 Alright, I'm going to get started. So good afternoon everyone. My name is James Stewart. It's a pleasure for me to be here. That's a picture of me on my bike. For many years I was a cyclist. And as you'll learn in my talk here, I'm a person living with multiple sclerosis and my life was changed pretty dramatically because of it. I wanted to give you a little bit of background. So what I'm going to talk about is about multiple sclerosis, and then also the mechanism of how they believe the disease of multiple sclerosis is working. What happens with it, how I'm going to talk about disability and how the disease affects people. And then I'll get into some of the medicines that are used for treating MS. And then I'll talk a little bit about the advocacy that I do to help find a cure for MS. And then I'll finish up with a few interesting research projects that are using those stem cells that we saw just a few minutes ago. My background is that up until the time I was 45, I had a very active career with a number of different things I studied at UC Davis and studied fermentation science, which is the art of making wine. But I used that and worked at Genentech, which is a pharmaceutical company. And early in my career, I help manufacture tissue plants, manage an activator, which is used to dissolve blood clots in the heart. So one of the big ironies that I experienced in my life here is that as my life evolved, I ended up becoming a patient that uses product that is made by Genentech. But in any case, I had a great career. And now it's about a quarter of my life that I've been living with multiple sclerosis. I was diagnosed in May 11 2007. And since then I've been working with not really employed, but helping to do advocacy with the National Multiple Sclerosis Society, and participating with Americans for Cures, which is an organization associated with CERM, which is the California Institute for Regenerative Medicine. And now I am serving on the UC Berkeley Stem Cell Research Oversight Committee as a patient advocate. So I'm able to look over research that is geared towards curing not only multiple sclerosis, but a number of different diseases. I wanted to clarify that you can see on this slide that I don't have, I'm not a doctor. I'm not a scientist per se. I have a little background in science, but I'm mostly a person living with multiple sclerosis and what I'm going to share with you today is really what I know about the disease from my personal experience. So, I don't know if any of you may have experienced or know somebody that has MS. But one of the things about multiple sclerosis is that it presents itself in many different ways for many, for different people, we're all different and we experienced the disease in different ways. Some of the common symptoms are that, in fact, one of the first symptom is a visual symptom where oftentimes people get blurry vision commonly in one eye. And it could be heat related, but you might also find difficulty just with with seeing what you're looking at on a computer, for instance. The other common problem that people first experience is what they call foot drop where your toe just doesn't quite pick up as you're walking like it normally would. And people end up tripping or sliding on this gravelly surface and not realizing why that's happening. But it's just that your muscles aren't coordinating. And so you end up tripping and falling. It could lead to walking difficulties. But as you see, some people might just experience depression, or some numbness, some people the first symptom, they experienced numbness in their face. And so it all depends on where the disease is affecting them. So primarily multiple sclerosis is a disease of the central nervous system. It affects the brain and the spinal column. And, you know, so that's where the disease resides and we'll get into more of that as we go along here. So it's, I have this point here is any one of these or all of them, it could be many of them, many of these symptoms that people have. And it's really the doctors concerned to figure out what's going on when a person experiences this and decides that they want to go to the doctor to figure out what's really happening. So one of the big things that also happens is fatigue. Many people, one of their first symptoms is just that they don't quite feel as energetic as they used to be. And you can see the dialogue here where someone is talking with a cyclist who's just really having a tough day. And, you know, it's what's what's wrong, and it's my multiple sclerosis fatigue. Someone else is saying, Well, maybe you're just tired, I get tired sometimes, and we all get tired. But this guy responds, I'm tired exhausted really, but it's, but it's more than that. His friend says, But you haven't done anything. He says, Well, thank you, I know this. That's, that's just the frustrating part of that. Oops, I'm sorry, I've hidden my screen here. There we go. And he says response a nap is needed your eyes are closing and the guy responds I'm not sleeping my eyelids are just heavy. It's hard to hold up. And that says I understand and he says no, no, you really don't. And I can really relate to this, the fatigue is something that it's just really hard to describe, because it'll hit you at any given day, or any given hour of the day. And it's really almost just staggering in its effect, it really is. It will slow