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The Role that Fragmented Sleep Plays in Cognition : Neurology Today – LWW Journals

By Jamie Talan January 9, 2020

A new study suggests that disrupted sleep throughout older age is accompanied by microglial cells that age faster and become overly active, potentially contributing to cognitive impairment.

Older adults who had experienced greater fragmented sleep showed higher levels of a gene signature suggestive of aged microglia, and they performed worse on annual cognitive tests.

The findingswhich were based on data from two prospective, observational, community-based studies of older persons who had donated their brains and medical records for research purposesunderscore the role that poor sleep can play in late life and cognition.

These findings add more evidence that fragmented sleep is bad for the brain, said Andrew S.P. Lim, MD, associate professor of neurology at University of Toronto and senior investigator of the study, published December 11 in Science Advances. It means that sleep problems in older people need to be taken seriously.

More research is needed to test whether modifying sleep can reverse these changes, and to figure out how much sleep fragmentation is enough to trigger activated microglia or other changes in the brain's innate immune cells that regulate inflammation and other immune system functions, Dr. Lim said.

There is growing evidence that microglia play a role in Alzheimer's disease (AD) and in sleep. Understanding microglia biology could ultimately allow us to target pathways in the brain that can reverse these problems, said Dr. Lim, a sleep neurologist.

Dr. Lim and his colleagues drew data from the Rush Memory and Aging Project and the Religious Orders Study. At the time of this assessment, 685 adults, 65-years-old or older265 with AD and 420 withoutwere enrolled in the study. A subset of study participants agreed to an annual test to measure movement during sleep. Results from this wristwatch-like accelerometer were paired with their yearly cognitive test scores. In subsets of participants, the autopsied tissue was also tested in two ways: first, neocortical microglial gene expression was quantified by RNA sequencing and then, neocortical microglial density and morphologic activation was assessed by immunohistochemistry.

The researchers reported that people who had more sleep fragmentation had higher expression of marker genes characteristic of aged microglia, an increased level of activated microglia, and worse cognition before they died. The problems with sleep fragmentation and its relationship to expression of genes related to aging microglia, and worsening scores on cognitive tests were present in patients with AD, as well as people who were not diagnosed with AD, said Dr. Lim.

The transcriptional changes were independent of chronological age, density of microglia, and dementia-related brain pathologies and were not completely accounted for by the increased density of morphologically activated microglia, the study authors wrote. ...These findings raise the possibility that microglial aging and activation may be a consequence of sleep fragmentation and may link sleep fragmentation to poor cognition in older adults.

The researchers are still not sure whether microglial aging or activated microglia leads to sleep fragmentation or whether waking up throughout the night triggers microglial aging and activation, and how this contributes to dementia pathologies.

It is possible that both processes play a role in what Dr. Lim and his colleagues called a two-hit model.

They wrote that it is also possible that greater sleep fragmentation is associated with higher expression of genes characteristic of aged microglia, irrespective of the presence or absence of AD pathology, but the subsequent impact of microglial transcriptional aging on cognition is greatest in those who also have AD pathology, in whom microglial transcriptional aging amplifies the cognitive impact of AD pathology.

The scientists said that they need to study sleep fragmentation in middle-aged people to understand how long the problem exists before it leads to changes in gene expression and activated microglia.

This is an exciting and interesting paper linking sleep fragmentation to microglial function that could open the door to new insights into how sleep protects the brain, said Erik S. Musiek, MD, PhD, associate professor of neurology at Washington University School of Medicine in St. Louis.

There are a number of studies suggesting that sleep disruption can increase inflammation in the periphery, and some animal studies show a relationship between sleep loss and inflammation in the brain. This study supports those previous findings and adds a new wrinklesleep fragmentation. This method to measure sleep fragmentation is quite powerful and has previously been used to correlate sleep fragmentation and risk of incident dementia. The participants in the study had their sleep measured on average about 1.5 years before they died, and there are correlations between sleep fragmentation and microglial gene expression.

In general, Dr. Musiek added, microglia gene expression patterns suggest aging and microglial activation, indicative of inflammation, in people with sleep fragmentation. Sleep fragmentation and microglial changes were also correlated with poor memory performance. This suggests that sleep fragmentation may contribute to brain inflammation via microglial activation in aging.

