one of those patients. Diagnosed with MS nine
years ago, he suffered severe attacks every four months that lasted weeks
at a time leaving him unable to use his arms and legs and with debilitating
fatigue. "Everything I was dreaming for my future adult life, it was
game over," he said.
-
- Scans showed that his two jugular veins were blocked,
60 and 80 per cent respectively. In 2007, he was one of the first to undergo
the experimental surgery to unblock the veins. He had a second operation
a year later, when one of his jugular veins was blocked anew.
-
- After the procedures, Mr. Zeppi said he was reborn. "I
don't remember what it's like to have MS," he said. "It gave
me a second life."
-
- Buffalo researchers are now recruiting 1,700 adults and
children from the United States and Canada. They plan to test MS sufferers
and non-sufferers alike and, using ultrasound and magnetic resonance imaging,
do detailed analyses of blood flow in and out of the brain and examine
iron deposits.
-
- Another researcher, Mark Haacke, an adjunct professor
at McMaster University in Hamilton, is urging patients to send him MRI
scans of their heads and necks so he can probe the Zamboni theory further.
Dr. Haacke is a world-renowned expert in imaging who has developed a method
of measuring iron buildup in the brain.
-
- "Patients need to speak up and say they want something
like this investigated -- to see if there's credence to the theory,"
he said.
-
- MS societies in Canada and the United States, however,
have reacted far more cautiously to Dr. Zamboni's conclusion.
-
- (EDITOR'S NOTE: Becaue they'll be out of business and
not be able to raise any more money?)
-
- "Many questions remain about how and when this phenomenon
might play a role in nervous system damage seen in MS, and at the present
time there is insufficient evidence to suggest that this phenomenon is
the cause of MS," said the Multiple Sclerosis Society of Canada.
-
- The U.S. society goes further, discouraging patients
from getting tested or seeking surgical treatment. Rather, it continues
to promote drug treatments used to alleviate symptoms, which include corticosteroids,
chemotherapy agents and pain medication.
-
- Many people with multiple sclerosis, though, are impatient
for results. Chatter about CCSVI is frequent in online MS support groups,
and patients are scrambling to be part of the research, particularly when
they hear the testimonials.
-
- Kevin Lipp, a 49-year-old resident of Buffalo, was diagnosed
with MS a decade ago and has suffered increasingly severe attacks, especially
in the heat. (Heat sensitivity is a common symptom of MS.) His symptoms
were so bad that he was unable to work and closed his ice-cream shop.
-
- Mr. Lipp was tested and doctors discovered blockages
in both his jugular and azygos veins. In January of this year, he travelled
to Italy for surgery, which cleared five blockages, and he began to feel
better almost immediately.
-
- "I felt good. I felt totally normal. I felt like
I did years ago," he said. He has not had an attack since.
-
- As part of the research project, Mr. Lipp's siblings
have also been tested. His two sisters, both of whom have MS, have significant
blockages and iron deposits, while his brother, who does not have MS, has
neither iron buildup nor blocked arteries.
-
- While it has long been known that there is a genetic
component to multiple sclerosis, the new theory is that it is CCSVI that
is hereditary that people are born with malformed valves and strictures
in the large veins of the neck and brain. These problems lead to poor blood
drainage and even reversal of blood flow direction that can cause inflammation,
iron buildup and the brain lesions characteristic of multiple sclerosis.
-
- It is well-established that the symptoms of MS are caused
by a breakdown of myelin, a fatty substance that coats nerve cells and
plays a crucial role in transmitting messages to the central nervous system.
When those messages are blurred, nerves malfunction, causing all manner
of woes, including blurred eyesight, loss of sensation in the limbs and
even paralysis.
-
- However, it is unclear what triggers the breakdown of
myelin. There are various theories, including exposure to a virus in childhood,
vitamin D deficiency, hormones -- and now, buildup of iron in the brain
because of poor blood flow.
-
- While he is convinced of the significance of his discovery,
Dr. Zamboni recognizes that medicine is slow to accept new theories and
even slower to act on them. Regardless, he can take satisfaction in knowing
that the woman who inspired the quest, and perhaps a dramatic breakthrough,
has benefited tremendously.
-
- Dr. Zamboni's wife, Elena, has undergone a battery of
scans and neurological tests and her multiple sclerosis is, for all intents
and purposes, gone.
-
- "This is probably the best prize of the research,"
he said.
-
-
- Why are drug manufacturers panicking?
-
- Check out these current annual prices for MS drugs:
-
- * Avonex (was $10,000/year): Minimum price = $23,736;
Maximum price = $30,660
-
- * Betaseron (was $10,000/year): Minimum price = $22,272;
Maximum price = $32,616
-
- * Copaxone (was $10,000/year): Minimum price = $23,208;
Maximum price = $33,804
-
- * Rebif was (was $15,600/year): Minimum price = $25,068;
Maximum price = $30,756
-
- * Tysabri (was $28,400/year): Now costs 31,332 for the
drug itself, with additional charges for the infusion facility or clinic
fees.
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- ORIGINALLY PUBLISHED
- http://tickerforum.org/cgi-ticker/akcs-www?post=118758
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