0:02

Welcome to the Healthy Brain Toolbox. I'm Dr. Ken Sharlin, neurologist, speaker, author, and host for this show. In each episode, I interview influential people whose work impacts how we live and how we think. My guests are leaders in the health and fitness industry, physicians, scientists. Authors and public servants. Here, you'll find conversations that break down barriers, expand your horizons, and give you the tools you need to protect your health and nourish your aging brain.

Dr. Ken Sharlin: 0:39

So today I am thrilled to welcome Jennifer Chester, APRN, MSCN to the show. Jennifer is a seasoned neurology nurse practitioner with over 30 years of experience in healthcare and more than a decade specializing in the diagnosis and management of neurological conditions, including Migraine, Multiple Sclerosis, Epilepsy, Stroke and Dementia. She began her career with a BSN from Creighton University, followed by an MSN and a family nurse practitioner from Binghamton University. Over the years, she's held clinical leadership roles across the HCA healthcare system, most recently at College Park Neurology, where she was known for her compassionate evidence-based care. Jennifer has now transitioned into a medical science liaison role at Octave Bioscience, and that's what we're gonna talk a lot about today. This is an innovative biotech firm focused on advancing neurodegenerative disease management through precision data science, and in particular the MS disease activity test. In this capacity, she bridges the gap between clinical practice and neuro analytical research expanding her impact from patient care to the forefront of medical innovation in neurodegenerative diseases. So please join me in welcoming Jennifer Chester. So great to have you.

Jennifer Chester: 2:09

Thank you. I appreciate being here.

COMMERCIAL BREAK: 2:13

Time for a brief message from one of our sponsors. Do you ever find yourself struggling with brain fog, memory lapses, or that mid-afternoon crash? Maybe it's difficulty focusing mental fatigue or even the early signs of cognitive decline. These can all be signals that your brain isn't getting the fuel it needs. That's why I recommend Keto5 a breakthrough in targeted brain nutrition. Their supplements, XO Genius and XO Ultra are scientifically designed to support focus, memory and long-term brain health. XO Genius delivers a rapid boost in ketone levels, giving your brain clean, sustained energy for hours without sugar, without carbs, without the crash. XO Ultra goes deeper, providing a pure beta hydroxybutyrate formula to help you achieve effective ketosis. For sharper focus and stronger mental clarity, but it's more than energy. Research shows that ketones can reduce neuroinflammation, protect brain cells, and support mitochondrial health. Key defenses against conditions like Alzheimer's and Parkinson's disease. Imagine clear thinking, better memory, and a brain that thrives not just today, but for years to come. Fuel your mind, protect your future. Visit drsharlins.com/collections/keto5 5 K E T O 5 to learn more and get started today.

Dr. Ken Sharlin: 4:05

Jennifer, just before we dive into things, tell me a little bit about your journey into neurology and what some of your discoveries along the way were that ultimately led you to be interested in the work being done at Octave.

Jennifer Chester: 4:19

I've had a toe in neurology since my first nursing job out of college in the nineties. I got a job in the Ortho-Neuro Trauma Unit and neuro stuck. Everybody didn't want neuro and I found it very interesting and it's amazing how far it's come since the early nineties when I first graduated. Personally, I was touched by it as well. I had various neurologic conditions within my families from Stroke to Parkinson's and Dementia, and I could relate to many of the things that my patients were dealing with.

Dr. Ken Sharlin: 4:54

That's wonderful.

Jennifer Chester: 4:55

MS came my way when after I got my nurse practitioner'cause we typically didn't see MS patients in the hospital unless they were there thinking it was a Stroke and it was actually MS. But for me, I started working with a general neurology practice at saw mostly Stroke. And the doctor I worked with said, why don't you see the MS patients because they are more time consuming. It's definitely a very holistic approach. You're treating more than just one thing. You're treating that whole patient from head to toe. And so being the nurse practitioner in the practice, I could spend a little more time with the patients. It piqued my interest and I did a little fellowship training at UT Southwestern. It was just a short few days, but just immersed myself in it. Came back and I'm like, I'm ready to go. And from there I got my certification in MS. Nursing and then eventually switched over to working for an MS Center time.

Dr. Ken Sharlin: 5:55

That's great. And again, as we get into the details of Octave the MS disease activity test, I wonder if you yourself had, because I will say just personally, I had an aha moment with this particular test. It really it really changed the game for me as a, as an MS neurologist and I was just curious if you ever had the chance to use the test before working with Octave as an MSL, and how your experience as a clinician was shaped by the information gained from the test.