He added that some caveats include the fact that all of the findings are correlational, and further experiments would be needed to show true causality. Also, the use of post-mortem tissue can be a problem, as death and postmortem interval may alter microglial gene expression. Confirmation of these finding using CSF biomarkers in living people would be an important next step. Finally, sleep fragmentation may result from disruption of the circadian clock, which has also been implicated in regulation of neuroinflammation.

This is another study that supports the importance of sleep for cognition, added Rachel Marie E. Salas, MD, FAAN, associate professor of neurology at Johns Hopkins Medicine and assistant medical director for the Johns Hopkins Center for Sleep.

Fragmented sleep is so common with older adults for many reasons. It is very important to address and optimize your sleep environment or it can have negative consequences. Sleep is a basic human need and we tell our patients that only they can make it a priority. Not only do we need enough sleep but it has to be quality sleep.

Although the pathways linking sleep and circadian rhythms with neurologic health are likely multifactorialincluding alterations in interstitial and CSF flow dynamics, neuronal metabolism, and oxidative stressrecent evidence in animals indicate that alterations in microglial function, together with microglial activation and neuro-inflammation are potential common pathways, added Phyllis C. Zee, MD, PhD, professor of neurology and director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine.

Although the causal role of sleep fragmentation and alterations in microglial aging was not directly addressable in the study, we now have further insight into accelerated microglial aging as a potential mechanism linking sleep disturbance and neurodegeneration in humans.

Dr. Zee added: The results from the current study are clinically significant because they highlight the importance of sleep and circadian health for successful brain aging, but also point to the potential of sleep and circadianbased approaches as a component for disease modification therapies in age-related cognitive decline and dementia.

Drs. Lim, Musiek, Salas, and Zee had no competing interests.

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Earlier Intervention After Concussion Linked to Faster Recovery – Medscape

Earlier initiation of clinical care after a concussion was associated with faster recovery in a new study.

Athletes who presented for evaluation within the first week after injury recovered faster than athletes who initially presented 2 to 3 weeks post injury.

"Our results show that following a concussion, patients should seek specialty care involving a comprehensive assessment and clinical exam that allows for more targeted treatments for specific symptoms and impairments as early as possible," lead author Anthony P. Kontos, PhD, told Medscape Medical News.

Kontos, who is research director of UPMC Sports Medicine Concussion Program, University of Pittsburgh, added: "Earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management, all of which can enhance the recovery process. Patients should not wait for a week or more to seek care to see if things improve on their own; rather, they should seek care as soon as they can to enhance their recovery process."

The study was published online January 6 in JAMA Neurology.

The researchers note that most athletes who experience a concussion do not receive care beyond an initial evaluation or diagnosis at or near the time of injury and that this may result in prolonged time to recovery.

There has been general reticence among clinicians who treat patients with concussion to engage in earlier active intervention because of perceptions that it may result in a prolonged recovery, but recent research suggests that provision of care in the first few days after a concussion, especially active interventions that target specific symptoms and impairments, may play a pivotal role in influencing recovery, the researchers say.

For the current retrospective, cross-sectional study, Kontos and colleagues analyzed data on 162 young people who experienced a concussion while playing organized or recreational sports and who received treatment at a sports medicine concussion clinic.

They compared time to recovery in the 98 patients seen within the first 7 days post injury (the early group) with 64 patients seen within 8 to 20 days post injury (the late group).

The early and late groups did not differ in age (mean, 15.3 years vs 15.4 years); number of female patients (early, 52.0%; late, 62.5%), or other demographic, medical history, or injury factors. The groups were also similar with respect to symptom severity, as well as cognitive, ocular, and vestibular outcomes at the first clinic visit.

Results from a logistical regression indicated that recovery time was increased for patients in the late-treatment group (adjusted odds ratio, 5.8). Having a score >2 on an assessment of visual motion sensitivity was also associated with increased recovery time (adjusted odds ratio, 4.5).

"We found that early access to clinical care was associated with an almost six times increased likelihood of a recovery within 30 days," Kontos said.

In the early group, 52% of patients recovered within 30 days, compared with 19% of those in the late group. Mean recovery time was 51 days in the early group vs 66 days in the late group.

Kontos pointedout that concussion treatment is not just a matter of prolonged rest. "Some patients may rest for 6 months and still have symptoms, but after 1 month of vestibular therapy they are better. The brain is like any other part of the body if it is damaged and you do nothing, it doesn't always repair itself. It needs the right therapy. We used an exposed recovery model which used active targeted treatments for individual symptoms of concussion.