a person down quite dramatically. All right. Multiple sclerosis was first described by this fellow Jean Jean Martin Charcot in 1868 and he realized that that it has something to do with with heat. And the problem that most people experience with MS is that when their body gets warm, the nerve conduction doesn't happen as well as it normally would, and it causes that fatigue that that I was just talking about. And they would test this in patients that they thought they would have that they thought would have had MS by asking them to sit in a warm bath. And if after 15 minutes in a warm bath their legs were weak, and they had difficulty moving them, then they would diagnose them with with multiple sclerosis. And then they described it as lesions disseminated in space and time. And really what that means is that you would have an attack or a lesion happening in one place of your brain or your spinal cord. And then a few months later, or even a year later, you would have another lesion that happens in another place in your brain that would affect a different part of your body. Because it's disseminated in space and time, then they would be clear that it was multiple sclerosis symptoms that they were that you're experiencing. And now, nowadays they use a spinal tap or an MRI picture of your brain to look for the inflammation that happens in the brain as a signal that you would have multiple sclerosis and because the MRI is recent, more recent development and technology, and it's becoming more widely used more and more people are being diagnosed with MS. There were other criterias for diagnosing MS that over the years and the more current one is this McDonald criteria that physicians use. The McDonald criteria, really, it's the best way now to describe or diagnose the disease. And because it presents differently from one patient to another, really what they're doing is trying to ascertain the difference in space and time. And they do that in this, there's a link here if anyone's interested. It's a pretty complicated process because they're looking at different parts of the body to see where the disease might be affecting them to come up with a diagnosis. So there's what's considered four types of multiple sclerosis. The clinically isolated syndrome or the early stage of multiple sclerosis is where a person would have their first attack. And that's where they would have that first instance of inflammation in the brain. And they would experience those symptoms that I was describing, you know, maybe a blurry vision if it's an optic neuritis in the optic nerve of your eye. And really what's happening with the clinically isolated syndrome in the past up until just a few years ago doctors would say, well, we can't really diagnose MS because we haven't had a second event in a different, in a different place in your body. So they would just describe it as a clinically isolated syndrome and they might treat it with some steroids. But then they would let you go and, you know, oftentimes the body is able to repair this damage. And so that symptom would go away. And things would be fine for a period of time. And it would rear its ugly head and come back and we would have another event. And at that point they would start to describe it as this recurring remitting MS where you have, you have an attack. And then the issue goes away. And I'll, I have more slides that'll share more information about these different versions of MS in the coming up. Then there's another version of MS that they describe as secondary progressive MS. This is where you would have an attack, it would resolve, then you would have another attack. It would resolve, but you might have a third attack and it was resolved but unfortunately the disability starts to increase. And the ability, the recovery isn't quite as good as it would be in, in recurring remitting MS. So the disability starts to add up and they describe it as secondary progressive MS. And the fourth type of MS is this primary progressive MS where people experience just a continual degradation in inability where they might have an attack that doesn't quite resolve, but things just generally get worse over time. And so that's described as primary progressive MS. And these are defined by lesions in the central nervous system. And right now, there's not really a clear understanding of what causes of lesions. They have lots of theories about what causing MS but really they do not know that the actual cause, and they're thinking that it may be related to stress or some infection. And there could be, they've studied genetic predispositions and they've learned that there are 200 variants of genes that that increase the likelihood of having MS. So, so as I mentioned, there's really don't know what causes MS. And there, this is a picture actually a self portrait of my, my brain with arrows pointing to some lesions that developed for me. And you can see the highlighted areas here, those are the inflammation that's caused by something that crossed over the blood brain barrier and, you know, our brains are very protected areas of our body. It's protected by this, by the fluid, the, that covers your, your brain and in your spinal cord and that's all protected by this blood brain barrier. And the cerebral spinal fluid, you know, is, is really a clear liquid it's, it doesn't have any blood in it, it, but something crosses over