Jennifer Chester: 6:34

Oh, absolutely. I was first introduced to Octave in the MS disease activity test in 2023, so I was still in practice and was, we started using it on as many patients as we could. And I definitely had my aha moment, which I'll definitely be happy to share that case with you. But I was already entertaining the idea of switching over to industry. And honestly, when I met the folks from Octave and saw what they were doing, saw the cool science behind it, I immediately was interested in this would be the company I'd wanna work for, and not just big pharma.

Dr. Ken Sharlin: 7:10

Yeah. That's wonderful. So let's give folks, I guess let's do two things. I wanna make sure that listeners have a little bit of idea of what MS is like the elevator speech, the three sentences, it's not gonna be super detailed. Not everybody listening to this podcast is gonna have MS. But in general, I think you probably agree that we think of MS as by and large as a neuroimmune disease whether it's truly autoimmune is more of an intellectual argument. But certainly our own immune cells do play a role in this disease. There are cells that largely belong in the peripheral bloodstream that make their way across the blood brain barrier and ultimately participate in the inflammatory response in the brain. We think too that there are changes, of course, that happen within the brain itself that are part of that overall middle use. It's probably not just the. Peripheral immune system. But ultimately people with MS develop these classic plaques that are seen on MRI, some of which enhance with contrast, meaning there's been disruption of the blood-brain barrier, they're acutely inflammatory. And then sometimes they do resolve, but many times unfortunately, they leave a footprint of a past injury, if you will. And then of course, in some cases, if they're if the degree of inflammation and ultimately neurodegeneration is enough, they actually leave in their wake a hole in the brain. And so there's very much loss of neurons. The flip side of MS is neurodegeneration. And we can think of not just the attacks that relapse and remit, but ultimately a progression of disease in which there's acquired increasing disability over time largely measured by changes in gait, but other aspects of course, as well. And there may be a more insidious kind of progressive pattern of the disease without discreet attacks, but just getting worse and worse over time. When I first started we're, we may be about the same age when I was resident at University of Virginia in'93. The first disease modifying therapy came out was called Betaseron and it's not a highly effective drug and it's probably not prescribed a whole lot anymore. I still have one or two patients using it, but they're legacy patients'cause they've been on it and it worked for them and they were happy with it. It did have some side effects but we lost, we've lost a lot of people over the years to Multiple Sclerosis. And so when the drug came out there it was under such demand. There was actually a lottery, at least in at UVA to get.

Jennifer Chester: 10:04

Yeah.

Dr. Ken Sharlin: 10:05

The drug following the development of this interferon based drug. We had Interferon beta 1A, beta 1B, or the other way around really beta 1B is Betaseron and beta 1A was Avonex and then Copaxone, we called them the ABC drugs. And we lived with those for a very long time until we started to see high, more effective drugs. Sometime in the early 2000s, initially with Natalizumab, and then eventually with a drug called Fingolimod. And then it's taken off from there. And we do have some very effective treatments. Probably the most exciting treatments right now that are. Available commercially are the B-cell depletion drugs like Ocrelizumab and Ofatumumab and Ublituximab, if I said that and at any rate and then some of the although not approved, the highly efficacious hematopoietic stem cell treatments, that are available to a limited extent. But at any rate, you and I have seen this over the years and it's really changed a lot. People are now HIV people live with HIV they don't die as much from AIDS anymore. I saw I was very much in the midst of the AIDS epidemic and training and saw some things that I wish I never saw. Some horrible things but people don't, of course there are people who are more severely affected, but by and large we're in a much better place. And then we have historically tracked our patients using MRI and I don't know what, I'd love to hear how you tell the story about MRI, what I've said, especially since this test came into my world, is, and I'm talking about the Octave test that, getting an annual MRI to track our patients. It's kinda like installing a fire alarm system in your home and then asking the technician, how do I know if it works? And then the technician says to you if your house burns to the ground. The alarm didn't go off, then it didn't work. Because really we get these MRIs once a year typically, right? And we look for new lesions. We look for disease activity. That has already happened. In other words, it damaged to the brain has already happened to meet our clinical decisions. And punchline, at least for me, is. What's amazing about this test is not only is it blood-based, so it's a fraction of the cost, and we'll get into that, but it is not just a snapshot of what is happening now, but it's predictive and so we can potentially catch that fire while there's just a little smoke and a flame in the kitchen'cause you forgot there was something in the oven, whatever rather than the whole house burning down. So it's a huge opportunity for folks to really avoid the disability associated with MS.