"Earlier care involving a comprehensive assessment and clinical exam allows for more targeted treatments for specific symptoms and impairments," he commented.

"For example, a patient with vestibular impairment would be able to begin therapy earlier and potentially accelerate their recovery simply by coming in for specialty care sooner rather than waiting. In addition, earlier care with a trained clinician allows patients to begin behavioral management strategies involving physical and cognitive activity, sleep, nutrition, hydration, and stress management, all of which can enhance the recovery process."

The researchers note that the earlier initiation of active rehabilitation strategies, including exertion progression and the opportunity to start structured physical therapies (eg, on vestibular, visual, and cervical systems), is one reasonable explanation for the shorter recovery time in the earlier group in this study.

"Further, without clinical guidance and behavioral management recommendations postinjury, athletes may have been engaging in counterproductive recovery strategies, such as strict rest or excessive physical activity," they add.

They point out that this explanation is supported by the fact that athletes recovered in a similar amount of time after the first evaluation. "It appears that all athletes had similar impairments and similar recovery time after they had received initial clinical care, highlighting the importance of clinical care as soon as possible," they conclude.

"As a parent, I would prefer my child to recover quicker from concussion symptoms, and that means accessing care sooner," Kontos added.

Commenting on the study for Medscape Medical News, Sarah Benish, MD, associate professor of neurology at the University of Minnesota, in Minneapolis, said: "I think this article adds to the growing literature that suggest early and active intervention is most likely beneficial to concussion improvement."

However, Benish pointed out that the latter group appeared to have more females, more migraine sufferers, a high rate of loss of consciousness, and a higher rate of posttraumatic amnesia, which may have had a bearing on the results.

"In addition, I would be concerned that there is a selection bias and those who had milder concussion that would self-resolve have been eliminated for the later-care group, as they would not have been seen in the clinic. The only way to truly know would be to do a prospective study where concussion athletes are assigned to an early or late appointment," she added.

"I agree the study suggests patients might benefit from improving access to care for athletes to get help for concussion, but I am not sure this is the definitive study that is needed to convince health systems to invest more money into helping access issues in an area that is historically underserved. However, it is another step towards improving care for concussion patients," she concluded.

Kontos has received grants from the National Football League, personal fees from APA Books, and other compensation from the University of Pittsburgh outside the submitted work.

JAMA Neurology. Published online January 6, 2020. Abstract

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Brain Diseases That Alter Language Abilities Vary by Native Tongue – Technology Networks

English and Italian speakers with dementia-related language impairment experience distinct kinds of speech and reading difficulties based on features of their native languages, according to new research by scientists at the UC San Francisco Memory and Aging Center and colleagues at the Neuroimaging Research Unit and Neurology Unit at the San Raffaele Scientific Institute in Milan.

Neurologists had long assumed that brain diseases that impact language abilities would manifest in essentially the same way in patients around the world. But recent discoveries have begun to question that assumption. For instance, Italian speakers with dyslexia tend to have less severe reading impairment than English or French speakers due to Italian's simpler and more phonetic spelling.

"Clinical criteria for diagnosing disorders that affect behavior and language are still mainly based on studies of English speakers and Western cultures, which could lead to misdiagnosis if people who speak different languages or come from another cultural background express symptoms differently," said study senior author Maria Luisa Gorno-Tempini, MD, PhD, a professor of neurology and psychiatry and the Charles Schwab Distinguished Professor in Dyslexia and Neurodevelopment at the UCSF Memory and Aging Center. "It is critical going forward that studies take language and cultural differences into account when studying brain disorders that affect higher cognitive functions -- which we know are greatly impacted by culture, environment, and experience."

The new study, published January 10, 2020 in Neurology, the medical journal of the American Academy of Neurology, focused on patients with primary progressive aphasia (PPA), a neurodegenerative disorder that affects language areas in the brain, a condition often associated with Alzheimer's disease, frontotemporal lobar degeneration, and other dementia disorders.

The researchers recruited 20 English-speaking PPA patients from the UCSF Memory and Aging Center and 18 Italian-speaking PPA patients from San Raffaele Hospital, all of whom shared a variant of PPA characterized by difficulty producing or pronouncing words -- so-called non-fluent PPA.