that blood brain barrier, and gets through that, that cerebral spinal fluid and gets into the nervous tissues that are really your axons and, and nerve cells that your brain is, is consisting of. So they're thinking that, you know, again, exposure to toxins might be a cause. We really don't know what the trigger is. And there's lots of research going on right now about the gut microbiome connection, where they recently came up with the idea that this type of perfringions toxin is a bacteria that may be living in the gut of people, or that is infecting in the gut of people living with multiple sclerosis. And that toxin apparently has fingerprints that look a lot like the myelin that coats the axons and then in the nerve cells. So they're able to that toxin is able to cross over the blood brain barrier and cause the infection that may be happening in people. So, and there's also some role of, you know, the B cells with MS the idea is that the body is an autoimmune disease, and the B cells are crossing over this blood brain barrier to attack the the whatever the infection is caused by, and that's causing this inflammation. And so they're thinking that possibly B cells are just randomly getting through the blood brain barrier and just starting to attack myelin, but they're not sure exactly why that happens so that's where they describe it as B cell dysfunctionality. And then the other part of our body that happens, this is normal where we have a ligand endocytes that remyelinate our nerve cells. And that's a process that happens. So, if there is damage, there's a process to fix it. And that maybe that process isn't working as well as it should be, possibly the ligand endocytes are being held back from remyelinating by astrocytes that are also cells that are in that area of our body. And there could be other T cells and T cells are part of our immune system, and they could be having a role of identifying the myelin that's coding the nerve as as an invader, and possibly they're signaling to the B cells that there's something here that needs to be taken care of and the B cells are honing in and doing the damage that they're doing. And there could be also a role of microglia as as we're when we're born we have just trillions of brain cells and there's lots of connections that are made and over the years that we're growing in our youth. Those connections are are are trimmed, if you will, and microglia are doing that they kind of kind of snip areas of the brain that are not being used so it kind of explains for instance why some people are able to, and when they're younger years or it's much easier for them to learn a foreign language, our language areas of our brain are developing in that period of the years of our life, but after the microglia have clipped those sections of the brain where if we're not using that foreign language says well we don't need this area of the brain and then it goes on and saves it for other other use. It's an interesting process our bodies are capable of doing. So here's some multiple squozes interesting facts. There's over a million people in the United States living with MS. And it affects women, three times more frequently than men. So there's something going on with the female anatomy that is potentially influencing the disease. There's I mentioned earlier the MRI sensitivity is showing that there's, it's being used to find more people living with MS. So the, the rate of MS has risen but possibly not. It's possibly just because we have the tools to help learn which people are affected by the disease. I mentioned those four types of MS, but there's a, the European Committee of treatment and research in multiple sclerosis ectroms. They have proposed a new way of classifying MS and they think that it's, you know, basically, one disease process that's happening, just showing itself in different ways in different people depending on their body makeup. So to further complicate things, scientists at Tisch, they're in New York. They think that primary progressive MS is its own disease, possibly immunoglobulin G driven. And that could be why people with with primary progressive MS have a more severe disease course. And each of these different exhibitions of the disease kind of lead to the need for personalized medicine to help people that are affected by by MS to be treated effectively for their own personal symptoms. So recently, just in the last two years there's been a lot of learnings about MS. And one of the more exciting studies that was done. And Science Magazine published the data about this was that they did a study in the military. People when they joined the military they have to have their blood sampled to make sure that they're healthy. So they're able to take blood samples from just thousands of people. And what they did is they studied those patients over the years. And they were able to follow them. And some of those patients ended up with Epstein virus, and, and then they followed they continued to follow them. They learned that those people that did experience Epstein virus, many of them went on to develop MS. And so they're that study really found this link between Epstein virus and MS, which is a very important discovery. And the idea here is that the, you know, the Epstein by virus is somehow your body is fighting it off. And it's somehow entering into the B cells. And part of that Epstein bar