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Posted On: 09/16/2025 10:42:36 PM
Post# of 157149
I would get another doctor quickly, and I would get them to consider this and this is not medical advice nor financial advice. This is simply a compilation from AI.:
Here’s a compact, copy-paste–ready packet of citations showing how CCR5 is implicated in MS (lesion biology, CSF/peripheral immune profiling, genetics) and what’s known about CCR5 blockade (mainly animal/EAE models and small clinical case series). Note: these papers support the biological plausibility of CCR5 as a target in MS, but there are no randomized clinical trials showing efficacy of CCR5 antagonists for treating MS as of Sept 16, 2025.
— Sorensen et al. (JCI, 1999): MS lesions and CSF contain abundant CCR5⁺ lymphocytes, macrophages, and microglia, linking CCR5 to active CNS inflammation. 
— Balashov et al. (PNAS, 1999): CCR5⁺ (and CXCR3⁺) T cells are increased in progressive MS vs controls, implicating Th1-type chemokine receptors in MS pathogenesis. 
— Trebst et al. (Arch Neurol/JAMA Neurol, 2001): CCR1⁺/CCR5⁺ monocytes accumulate perivascularly in inflamed MS brain, consistent with CCR5-mediated leukocyte trafficking. 
— Simpson et al. (J Neuroimmunol, 2000): Post-mortem MS tissue shows CCR2/CCR3/CCR5 expression on macrophages/microglia and infiltrating lymphocytes in chronic active lesions. (See also recent 2025 review summarizing these data.) 
— van Veen et al. (J Neuroimmunol, 2007): CCL5/CCR5 genotypes modify clinical, radiological, and pathological MS features, highlighting this axis in disease variability. 
— Cui et al. (Frontiers Immunol, 2020 review): Summarizes CCL5/CCR5 in neuroinflammation and MS, with CCR5 as a marker of pro-inflammatory M1 macrophage activity. 
Preclinical/animal (EAE) evidence for CCR5 blockade:
— Gu et al. (2016): Genetic CCR5 knockout suppresses EAE severity in mice, supporting a causal role of CCR5 signaling in autoimmune neuroinflammation. 
— Karampoor et al. (2020): Maraviroc (CCR5 antagonist) attenuates EAE and spinal cord neuroinflammation in mice. 
— Alghibiwi et al. (Biomedicines, 2023): DAPTA (CCR5-targeting peptide) reduces EAE severity via down-regulation of inflammatory pathways (NF-κB/Notch). 
— Ahmad et al. (2022): A CCR5 antagonist candidate (TCDCA) alleviated EAE features in mice (supportive EAE model data). 
Human genetics (mixed findings, but generally linking CCR5 biology to MS course):
— Kantor et al. (Neurology, 2003): Carriage of the CCR5-Δ32 mutated allele associated with a more favorable MS prognosis, suggesting functional CCR5 may worsen disease activity. 
— Pulkkinen et al. (Genes & Immunity, 2004): Conversely, more Δ32/Δ32 individuals among MS patients; authors suggest lack of CCR5 does not protect and may relate to chronic course—illustrating complexity. 
— Sellebjerg et al. (J Neuroimmunol, 2000): CCR5-Δ32 did not confer protection from MS but correlated with aspects of disease activity (e.g., MMP-9), indicating nuanced effects. 
Early/limited clinical experience with pharmacologic CCR5 blockade (not definitive for MS):
— Giacomini et al. (NEJM letter, 2014): In natalizumab-associated PML/IRIS, the CCR5 antagonist maraviroc was associated with clinical/radiologic improvement; no new MS activity noted during use (case context, not MS efficacy trial). 
— Hodecker et al. (Neurology: Neuroimmunology & Neuroinflammation, 2017): Additional PML/IRIS cases where maraviroc was used to modulate immune reconstitution. 
— Scarpazza et al. (J Neuroimmunol, 2017): Three PML cases on natalizumab where maraviroc showed no clear benefit; authors advise caution—underscores that evidence in humans is inconclusive. 
Additional notes/reviews touching CCR5 antagonists and CNS inflammation:
— Kim et al. (2016 review): Overview of next-gen CCR5 antagonists from preclinical to phase II (not MS-specific efficacy). 
— Le et al. (Sci Reports, 2022): Maraviroc showed limited effect in an in-vivo CNS infection/inflammation model, reminding that CCR5 antagonism may not generalize across conditions. 
Bottom line to convey alongside these papers: CCR5 is consistently implicated in MS neuroinflammation and lesion immunobiology; blocking CCR5 improves outcomes in multiple EAE models. In people, published data are case-based (mostly PML/IRIS contexts) and observational rather than controlled MS trials. Use these citations to brief clinicians on the mechanistic rationale and preclinical support; any treatment decisions for an ICU patient with MS require specialist judgment and current standard-of-care considerations.