Jennifer Chester: 13:02

Yeah.

Dr. Ken Sharlin: 13:03

I hope that's all good.

Jennifer Chester: 13:05

Yeah. It was great.

Dr. Ken Sharlin: 13:06

My enthusiasm for this test. So let's go back. Okay. So it's a blood test, right?

Jennifer Chester: 13:12

Yes.

Dr. Ken Sharlin: 13:12

Walk folks through this because it's really it's critical and it's detailed, it's complex, but you guys do a great job of making it easy at the same time.

Jennifer Chester: 13:22

So it is a blood test. It is a simple blood test, one little vial of blood, but what it's blood biomarkers, which are actually proteins that are in the blood. And so through this we see different effects of the disease. Through these proteins. So if you think of MS, and the way you described it and the way that it works on the body, it it affects the immune system. So there's immunomodulation, there's neuroinflammation, there's Myelin Biology.'cause the Myelin is what's being attacked. And then there's Neuroaxonal integrity, right? So that's where the damage is happening. So those are the four pathways that make up the different biomarkers that we're testing and together. We get four different pathway scores based on the 18 proteins that are being tested. And then from there we give one disease activity score from one to ten, and one is low disease activity, which is where we want everybody to be, and ten is high disease activity.

Dr. Ken Sharlin: 14:26

Yes. And you divide it into three groups where you can be one to four, up to four, correct.

Jennifer Chester: 14:35

Yes. And then four and a half to seven and a half I believe, and then or seven and seven and a half to 10 is high.

Dr. Ken Sharlin: 14:43

So I get this test and to just, I'm curious, and again I don't think. I could be wrong. So you've got, we've got the expert here right now to make the diagnosis of MS in the most mainstream, traditionally accepted, validated, I suppose way at the moment, is to use what's called the 2017 Revised McDonald criteria. Although, as there's the revisions that are, the 2025 that are in the works. I don't think it's been certainly presented, but I don't think it's been rubber stamped yet as, yes, we're doing this. But the McDonald criteria does not say, if you have an abnormal MS disease activity test, you have MS. In other words, the MS disease activity test is not technically right now considered a diagnostic test.

Jennifer Chester: 15:36

It is not diagnostic. I think with the new McDonald criteria, which really focuses on early diagnosis. So some of those patients who typically may not have fallen into the right category may now fall into that category, and you could use this. Then do we go ahead and start treating early or not? Because they meet all the criteria where maybe some of those patients years ago may have waited to be treated.

Dr. Ken Sharlin: 16:02

That's right. So you would typically, I would, and I know you and as a clinician, we've taken a medical history, you performed a physical exam ultimately to arrive at the diagnosis of MS. Today, we can't make a diagnosis of MS without performing an MRI because we want to at least demonstrate the lesions or plaques separated by space. There is. This is more of a technical point, of course, you know that there are ways to demonstrate that they have appeared at different timeframes. If that is not apparent on the MRI, although I understand some of that is changing a little bit with the new criteria. There is a lot of interest in what is called Clinically Isolated Syndrome. So the person that has their first attack, they haven't had the repeated attacks. We can't establish that space and time factor only in perhaps the space part. But we think it's probably MS. And then there's even what is called radiologically, isolated syndrome, where maybe you. We're in a car accident and you had an MRI because somebody was worried about, did you have a brain injury? And somebody looks at the MRI and goes I don't see any evidence of brain trauma, but does this person have MS because they have periventricular, white matter lesions or Dawson's fingers and and so forth and. Some of the other classic signs of MS that we see on MRI, but they've never actually experienced the symptom. They never had Optic Neuritis or whatever manifestation of the disease. There is even discussion, of course, of a premonitory or, what is happening at the biological level before we start to see those lesions. And I think that even potentially is a place that the disease activity test could theoretically. Have a role, but I'm gonna, I'm going back now, I'm gonna make my diagnosis, I've got my MRI, I am sitting down and having a serious conversation with a patient, and I'm gonna probably want to order that MS disease activity test. From the beginning, right? Once I know. Yes. This is MS. Okay, so tell me how would you see now we have all this data, right? Because I always tell my patients, look, tests are data tests are just nobody is fixed with a test. It's just information. So let's talk a little bit about how the test then could be used in clinical practice. Why do it?