virus RNA, if you will, the rabbinic acid is incorporated into the B cell. So that B cell then starts to look like it has that Epstein bar virus in it. And that same protein is what's involved with the myelin. And so our body ends up becoming a little confused as to where what is the myelin and where is the Epstein bar virus and, and it essentially starts to learn to attack the myelin because the Epstein bar virus presence in the B cells. So that's kind of the theory. So, and you can see that the medium time from the first EBV positive sample to MS onset was five years so it took a while for the body to develop that sensitivity. And one of the things that they learned also was this this biomarker. They call it neuro filament light chain is something that can be used to monitor this Sarah conversion where they're able to see that that Epstein bar viruses is is infecting in the in causing an infection or a reaction in the in the central nervous system. And as you see this is very recent study 13th of January, just last year. Just this is a slide that just kind of shows the epidemiological dispersion of MS, and it's more happening in the northern and southern latitudes. So you can see in the red here. And then also down in New Zealand, where more people are at high risk and the theory here is that possibly vitamin D or exposure to sunset sunlight, or lack of that is is really causing our body to be more sensitive to that infection. Well, in the middle part, the middle latitudes here don't experience MS as much for some reason, and they don't really understand why that is. So switching gears, I wanted to talk about some of the people that have MS. Here is a list of a lot of famous people that that have MS. One person that I'm particularly interested in was Selma Blair, she, many of you, she was recently on the cover of Vogue magazine actually, or one of the covers I guess they have many covers, and she was brave enough to do a stem cell study where her body was ablated of the immune system and then they re-injected stem cells into her that they thought would help her and she claims that she was helped by that, but I have another slide later in this presentation that shows how that affected her. But so she's a more one of the more famous people that have lived with that are living with multiple sclerosis. And, you know, so a lot of people that are famous are affected and otherwise some not so famous people as well. So this slide here is a slide that shows some data that is really my own personal experience with MS. You may have gathered by the earlier images I was a cyclist when I was younger, and I enjoyed cycling to a great degree I live here in Sonoma County in Northern California and we just have a wonderful place to ride bikes. Lots of hills and just beautiful vineyards. And I really took advantage of that when I could. I was able to do these century rides so I would ride a century ride is where you're riding 100 miles and I was able to do that I, but, and then I also rode my bike to work. And this graph here is really a graph of how many miles I rode in a given month. And so you can see I was a really active cyclist some months I would ride over 350 miles and in one month. There were a few times where I experienced some issues that I was thinking maybe I was riding my bike too much and this turned out to really be one of the first symptoms that I experienced with multiple sclerosis. This arrow here indicates where I was riding to work. And, and I would, of course, when you're riding a bike your body temperature heats up, and I would get to work and I noticed two things one, I would look at stops lights in the distance and out of one I would see the red and and yellow lights changing but out of my right eye, I would look for the red and the green and they were kind of gray. So the color perception wasn't right. And then, by the time I got back to work I would sit down and take a shower and get it, get over to my computer and look at my, my emails and I couldn't really read out of my right eye so well there was blurry. And so I went to the doctor and I said something's not right and they said well it's central serous retinopathy. And which is a leaky retina. And they said it just causes this blurry vision and it'll go away and sure enough it did. So you can see for about a year later in the latter part of 2003. I also had, I was cycling and I noticed my leg cycling up one of the hills nearby, and I noticed my leg was tremoring in a funny way it was just really shaky. And so I thought something's not right. I just blamed it on cycling too much. So then I got excited to do another century ride. That was this one over here. But then I noticed things were getting a little bit more difficult. And I actually ended up changing my job location. So instead of writing to my workplace that was about 12 miles away. I started writing to a workplace that was about seven miles away. So that's where my riding distance started to diminish. And I ultimately ended up changing jobs at this point, where I started working on the Boeing 787 aircraft with a company that supplied conduits for the landing gear. And it was about that time when things really got rough for me, because I was experiencing this new job it was a stressful change for me. And I started to experience some depression, maybe because of my job change. But, but really what was going