But surely, an effect on MS of such widely used drugs should have been noticed by now? Not so sure, Steinman said. "Generally, one doesn't start taking an ACE inhibitor until about age 60," he said. "Multiple sclerosis is a disease that starts in early adulthood, so not many people in the early stages of MS are taking an ACE inhibitor."
Steinman would like to go directly to a human trial to test his proposal, but there are practical difficulties. "Who's going to pay for it?" he asked. A standard proof-of-concept study with about 200 patients would cost in the vicinity of $20 million. ACE inhibitors are as inexpensive as any prescription drug at this time, so pharmaceutical companies won't see any profits from financing a study, he said.
Steinman said he plans to apply to the U.S. National Institute of Neurological Disorders and Stroke for funding, but he acknowledges that "in general, NINDS doesn't have that kind of money."
In the meantime, basic research will continue, he said. "We are seeing the type of nerve cells that angiotensin reacts with, the mediators that are reducing inflammation," Steinman said. "This is an unexpected pathway of inflammation in MS."
"It's a very interesting proposal," said Patricia O'Looney, director of biomedical research at the National Multiple Sclerosis Society, which has financed some of the research. "The interest in MS is to find new strategies in order to control inflammation, what is the best way to control the pro-inflammatory molecules in MS."
There was some interest in studying the role of angiotensin in MS years ago, "but we didn't know much about the immune system 10 or 15 years ago," O'Looney said. "Now we can use state-of-the-art technology to examine the expression of proteins in human tissue. There could be a role of angiotensin in this inflammatory pathway. Perhaps by controlling these pathways we can actually shift the immune balance in a favorable
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