Jennifer Chester: 18:35

Yeah, so we're gonna do it. That first patient when they're first diagnosed, we really wanna get that baseline. of how active is their disease right now today, gonna get that initial score before they even go on treatment. So let's say we've got our baseline score and then you've chosen the treatment, they're gonna go on six months later, we recheck it and that tells us are we on the right medication? Has your disease activity score come down? To a much safer level, and that's what we want. So say, they went on Avonex, which we're not really using now as much, but that would be one where you wouldn't expect much of a drop in that disease activity score just'cause it's As efficacious, but today we have so many good medications. We can see that disease activity score come down quite a bit, but things happen. People need to switch treatments, they have side effects or breakthrough disease, so that would be another time you would retest, say you're testing on a regular basis to make sure they're stable. You're gonna test'em again if they have any breakthrough disease activity or new symptoms to assess for relapse. After a switch, you're gonna reassess them. And then, through the years, checking it on a regular basis, just as you would with an MRI, it's still assessing their level of disease activity. Either you're visualizing it on an MRI or you're doing it in a blood test. Both would be still important. Then it comes to discontinuation, you know now'cause people are living longer with MS. When do we stop treatment? So that's a big question. So if they've been getting their baseline testing done and routine monitoring over the years and they've been stable and now maybe they're 65, 70 years old and doc, do I need to continue taking this? Let's see. Your disease activity scores been maybe a two for 10 years and now maybe it's time to come off. You stop the treatment and you continue to monitor their disease activity. Think about the treatments we have like Cladribine, A lemtuzumab where you dose for two years and then you're done. And those patients ask how are you gonna know everything is okay? Now we have something else to do. We can watch your MRIs, which as could be too late. Disease happens or we do an MS disease activity test, hoping to see that underlying activity even before the changes in the MRI.

COMMERCIAL BREAK: 20:53

Now it's time for a short commercial breaks. Imagine a future where brain health is not just managed, but optimized, where the symptoms of Parkinson's, Alzheimer's, traumatic brain injury, stroke, depression, anxiety, and even long COVID can be addressed with cutting edge technology. That future is here with the Neuronic Light and the Neuronic 1070 nanometer. Photobiomodulation helmets a breakthrough in noninvasive brain therapy using near infrared light. These devices penetrate deep into brain tissue, stimulating cellular repair, reducing inflammation, and enhancing mitochondrial function. Research suggests this technology can even enhance cognitive performance in healthy individuals all without drugs. Or invasive procedures. The Neuronic 1070 helmet takes it further, offering four customizable operating quadrants. Ideal for tailoring programs and conditions like stroke or traumatic brain injury. And with every 1070 helmet, you'll receive a free 30 minute brain health consultation to help you maximize. The benefits. Whether you want to support memory, restore energy, or take proactive control of your brain health. Neuronic technology could be the game changer you've been waiting for. Unlock the power of light, heal, restore, thrive. Learn more at Neuronic. Online and when you make that investment, be sure to use the code Sharlin100 with a capital S to get your$100 discount and let Neuronic know where you heard about this valuable technology.

Dr. Ken Sharlin: 22:54

I have a slide deck that you guys gave to me a while ago, so I don't know if it's been updated. A PowerPoint type, presentation unbranded. And it has referenced one study that you guys did where you compared people in the low and moderate. Disease group to people in the high disease group. And I think, and you were looking at the likelihood of new enhancing lesions,

Jennifer Chester: 23:17

Yeah.

Dr. Ken Sharlin: 23:18

and if you were in low and moderate versus high, if you were in the high, you were 23 times more likely to have new gadolinium enhancing lesions.

Jennifer Chester: 23:27

21 times more likely if you're in the higher range. If you're in the moderate to higher range, it's five times more likely to develop a new lesion.

Dr. Ken Sharlin: 23:35

And where I'm also going with this is, and I alluded to it in my analogy about the fire in the house and the alarm system, that it doesn't also necessarily mean that you do have a new lesion, but you are at great risk for having a new lesion.

Jennifer Chester: 23:53

Now if we wanna share my, can I share my aha moment?

Dr. Ken Sharlin: 23:56

Yeah.