"We wanted to study patients with PPA to understand whether people from different language backgrounds actually experienced the disease differently, and what that might mean for how we try to help patients remain resilient to the disease," said study lead author Elisa Canu, PhD, a neuropsychologist and researcher in the San Raffaele Scientific Institute's Neuroimaging Research Unit, which is led by co-author Massimo Filippi, MD, full professor of neurology at the affiliated Vita-Salute San Raffaele University, and director of the neurology and neurophysiology units at the San Raffaele Hospital.

Cognitive tests and MRI brain scans revealed similar cognitive function and comparable levels of brain degeneration in the two groups. But when the researchers compared their performance on a battery of linguistic tests, they observed a key difference.

English speakers had more trouble pronouncing words -- the traditional hallmark of nonfluent PPA -- and tended to speak less than usual. In contrast, Italian speakers with the same disorder had fewer pronunciation difficulties but tended to produce much shorter and grammatically simpler sentences. For example, when asked to describe a drawing of a family at a lake house picnicking and flying a kite, Italian speakers with non-fluent PPA might respond (in Italian): "The man and the woman and the dog"; "Boat in the water"; "Family have picnic"; "There is a kite".

"We think this is specifically because the consonant clusters that are so common in English pose a challenge for a degenerating speech-planning system," said Gorno-Tempini, who directs the language neurobiology laboratory at the UCSF Memory and Aging Center, and is co-director of the UCSF Dyslexia Center and the recently launched UCSF-UC Berkeley Schwab Dyslexia and Cognitive Diversity Center. "In contrast, Italian is easier to pronounce, but has much more complex grammar, and this is how Italian speakers with PPA tend to run into trouble."

The results are important for efforts to ensure accurate diagnoses for patients with PPA across different cultures: in the current study the Italian speakers do not match the established diagnostic criteria for nonfluent PPA as closely as the English speakers, since the criteria are based on studies of English-speaking patients.

"This means that there are probably many people around the world -- including non-native English speakers in the U.S. -- who are not getting the right diagnosis because their symptoms don't match what is described in clinical manuals based on studies of native English speakers," said Gorno-Tempini.

The researchers acknowledge that this is a small study and cannot completely exclude the possibility that differences in dementia severity, undetected anatomical differences and differences in education level between Italian and English participants could be confounding factors in the results.

Future studies in partnership with the Global Brain Health Institute (GBHI), a joint effort of UCSF and Trinity College Dublin to reduce the impact of dementia around the world, will attempt to replicate the findings in larger groups of patients, and look for further differences between speakers of even more diverse, non-Western languages, such as Chinese and Arabic.

"We hope that such studies will advance our understanding of the brain science underlying language and language disorders, raise awareness of health disparities in dementia treatment, and ultimately improve care for all patients," Gorno-Tempini said.

Reference: Canu, E., Agosta, F., Battistella, G., Spinelli, E. G., DeLeon, J., Welch, A. E., Mandelli, M. L., Hubbard, H. I., Moro, A., Magnani, G., Cappa, S. F., Miller, B. L., Filippi, M., & Gorno-Tempini, M. L. (2020). Speech production differences in English and Italian speakers with nonfluent variant PPA. Neurology, 10.1212/WNL.0000000000008879.

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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Prevalence and Risk Factors of Restless Legs Syndrome in Hemodialysis | NSS – Dove Medical Press

Li-Yan Zhang, 1,* Xiao-Yang Ma, 2,* Jun Lin, 3 Wen-Hu Liu, 4 Wang Guo, 4 Le Yin, 4 Shi-Xiang Wang, 3 Xia Li, 5 Jing Li, 5 Li-Li Jin, 6 Ze-Long Tian, 7 Yi-Tong Du, 1 Hou-Zhen Tuo 1

1Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peoples Republic of China; 2Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, Peoples Republic of China; 3Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peoples Republic of China; 4Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, Peoples Republic of China; 5Blood Purification Center, Beijing No. 6 Hospital, Beijing, Peoples Republic of China; 6Department of Nephrology, Beijing Zhongxing Hospital, Beijing, Peoples Republic of China; 7Department of Neurology, Tianjin 4th Central Hospital, Tianjin, Peoples Republic of China

*These authors contributed equally to this work

Correspondence: Hou-Zhen TuoDepartment of Neurology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yongan Road, Xicheng District, Beijing 100051, Peoples Republic of ChinaTel/Fax +86 10-63139807Email

