There is recent evidence to suggest that Human Endogenous Retroviruses (HERVs) may be involved in amyotrophic lateral sclerosis (ALS). HERV-K has been directly linked to motor neurone damage and has been found in the brain tissue of patients with ALS.
The MND Association recently awarded a small grant to fund part of the ‘Lighthouse Project’ which is investigating the safety and any beneficial effects of an antiretroviral drug on ALS symptoms.
What is the Lighthouse Project?
The Lighthouse Project is a Phase 2 open label clinical trial investigating the safety, tolerability and efficacy of Triumeq in 40 patients with ALS. Triumeq is an established antiretroviral therapy. This study is supported by the MND Research Institute of Australia and Cure for MND. It is being conducted at four centres in Australia. All participants have been recruited and more than 60% have completed the study.
Why is Triumeq being tested in MND?
There is evidence to suggest that Triumeq may help control the symptoms of ALS. ALS-like syndromes have been seen in patients with HIV, and several investigators have documented improvement of these symptoms with antiretroviral therapy.
The main aim of this study is to establish whether Triumeq is tolerated and safe in patients with ALS after 24 weeks of treatment. It also hopes to show improved quality of life by assessing changes in symptoms such as respiratory and muscle function. Initial assessments suggest that Triumeq has a positive effect on these symptoms.
Because this study is ‘open label’ all participants will have been given Triumeq. A down-side to this is that there is no placebo group. A placebo is a ‘dummy drug’ that has no effect, either positive or negative. It is used as a control to assess that any beneficial effects seen are entirely down to the trial drug and not to the power of wishful thinking. This means that these results, on their own, are of limited value.
How will the MND Association funding tell us more about Triumeq?
The MND Association has funded a project to measure two biomarkers, P75 and neurofilament light-chain (NfL), in 20 patients who have completed the trial. P75 and NfL levels have been found to be higher in patients with ALS than in normal controls. This will help address concerns and make the findings from this open label study more robust. The results of this will be analysed, to establish if Triumeq has had a positive effect, before a more thorough trial can be carried out.
Blood and urine samples were taken from each participant before, during and after treatment and stored. Under the supervision of Dr Mary-Louise Rogers, the urine P75 samples will be analysed at Flinders University, South Australia. The blood NfL samples will be sent to the Blizard Institute in London for analysis by Dr Andrea Malaspina. Both sites are considered to be experts in measuring these biomarkers.
All biomarker data, together with personal and clinical data from before, during and after treatment will be sent to Professor Ammar Al-Chalabi in London who will report on any association between these data.
What are HERVs and how do they cause disease?
Endogenous means ‘within the body’ and HERVs are genes that are found in our genome. Our genome contains all our genetic material, in the form of DNA, and is stored in the nucleus of all the cells in our body.
It was a long-held belief that HERVs were ‘fossil viruses’, or ‘junk’ DNA, rendered inactive as they had become defective or mutated as they were passed through generations over millions of years. They comprise up to 5-8% of the human genome. There is now evidence to suggest that they are not inactive.
HERVs are a type of gene called a retrotransposon which can ‘jump’ from one part of the genome to another. It contains DNA and this uses a ‘copy and paste’ mechanism which enables it to integrate itself into the genome at a different place. In a process called transcription, the viral DNA sequences are converted into RNA. RNA is a short section of genetic code which, in normal cells, encodes for the proteins that make up the building blocks of our bodies. In virus-infected cells, the RNA is moved out of the nucleus and into the cytoplasm. Using an enzyme called reverse transcriptase, the RNA is ‘copied’ to make identical DNA sequences, moved back into the nucleus and ‘pasted’ into the genome near another gene. This can cause disease if too many copies of these genes are made. Triumeq inhibits reverse transcriptase activity.
The results of the trial and the preliminary biomarkers analysis will be presented by Dr Rogers at the 28th International Symposium on ALS/MND in Boston in December this year.
The Lighthouse Project is supported by the MND Research Institute of Australia and Cure for MND
This research sounds promising let us know the outcome of the study.
Thank you for your comment. The researchers are presenting their work on the p75 biomarker at our Symposium in Boston in December. We will keep everyone updated via Twitter and our blog.
Dr David Perlmutter from USA suggests in his book Grain Brain that his ketogenic diet can prevent some neuro degenerative diseases including ALS. Have you researched this?
Thank you for your comment.
A research paper by Paganoni from 2013 reviewed studies on high-fat and ketogenic diets in ALS(MND), including a paper by Zhong Zhao and colleagues, who looked at the potential of ketogenic diet in ALS. The review concluded that “increased dietary fat and cholesterol intake might reduce the risk of amyotrophic lateral sclerosis and the rate of the disease. However, determining whether amyotrophic lateral sclerosis patients should be treated with a high-fat or ketogenic diet can be based only on randomized double-blind placebo-controlled interventional trials.”
Ketogenic diet is also a part of the ‘Deanna protocol’, an unproven treatment that has been reviewed by ALS Untangled.
To my knowledge, there hasn’t been a paper published on this topic since.
My dad is suffering from MND. He has history of Herpes infection around 1 year before the onset of MND symptoms. So can MND be because of latent herpes virus infection??
Thank you for your comment, I’m sorry to hear of your father’s diagnosis.
The exact role that viral infections play in causing MND is unknown. A study from 2003 looked into the risk of developing MND and the presence of antibodies for the herpes virus (antibodies are the cells in your body that fight an infection and remember what it ‘looked like’ so it can fight it again if needed).
The study found a slight association between the presence of these antibodies and MND, but they could not accurately say if it was a causal association due to only observing the association in a small number of people in the study.
However, we think that MND is caused by a combination of factors so, even if a direct link was ever found, it is unlikely that it would be the sole reason for explaining why someone developed MND.
So, whilst there have been instances of someone who had the herpes virus later on developing MND, there isn’t sufficient evidence at the moment to suggest the virus caused the disease.
Please post a link to the presentation given at the ALSMNDSymposium 2017 on the results of:
What are HERVs and how do they cause disease?
Unfortunately, the presentations given at the Symposium are not available to us and it is up to the individual presenters whether they would like to share their poster/slides.
I couldn’t find the presentation that you mentioned, however, you can find titles of all poster and oral presentations in the Programme. You can also see their corresponding abstracts via Abstracts online.
This is my first post in this blog.
Do you have any news of the Triumeq clinical trial? Was it presented in Boston as expected?
Thank you for your comment.
There was a poster in the Clinical trials theme on the ‘Lighthouse project: Phase 2 safety and tolerability clinical trial of the combination antiretroviral therapy, Triumeq, in MND (CLT-21)’. Their preliminary results showed that people taking the treatment did not show any adverse effects and it was well tolerated. We will be updating on any new findings relating to the effectiveness of Triumeq in the future.
My son aged 50 was diagnosed 2 yrs ago with mnd 2 things in his life changed 1 contact with horses (his eczema was worse when in contact with horses as a child) 2 working with rubber products eg bicycle tires and the chemicals these give off ? Another tigger to this debilitating illness
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