Here’s a compact, copy-paste–ready packet of citations showing how CCR5 is implicated in MS (lesion biology, CSF/peripheral immune profiling, genetics) and what’s known about CCR5 blockade (mainly animal/EAE models and small clinical case series). Note: these papers support the biological plausibility of CCR5 as a target in MS, but there are no randomized clinical trials showing efficacy of CCR5 antagonists for treating MS as of Sept 16, 2025.
— Sorensen et al. (JCI, 1999): MS lesions and CSF contain abundant CCR5⁺ lymphocytes, macrophages, and microglia, linking CCR5 to active CNS inflammation. 
— Balashov et al. (PNAS, 1999): CCR5⁺ (and CXCR3⁺) T cells are increased in progressive MS vs controls, implicating Th1-type chemokine receptors in MS pathogenesis. 
— Trebst et al. (Arch Neurol/JAMA Neurol, 2001): CCR1⁺/CCR5⁺ monocytes accumulate perivascularly in inflamed MS brain, consistent with CCR5-mediated leukocyte trafficking. 
— Simpson et al. (J Neuroimmunol, 2000): Post-mortem MS tissue shows CCR2/CCR3/CCR5 expression on macrophages/microglia and infiltrating lymphocytes in chronic active lesions. (See also recent 2025 review summarizing these data.) 
— van Veen et al. (J Neuroimmunol, 2007): CCL5/CCR5 genotypes modify clinical, radiological, and pathological MS features, highlighting this axis in disease variability. 
— Cui et al. (Frontiers Immunol, 2020 review): Summarizes CCL5/CCR5 in neuroinflammation and MS, with CCR5 as a marker of pro-inflammatory M1 macrophage activity. 
Preclinical/animal (EAE) evidence for CCR5 blockade:
— Gu et al. (2016): Genetic CCR5 knockout suppresses EAE severity in mice, supporting a causal role of CCR5 signaling in autoimmune neuroinflammation. 
— Karampoor et al. (2020): Maraviroc (CCR5 antagonist) attenuates EAE and spinal cord neuroinflammation in mice. 
— Alghibiwi et al. (Biomedicines, 2023): DAPTA (CCR5-targeting peptide) reduces EAE severity via down-regulation of inflammatory pathways (NF-κB/Notch). 
— Ahmad et al. (2022): A CCR5 antagonist candidate (TCDCA) alleviated EAE features in mice (supportive EAE model data). 
Human genetics (mixed findings, but generally linking CCR5 biology to MS course):
— Kantor et al. (Neurology, 2003): Carriage of the CCR5-Δ32 mutated allele associated with a more favorable MS prognosis, suggesting functional CCR5 may worsen disease activity. 
— Pulkkinen et al. (Genes & Immunity, 2004): Conversely, more Δ32/Δ32 individuals among MS patients; authors suggest lack of CCR5 does not protect and may relate to chronic course—illustrating complexity. 
— Sellebjerg et al. (J Neuroimmunol, 2000): CCR5-Δ32 did not confer protection from MS but correlated with aspects of disease activity (e.g., MMP-9), indicating nuanced effects. 
Early/limited clinical experience with pharmacologic CCR5 blockade (not definitive for MS):
— Giacomini et al. (NEJM letter, 2014): In natalizumab-associated PML/IRIS, the CCR5 antagonist maraviroc was associated with clinical/radiologic improvement; no new MS activity noted during use (case context, not MS efficacy trial). 
— Hodecker et al. (Neurology: Neuroimmunology & Neuroinflammation, 2017): Additional PML/IRIS cases where maraviroc was used to modulate immune reconstitution. 
— Scarpazza et al. (J Neuroimmunol, 2017): Three PML cases on natalizumab where maraviroc showed no clear benefit; authors advise caution—underscores that evidence in humans is inconclusive. 
Additional notes/reviews touching CCR5 antagonists and CNS inflammation:
— Kim et al. (2016 review): Overview of next-gen CCR5 antagonists from preclinical to phase II (not MS-specific efficacy). 
— Le et al. (Sci Reports, 2022): Maraviroc showed limited effect in an in-vivo CNS infection/inflammation model, reminding that CCR5 antagonism may not generalize across conditions. 
Bottom line to convey alongside these papers: CCR5 is consistently implicated in MS neuroinflammation and lesion immunobiology; blocking CCR5 improves outcomes in multiple EAE models. In people, published data are case-based (mostly PML/IRIS contexts) and observational rather than controlled MS trials. Use these citations to brief clinicians on the mechanistic rationale and preclinical support; any treatment decisions for an ICU patient with MS require specialist judgment and current standard-of-care considerations.
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