Objective: The current study aimed to investigate the prevalence and risk factors of restless legs syndrome (RLS) in patients undergoing hemodialysis, as well as the mortality and risks of cardiovascular and cerebrovascular events.Methods: A total of 354 hemodialysis patients from four hospitals were enrolled. RLS was diagnosed using the International RLS Study Group (IRLSSG) criteria. The patients were evaluated face-to-face using the IRLSSG rating scale, Epworth Sleepiness Scale (ESS), Hamilton Anxiety Scale, Hamilton Depression Scale, and Pittsburgh Sleep Quality Index (PSQI). The patients were followed up for 9 months. Death was considered an endpoint event. The cardiovascular and cerebrovascular events were investigated.Results: The prevalence of RLS in hemodialysis patients was 40.7% and was associated with factors such as duration of hemodialysis, hypersensitive C-reactive protein, hyperparathyroidism, glycosylated serum protein, and erythropoietin treatment. The scores of the PSQI, ESS, and Hamilton Depression Scale in the RLS group were significantly higher than those in the non-RLS group (p < 0.05). During follow-ups, the incidence rate of cardiovascular diseases was 18.8% in the RLS group and 8.6% in the non-RLS group (p < 0.005). The IRLSSG rating scores were significantly higher in RLS patients with kidney transplantation failure compared with those without transplantation (p < 0.05).Conclusion: The prevalence of RLS was high in hemodialysis patients. The risk factors of RLS included duration of hemodialysis, hypersensitive C-reactive protein, hyperparathyroidism, glycosylated serum protein, and erythropoietin treatment. RLS affected sleep quality and emotion and increased the risk of cardiovascular diseases in hemodialysis patients. RLS was more severe in patients with kidney transplantation failure compared with those without transplantation.

Keywords: restless legs syndrome, hemodialysis, prevalence, risk factor, cardiovascular disease

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License.By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Alexion’s neuro bet, Rubius’ trial troubles and biotech’s gene therapy milestones – BioPharma Dive

SAN FRANCISCO Pharmaceutical companies and their investors have grown accustomed to big news kicking off the year, specifically multibillion-dollar deals.

The last three J.P. Morgan Healthcare Conferences, considered a sort of Opening Day for the industry, were hallmarked by the acquisitions of Ariad Pharmaceuticals, Impact Biomedicines and Loxo Oncology. (And that's not including Bristol-Myers Squibb's $74 billion deal for Celgene the week before the meeting last year.)

In fact, Eli Lilly pressed Loxo for a quick buyout to have something flashy to announce at last year's conference. Such enthusiasm was noticeably absent this time around, though, resulting in a quieter first day than biotech shareholders had hoped for.

The Nasdaq Biotechnology Index fell almost 2%, with Sage Therapeutics, Clovis Oncology and other potential takeover targets trading down by market's close. Brad Loncar, a founder of biotech exchange-traded funds, noted on Twitter how even shares of MorphoSys fell despite the German drugmaker having the most positive news of the day.

While major M&A announcements seem unlikely for the rest of the week, industry experts still expect the challenges facing bigger companies will result in a healthy number of deals in 2020. In the meantime, biotechs will be busy trying to deliver on their development plans some of which were provided in more detail during Monday's presentations.

Connecticut-based Alexion Pharmaceuticals is best known for its high-priced rare disease drugs Soliris and Ultomiris. On Monday, the company gave an early look at full-year financials, reporting a top line revenue increase of more than 20% between 2018 and 2019. That growth correlates to, at the very least, roughly $4.96 billion in annual revenue, which would be slightly higher than the average analyst estimate.

For Stifel's Paul Matteis, more surprising than the revenue beat was Alexion's plan to treat four times as many U.S. neurology patients with Soliris and Ultomiris by 2025. If successful, the plan would create a "substantial upside" to revenue estimates, according to the analyst.

"This of course raises a number of natural questions," Matteis wrote in a note to investors, "such as where will this growth come from, and what does it assume (if anything) for additional neuro indications where Soliris/Ultomiris isn't derisked."

Shareholders, however, responded positively to the updates, sending Alexion shares up 4%.

Soliris is approved to treat several diseases, including a chronic neuromuscular illness known as gMG and a type of central nervous system inflammation abbreviated as NMOSD. Alexion says that, in less than two years time, these neurology indications have become its largest franchise by patient volume. By the end of 2019, almost 1,900 U.S. neurology patients were taking Soliris.

Ultomiris, a follow-on to Soliris, is under investigation as a treatment for gMG and NMOSD across a couple of late-stage studies. And on Tuesday, Alexion announced it will soon begin a Phase 3 study of the drug in ALS, with plans to enroll 350 adults in a 50-week trial.

