Neuroimmunology in MS

Nervous System

100

The largest part of the brain is the ____________?

Cerebrum

200

The ______________ contains an outer layer of white matter and an inner layer of gray matter

Spinal Cord

300

What are the three main components of a neuron?

Cell body

Dendrites

Axon

400

Name the four main parts of the brain

Brainstem

Cerebellum

Diencephalon

Cerebrum

500

What type cells lay down layers of myelin around axons?

Oligodendrocytes

Immune System

100

This type of immunity serves as the front line defense against pathogens.

Innate

200

The primary function of these cells is to produce antibodies (immunoglobulins) against foreign antigens. 

B Cells

300

What is it called when an individual produces an abnormal immune response against his or her own tissue due to a breakdown in tolerance

Autoimmunity

400

This system of peripheral lymphoid tissues and lymph-carrying vessels
through which extracellular fluid from tissues travels before being returned to the
blood.

Lymphatic

500

These play a critical role in recruiting and activating other immune
cells to participate in immune responses by inducing inflammation

Macrophages

Immunopathophysiology

100

In the absence of disease, the cells residing in the CNS are mainly those involved in what type of immunity?

Innate immunity

200

 In MS, there are the four ways CNS-directed naive autoreactive T cells and B cells can be activated outside the CNS to become effector cells.  Name two of the four

1. Presentation of newly exposed autoantigens

2.  Recognition of sequestered CNS antigen released into the periphery

3.   Molecular mimicry

4.  Bystander activation

300

What is the process called where immune cells are thought to exit the circulation and enter the CNS through the Blood Brain Barrier, subarachnoid space, choroid plexus and the blood–cerebrospinal fluid barrier?

The transmigration of immune cells into the CNS

400

Within the CNS, peripheral innate and adaptive immune cells act in conjunction with what to cause inflammation and promote demyelination and oligodendrocyte and neuronal- axonal injury?

Activated resident microglia and astrocytes

500

Autoreactive immune cells are believed to trigger a process that contributes to the symptoms of progressive MS without continued migration of autoreactive immune cells into the CNS.  What is that process called?

 A self-sustaining chronic neurodegenerative process

Mazyent

100

There are eight signs of MS progression.  Name six.

1.  Bowel/bladder dysfunction;

2.  Trouble with memory or concentration

3. Weakness or problems with ambulation

4. Numbness or loss of sensation 

5. Problems with coordination

6. Difficulty with speech or swallowing

7.  Vision problems

8. Other neurologic findings related to MS

200

In EXPAND, what was...

1.  The average patient age?

2. The percentage of patients required walking assistance at baseline?

3.  The percentage of patients had documented EDSS progression in the two years prior to entering the study?

Average age was 48, 

56% of patients required walking assistance 

100% of the patients had documented EDSS progression two years prior to entering the study

300

Mayzent's primary end point was time to three month confirmed disability progression.  What was the Relative Risk reduction of brain volume loss, which was one of Mayzent's additional secondary endpoints?

23% relative reduction in brain volume loss

400

Mayzent’s impact on cognition was an exploratory end-point and Mayzent’s impact on progression to wheelchair results were identified in post-hoc subgroup analysis.  What specific impact did Mayzent have on cognition and progression to wheelchair?

1.   Cognitive endpoint results: Mayzent demonstrated a 21.3% overall reduction in risk of sustained decrease in SDMT score of >4 points (and had a 2.48 point difference vs placebo at 12 months). 

2.  Mayzent reduced the risk of progressing from an EDSS score of 6.5 to 7 (or greater) by 37% compared to placebo

500

Mayzent’s dual MOA is thought to play a role in RMS inflammation and neurodegeneration.  What is the proposed MOA of Mayzent?

1.   Mayzent works on the periphery to limit active lymphocytes from leaving the lymph nodes, which may reduce lymphocyte migration into the CNS.  The lymphocytes are stored, not destroyed in lymph nodes and upon discontinuation, blood lymphocyte counts rapidly recover within 10 days.

2.  Mayzent readily crosses the blood-brain barrier and enters the CNS where it binds with high affinity to the S1P1 and S1P5 receptors.

Our fun Pharma

100

This Chicago team member, after gaining weight, had a physician exclaim, “You’re HUGE!”

Amy

200

This Chicago team member had a physician could string together many F%*# bombs, their goal was not to swear when he did.

Steve Johnson

300

This Chicago team member shared a lunch with a counterpart and they BOTH brought the food.

Rachel

400

This Chicago team member promoted a product that had multiple indications and the first day in the field, shared their knowledge, only to realize the data was for the wrong specialty.

Tammy

500

This Chicago team member passed up the chance to go home during product training to stay with their study buddies and watch “Something About Mary” over a beer and pizza.

Steve Hopkins