Jennifer Chester: 23:57

Where, in prac, and I actually shared this case with Octave when I was in practice, and now that I'm here, I get to continue sharing this case. But this was a patient who was treated with Cladribine, so she was one that we were monitoring. After she completed her two years of medication and she was three years out and we did her MSDA, which was her first test, so her baseline test, and she was a five and she's actually a nurse and she's I don't like that score. And I'm like I don't like it either. But this was your first test. So I don't know what this means. It's in the middle. I don't love it. I'd rather you be low, but let's, she had no new symptoms. She felt fine. I said, we'll retest you. So that was in 2023. And then in 2024 we re, we tested her, she came in for a usual visit, no new symptoms, was feeling great, and her score was a seven. So Increased by two points, which we would consider significant. And I said, I know you don't have any new symptoms, but we need to make a plan here.'cause I don't know that this is working for you. Because you increased by two points. So we had the discussion about treatment and maybe we should switch or continue the same one. And I said, let's get your MRI done sent her for an MRI two new lesions and she had no new symptoms I wouldn't have, and it was a little early yet she wasn't quite due for MRI, so I wouldn't have sent her except for that change in her score. And then, I called her of course, and she knows when I call the day after her MRI, that. Never a good thing. And so we had that conversation of what we're gonna do next, and we switched her DMT. That's what she felt most comfortable doing. But that was that first moment of, because of this test, it actually made a difference in how I was treating my patient.

Dr. Ken Sharlin: 25:45

So true. I have had similar, not exactly the same. Some scenarios that I think is, we're sharing with folks listening'cause we can, I think, everybody's gonna identify with one of these cases. I've been very interested in MS remission and what the data has told us. And of course we've had to rely largely on clinical data up until recently with the MS disease activity test not that it's necessarily become the gold standard to determine if somebody's in remission, but it is certainly a exceedingly helpful tool. So I have had patients actually who have mo we, I live in Southwest Missouri where a lot of people choose to retire'cause. The Ozark Mountains and, table rock lake and real estate is inexpensive and people move from California where they're, paying over a million dollars for a little two bedroom, three, two bathroom, three bedroom, ranch, on a 1600 square foot, footprint or whatever. And then they come to our area and they can buy a veritable mansion for the same amount of money. So anyway, the point is soon he moves here. It's unfortunately difficult to get into neurologists all around the country. It's often a long way. And they did. Don't always plan the best. But they come here, they've, they're not on their medicine. Maybe it took'em a while to get around to getting an appointment. They're say six, I'm gonna make up a number. 63 years old. Haven't been on drug for two years. Maybe they were in Ocrelizumab is a case that comes to mind, and I said have you had anything that you would consider relapse? No. Have you had any disability progression? Any changes that are, sustained? No. Exam looks good. And I do the MS. Maybe we get an MRI, of course they're gonna have lesions. They may not be enhancing, but that doesn't necessarily move the mark for me. So I do an MS disease activity test, and they have a disease activity score of maybe two or 1.5. And I say, you're 63. You've gone two years, you've had no relapses, you've had no progression, you have no enhancing lesions on your MRI and you have low disease activity. I think you are in remission. If you are comfortable with this idea, I would recommend that we not initiate disease modifying therapy, but we track your disease activity test maybe semi-annually for a couple of years, and if you still are low disease activity. We're done. Your MS is done. It's over.

Jennifer Chester: 28:18

Yeah.

Dr. Ken Sharlin: 28:19

So very good one. Another patient I've seen is a gentleman who came in from another clinic. Progressive MS, for some reason was on Gilenya, which is not, or fingolimod non-indicative for progressive MS. But at any rate. Visits five minutes with a neurologist. Your MRI looks okay, but I think I'm getting worse. I think I'm getting worse. Oh, your MRI looks fine. So he did this for about seven years at least. Comes in and sees me, said let's do an MS disease activity test Score is 7.5.

Jennifer Chester: 28:52

Wow.

Dr. Ken Sharlin: 28:53

He practically, he was almost in tears, not just because you know that someone was listening to him.

Jennifer Chester: 28:59

Yeah.

Dr. Ken Sharlin: 29:00

Validating. So we put him in one of our clinical trials on a BTK inhibitor. So he's doing just fine. There are these cases and I do find that sometimes the, even following the standards of the McDonald criteria from a diagnostic perspective, sometimes you're like, ah, I'm just not, maybe not. And off-label, quote unquote. I have used the disease activity test to add to the database as it were to make a decision. Is this definitely MS? I would wonder, and this would be a question for you or your associates in more on the science side of the company is, could this test be have higher disease activity and conditions that are not MS.