Selling new paths to growth is particularly important for Alexion now, as the company has come under pressure from activist investor Elliott Advisors to seek a sale.

BioMarin could bring the first hemophilia gene therapy to market later this year. While waiting for regulators to confirm its approval application is under review, the California biotech announced Monday it has more than doubled capacity at a gene therapy plant. Altogether, the facility can make up to 10,000 doses each year of either the hemophilia treatment or a separate BioMarin gene therapy that's about to begin human testing.

That capacity level, according to executives, would allow the company to treat all U.S. hemophilia A patients in roughly two year's time. The update increases the competitive pressure on drugmakers with marketed products, such as Takeda and Novo Nordisk, as well as those working on rival hemophilia gene therapies. Swiss pharma giant Roche falls into both buckets, and could lose out on many patients because of BioMarin, according to a recent doctor survey from Citi Research.

Sarepta Therapeutics also had a manufacturing update, announcing that production for its experimental micro-dystrophin gene therapy is now large enough to be considered commercially viable.

RBC Capital Markets analyst Brian Abrahams called this a "critical manufacturing milestone" for Sarepta, one that shores up the timeline for a pivotal study scheduled to start sometime in the middle of the year.

Despite launching one of the industry's largest initial public offerings in 2018, Rubius Therapeutics has struggled out of the gate in getting its first clinical data. While its ambitions are large, the Flagship Pioneering-backed biotech failed to meet expectations it set for delivering early Phase 1 data from its lead asset, a PKU drug, by the end of 2019.

"We understand what we didn't do right in 2019, and we are doing it differently in 2020," CEO Pablo Cagnoni told a half-filled breakout room at the JPM conference. "We will deliver in 2020."

While Cagnoni and other executives emphasized cancer therapies set to enter clinical testing in 2020 and speedy progress on its own manufacturing plant, the biotech also admitted it still has not dosed a single PKU patient to date, calling into question the company's ability to execute.

Pressuring Rubius further is BioMarin's announcement that it will develop a PKU gene therapy, with plans to dose its first patient this quarter. BioMarin already sells two PKU drugs and could be a formidable competitor.

Shares in Rubius ticked down by about 5% Monday and have shed two-thirds of their value since the company went public.

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Dr. Lisak honored with Healthcare Professional Champion Award for efforts against MS – The South End

Wayne State University School of Medicine Professor of Neurology Robert Lisak, M.D., FRCP, FAAN, received the Healthcare Professional Champion Award from the Michigan Chapter of the National Multiple Sclerosis Society.

The award is presented to an individual who has demonstrated their commitment to helping people meet the challenges of Multiple Sclerosis, including improving access to and quality of MS clinical care. Recipients must have demonstrated leadership in establishing relationships with other health care providers and professional organizations, increasing referrals to the society and improving MS knowledge in the health care workforce.

It is nice to be recognized for doing things that you enjoy doing for others, said Dr. Lisak, who received the honor Jan. 11 at the chapters annual Breakthroughs in MS meeting in Novi. Mich.

Mirela Cerghet, M.D., Ph.D., a neurologist with the Henry Ford Health System, presented Dr. Lisak, also a professor of Biochemistry, Microbiology and Immunology, and former chair of WSU Neurology, with the award on behalf of the chapter.

Dr. Lisak, said Dr. Cerghet, has been a champion for patients living with MS for the entire span of his distinguished career. His involvement with the National MS Society spans decades, and over the years of his service great strides have been made toward creating a world free of MS, including the development of all the disease-modifying medications.

A member of the societys Board of Trustees and chair of the Healthcare Provider Council, Dr. Lisak has played a critical role in attracting new talent to the field through his involvement in MS professional education, medical student mentoring, clinical training programs and engagement with clinical fellows, Dr. Cerghet said.

Most recently, Dr. Lisak, representing both WSU and the Consortium of Multiple Sclerosis Centers in his role on the AAN Guideline Development, Dissemination and Implementation Subcommittee, helped develop new guidelines for disease-modifying therapy for multiple sclerosis. The Consortium of Multiple Sclerosis Centers is a professional organization of MS centers and health care providers and researchers in the United States and Canada committed to a comprehensive multidisciplinary approach to treatment and care, education and research and advocacy for MS so that the centers can provide the best care and outcomes for patients and their families. The consortium also is an international clearinghouse for research results, the latest treatments, clinical trials and patient education programs.

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