on, and I didn't know it at the time was that I was living with multiple sclerosis. And at this point, I was diagnosed, and two days after I was diagnosed I started the first treatment, which was an injection, a daily injection of an interferon that tightens the blood brain barrier, basically making it more difficult for B cells to get into the central nervous system. And then I, you know, continue to do some rides. I really thought that cycling would would help me feel better. Exercise is a, is a recommendation for, you know, if you want to maintain your body in a good way. It's good to exercise and I really tried hard to do another century ride this one here I wrote about 50 miles I couldn't do the hundred. And then I was on this medicine for a long time, steel experiencing difficulties with just my ability to get around. And my doctor realized that my disability was increasing even with that medicine. And they changed my medicine to this or the moon is I started taking copaxone, which was another injectable. That drug is one that instead of tightening the blood brain barrier, it is putting a mile and like protein in our in your body, just everywhere so it's a decoy. And the idea is that your B cells of fight will go after that that mile and like protein that's injected in you and leave your nerve cells that are coded by my own alone. And so that's the idea of that medicine. But, unfortunately, they're about they, I actually stopped working because of my disability started to really ramp up. And actually this is a good point for me to point out at the bottom of this slide, I'm showing the EDSS scores that I had. And here's another slide that I'll explain this a little bit further but my EDSS scores were going from from zero to one to two to three, and all the way up to four here. After I stopped working, I switched over to guess what a medicine that I didn't have to inject myself with. This was a pill. And they that was really hopeful because boy, not having to inject yourself every day is a real treat. So, but at the same time, I was, you know, really hopeful that that would make a difference in my life. And that's when I did the last bike ride fundraiser with the MS Association. And we saw the picture of earlier of me cycling. And I was able to ride, I lived near a park and I would was able to ride for quite a while. Just a 12 mile loop, if you will, that I did consistently every day thinking that that would really help me, and it did. I think it really delayed any real further disability. But unfortunately, it just got harder and harder for me. You can see this bottom graph here is then the frequency of rides and it my frequency went up there was actually one year here that I wrote every Monday, Wednesday, Friday, for an entire year. And that 12 miles and it did help, but at the end here towards the time when it was started to rain and in January of 2015, I realized that it was really more dangerous for me to, and I could injure myself pretty seriously. And coincidentally, so that's when I stopped riding and coincidentally that's when my doctor said, gee, this Jelenia is not working for you. So I wanted to start taking an infusion of this medicine called Rituxin, and that's the medicine that that Genentech manufacturers. So I'm going to move on off of that. And just talk a little bit more about the theory of what's happening to explain the MS progression. You can see that it really affected me in my ability to do things. So they're thinking now, and this is just really recent thinking over the last two years is that the Epstein virus causes that immune response. The blood brain barrier breakthrough. It causes mitochondrial injury. There's these inflammatory events that happen that activate the B cell response. The allele activation decreases the immunosuppression and causes cytokine production, which causes inflammation. And then the other thing that happens is these ion channels start to not work so well on the ion channels or what's transmitting our nerve signals. The nerve signals are just not getting to where they need to be. And that it would explain why when you're walking the signal to lift your toe every step you take is just not happening. And it just gets there a little bit too late. And so it's because of this ion channel deficiency that's happening. Dendrocytes might be in secreting cytokines and that's inhibiting the oligodendrocytes from remyelinating the cells. And then there's other structural issues that are happening causing that inflammation to become more, more real. And then the loss of my own induces what this axonal degeneration where really the axons aren't working anymore. So I'm going to show you a few slides here of again more pictures we saw the self portrait of me, but here are more indicators of where the grain matters changed in the brain when that inflammation starts to happen. The idea is that the inflammation starts and the demyelination starts to happen. And then it leads to this axonal loss that's indicated. These are nerve cells. And then there's another picture of this model that kind of explains what they think is happening. This Epstein virus, bar virus infection, getting into the B cells. And then this molecular mimicry that I described where the body starts to think that the myelin is part of this B cell infection that it has a desire to, to fix. Parts attacking the myelin that's where these little ridges here that are kind of oddly shaped our parts of the myelin that have been impacted by the B cells. And there was also a paper just describing how primary progressive MS might be a little bit different. They're, they're just realizing that there's a lot of differences with primary progressive MS, and they have a lot more to learn about it. Because there's something else going with primary progressive MS that's not clear with the recurring remitting MS. So I'm going to assume that the scientists have come up with to kind of show the picture of what's happening. The yellow is a nerve cell. The blue is in the liquid dendrocyte that's remyelinating or myelinating that nerve cell. The B cell sends out antigens they started attacking that myelin and the astrocytes have a role. You can see that up here. The blue here is depicted in this part of it. And here's where the nerve signal transmission is just affected by the, by the sodium and potassium signaling that our nerve cells do. And this is more description of that what I just showed you on in the pictorial form. I highlighted this one section because it really explains that fatigue that happens in so many people with MS. And it's just that the energy requirements increase due to disruption of that, then myelin loop that's caused by the beast cells that's attacking the myelin. And it's this sodium potassium pump failure that that sodium potassium pump is what enables us to send a nerve signal from one neuron to another. And you can imagine that happens every second, millions of times every second as we're moving around. And is that disruption that's happening where our body senses that it's being disrupted and so it sends a little bit stronger of a signal to say put your foot when you're walking be sure to lift up that foot and it gets very tiring. So I mentioned earlier about the expanded disability status scale. And here's really what they're what the physicians are looking for. This steps of one through four. It really shows people that are describes people that are able to walk fine. But they're also seeing where, you know, the doctors are observing other other deficiencies and so one of the things they might do is just ask you to close your eyes and, you know, touch your nose. It's a coordination issue that they're checking or another thing they would ask you to close your eyes and stand on one foot. And these are things that most normal, normally, people can do these things but with a person with MS, because they might have a little bit of loss of balance. It shows that it's not quite working quite right. And that's where they start to realize that that something's not not right. They start associating an EDSS score with that. Unfortunately, the MS disability in many people it kind of continues on so it starts out in this area here where everyone's able to walk just fine, but they're, they have the disease. It slowly but surely affects them and I showed that in that earlier slide with my cycling endeavors where the EDSS score would increase and ultimately it got to the point where I was using a cane and that's about when I started to when I stopped cycling. And unfortunately for me it's gotten a little bit worse still after even though I am taking medicines, Rotexin medicine to do, this is a disease modifying therapy that slows down this disease. I'm at a point where I need to use a walker and I'm trying to stay away from having to use a wheelchair, because you know if you, my thinking is, if you, if you don't use it you're going to lose it so I try to keep walking even though it's very difficult for me. And a little bit further on that EDSS score. This is what they're looking for, and what I kind of just described. So you can kind of guess. I'm over here at about six and a half requiring I need to walking aids which means two canes really to for me to walk without without a walker. And I'm trying to stay away from this seven where I would be in a wheelchair. And unfortunately it gets worse for for many people. And this is even with the disease modifying therapies that that we take. So I wanted to go a little bit further into the descriptions of those four types of MS, just so that we know a little bit more information about each of those symptoms. The first one was clinically isolated syndrome. This is where you would experience those those problems that we've been talking about. Maybe a walking difficulty or some people might have a bladder problem. All of a sudden they have this urgency where they have to urinate, or they might have a dizziness problem. All of these things are where you would have these symptoms lasting for at least 24 hours. And it's just one episode of this. And the now that they have the MRI they might show one area of myelin damage. And then they would see, you know, where there's more myelin damage, if there's more than just one area that would indicate that they're more developed or further along than this clinically isolated syndrome. Here's relapsing remitting MS, it shows where you would have a relapse, and then it would remit. So the relapses are where there's exacerbations. And then you would have a problem so maybe one is an eye problem. Another one is leg weakening another one is numbness in the face. And the idea here is that because you are taking these medicines, these disease modifying therapies, the conditions are improving, and it's kind of delaying the worsening of it. And ultimately, this could continue to get worse. And it develops into this secondary progressive MS. And this is marked by these frequent exacerbations where, you know, just problems are happening more frequently. And, you know, also steady progression of the symptoms. So, you know, this is a steady progression, primary progressive MS where things just slowly but surely get worse over time, you might have one attack or an issue with something else that's happening. And, but generally it's slow and steady progression with no remission periods, so it's not returning back to what it used to be like. It's just continually getting worse. And without these relapses. When they happen, they're generally what doctors will do is prescribe steroids, and they slow down the inflammation, and they make you feel pretty good about how you're feeling so that reduces that inflammation that kind of puts a halt to the inflammation. But it's there. The disease is still happening in the background. And there's something they call pseudo exacerbations. And this is where you would have relapses and that are related to heat or exercise or, or even illness that if your body temperature gets raised by by a fever it really affects people with MS. And there's no cure for MS. And all these desired disease modifying therapies they slow the progression of MS, but unfortunately it doesn't stop the disease. I wanted to show you a little bit more about the medicines for MS. Over the years, they, they started out thinking that it was inflammation related to our diet. In the 1950s, they gave suggested that people go on to the swank diet, and we're still seeing that diet is an important factor in in helping people live with MS. When I was on bed of serum that was developed in 1993. So, most of these medicines have are currently just recent developments, Rituximab I mentioned I took that one and also copaxon you can see that these are really recent developments. And some of these the big thing here all these were injections. And the big news, as I mentioned when they came out with gelinia and that was a big treat for us to put on these injections that suddenly we could have medicine that what didn't involve injections. And then they came up with the Rituximab is an infusion but they started realizing that that infusions might help people in with the disease and they came up with some more medicines that are infusions. And only in 2017 that they came up and approved a medicine called a crevice. This is also a genetic product that is for primary progressive MS up until this time there was no medicine, or disease modifying therapy available for people with primary progressive MS. And they're finding that this is a B cell, they know it depletes B cells and that's why it's working it basically is, you know, killing off a big part of your immune system that is really the part that's attacking the myelin. And that's how it's working. All these other medicines do the same kind of thing depleting the B cells. It's about 10 minutes to noon here I'm going to go quickly through a few slides. There's, these are more, more medicines that I wanted to show you just the pricing of these medicines. It's very expensive these treatments $111,000 for the for the beta serum. This is an annual price. So, people that live with MS have a huge burden. It's just, it's not just the disease modifying therapies, but it's also, you know, the medicines that are prescribed to treat the co symptoms that happen with MS. So I'm thinking and idea of those. These are all those symptomatic medicines I just mentioned. So, you know, some people have depression so they're having to get some paxil or some balta. You know, for fatigue they might get pro pro vigil or riddling different medicines for different problems that they might also experience. So it's just not the, it's not just the disease modifying therapies they're needed to purchase they're getting these other medicines as well. So my suggestion if you do have MS or if you know anyone that does please suggest that they take a disease modifying therapy. And what about prevention. You know they're working on a vaccine against Epstein virus and the other idea is to reduce stress there's there's a real thinking that stresses part of it. So, go get some sun. And, and then they're talking about the diets again. This is real recent that they came up with some suggestion to go on a keto, excuse me a ketogenic diet high and omega three is olive oil avocado nets all those good foods, and then the physical diet is still important but they suggest doing yoga massage is really helpful for people that experience spasticity that's muscle tightening that happens with because of the inability to relax the muscle and meditation is also really helpful for people. Okay, and then I just get I'm getting towards the end here of my presentation, but I want to mention the importance of advocacy. I worked with the, I do advocacy with the National Multiple Sclerosis Society really to get funding for for MS research and then also with Americans for cures this is the California Institute for regenerative medicine. And here, here we in California we voters approved at five and a half billion for stem cell research. And I was part of that effort to get that, get that bill passed. So, and this is just showing some of the latest theories that they're looking at. There's a lot of talk about this Bruton's kinase inhibitors. They're still working on more, more treatments. And a lot of them are due to National Institute of Health funding fact almost all the therapies that I was talking about earlier are resulting from from that. There's also funding for research that's done by the National Multiple Sclerosis Society. We're doing this, this project that is essentially looking for cures that are there basically trying to coordinate all the researchers to find cures. And there's some funding. This is shows you what the CERM funding did over over 11 million dollars funding for research at various organizations related to multiple sclerosis. And I didn't need to click on that. I'm not sure how that happened. Okay, let's do that. And then there's from the National Multiple Sclerosis. This is the pathways to the cures. There's just a whole bunch of research that's happening with stem cells actually as well as just other projects. So, just going through these quickly you can see there's just lots of research happening all over the United States. And these are coming up with some, this is a recent study with stem cell reports that came up with this. They're learning that fractaline enhances a ligand dendrocyte regeneration and remyelination. So these are things that really could help people living with MS. And you can see there's a lot of projects, 87 of them just looking at how do we reverse the symptoms and promote wellness. And that's really the issue for people with MS. All those disease modifying therapies they slow down the disease but they don't repair any of the damage that's happened. And that's really where this research is focused is to try and make it so that our bodies get back to normal. I mentioned Selma Blair. This is a picture after she had her immune system ablated really, you know, caused her some challenges. But she says it helped her. And most promising with stem cell therapy is that they have this idea of doing mesenchymal stem cell derived neural progenitors. The idea is to inject these into the space in the spinal canal where people would essentially have these stem cells injected in their spinal canal. And they find that that's really helpful for people. So this is where the latest and greatest research is happening. And there's some great tools for scientists to use to discover more cures and that's exciting for us as well. So there is hope for people living with MS. If you're one of those people just keep in mind that they're doing a lot of work. And they're getting really a lot closer to finding a cure for MS. There's a study in this ATA-188 that's pretty promising. We'll see what happens. There's some citations here just to show where I got that information. And I also want to point out that there's multiple sclerosis support organizations around the country and around the world really that help people living with MS. And World MS Day is coming up on May 30th. So please, please note that and support it in any way that you can. So it's an exciting time of the year. So let me stop here and see if there's any questions in the chat. I know we're running a little short on time but hopefully we can, I can look at a few questions and, and get some responses. Okay, let me, I'll leave this cartoon up there while you're on looking at the questions. So, hi there Nick. I see that you had a point there. Is MS affected more predominantly from environmental factors or genetic? So yeah, Lesina, that's a really great question. And this really what they're trying to figure out. I don't think that there's a genetic component because people that it's not true that people that have MS are going to have children that have MS. So it's not entirely a genetic disease. But I know of people who who have two people living with MS and their family. There's some things going on, and it could be genetic. And they're also thinking, and I showed you in that slide that there is a genetic component that they think might be explaining the sensitivity that leads to susceptibility for environmental influences that could be the cause of MS. So, I, hopefully, I've, I've answered that one. And then, oh, you have more comments here. I believe that T cells, let me sort of, you guys can read it as well. So, okay, this is interesting. I've heard a lot about the theory of T cells being a big part of MS, and the cause of MS. And there is a company that is working on that Atari therapeutics I mentioned, they, that at 188 and the idea is that they can use the T cells to, to essentially fix the B cells that are infected, these antigen presenting cells. So this is a really great question. There's lots of technical details here that maybe I can follow up on this offline. Right. Are there any other questions. Well, I, I suppose there's not. And we're right at the end of the hour here so I think our timing worked out pretty well. I just want to thank you. I also want to thank Shay and shop for setting this up it's been a real pleasure to share my MS journey with you, and I am, and hopeful that we find a cure for MS real soon, and so that I can get back on my bike, and get out there and ride and I wish you all the best and success in your endeavors to pursue your careers and in nursing and doing what you're all doing. So thank you very much, and have a great rest of your afternoon.