Jennifer Chester: 29:45

The test is validated just for patients with MS, but each individual biomarker can have fluctuations in other disease states. Of course. Yeah.

Dr. Ken Sharlin: 29:54

And the top, the two big ones, there are 18 separate biomarkers and again, divided into roughly four categories. They are distinct categories, but you do this lovely job on the report of how this Venn diagram that shows how some of the biomarkers fall into more than one category, but they do include the neurofilament light chain and glial fibrillary acidic protein, which are two measures that have been used for many years in clinical research and only in the last year and a half became commercially available. So you can go to LabCorp Quest and have that drawn and in fact within about a month or two before I started ordering the Octave test I did order a few GFAP and NFL tests, but in the end I was like, why am I doing this? Because, I'll get those two biomarkers in 16 more. But the, especially like NFL is fairly non-specific. It's just a marker of, neurodegeneration and GFAP can be predictive in that manner as well as a predictor of disability in MS. But when I've put all of this stuff together globally or in a gestalt manner, I wonder whether there would really be a way to have a false positive, meaning a high disease activity score. And some of you didn't. Have MS at all with all of the biomarkers combined, it'd probably be unlikely.

Jennifer Chester: 31:18

It is unlikely. There are those occasional cases where head scratchers where you're you were really stable and your score's higher. But did they have other comorbidities? Yes, they things going on that you probably were skewing those numbers, but that is rare.

Dr. Ken Sharlin: 31:32

Yeah. And to be clear, Octave is not promoting this test for other diseases and it really is a tool for establishing a baseline and tracking over time. And we should probably talk a little bit about how often but I do want to share one more. Case that I think is really important to MS. Patients listening to this, and I don't, I will say upfront, I don't especially love the term, but I'll say I didn't make it up. And that is the pseudo relapse, right? And that basically means someone who has developed acute MS-like symptoms, neurological symptoms, and we have a case of this very recently of a gentleman with progressive MS, who is largely in a wheelchair, a lot of lower extremity spasticity, had been making some very positive progress with physical therapy doing some walking. And then had a major relapse where he basically couldn't use his lower extremities. And I ordered an MS disease activity test on him. And by the way, this was the third time,'cause we do it serially again, that I had done this. And not only was he low disease activity, but he was, it was his lowest score that he had ever gotten. It was something like 1.5 overall. So I said, i'm not questioning that you're having changes, but I'm not so sure. This is due to some acute change in your MS.

Jennifer Chester: 32:53

Yeah, we saw that too. And we would even, we'd go so far, we do the clinical exam, send'em for an MRI, and we're like, everything looks the same. But now we can add in the MSDA to be that little tiebreaker of is something really happening or not?'Cause maybe we're catching it before the MRI changes are actually happening and it is creeping up, or maybe it's stable and there's something else. Causing those changes.

Dr. Ken Sharlin: 33:14

Yeah, hugely helpful. Let's talk a little bit about how often one might have this test done and we could couch it in, everybody is unique and different and, consult with your doctor and all those sort of, default things. And of course, Octave is not gonna you as a representative of Octave not gonna make a specific recommendation. But in general, what is your personal, clinical experience, what are you generally seeing? How often should someone with MS consider having the blood test done?

Jennifer Chester: 33:42

I would say I cover half the country in my role, so I talk to a lot of clinicians who use this test, and I would say in general, about every six months is pretty standard for most places.

Dr. Ken Sharlin: 33:54

I agree. In my experience, I have done it every three months in a few patients here and there, but I will also add that when my patients are on the B-cell. Depleters Ocrelizumab, and Kesimpta and Ocrevus primarily BRIUM VI as well. The new kid on the block,

Jennifer Chester: 34:13

Yeah.

Dr. Ken Sharlin: 34:13

but certainly has a place in the toolbox. But at any rate I have found that in general for relapsing remitting MS, these drugs are so incredibly effective. I just say it shuts the disease activity down. I very rarely see a score above 1.5 or two. Very rarely. So as long as you know they're doing fine, I have backed it off to annual when they're on those drugs.

Jennifer Chester: 34:40

It makes sense. Yeah.

COMMERCIAL BREAK: 34:44

Let's take a short commercial break. Looking for a natural boost to keep your brain sharp and your body energized. Discover everyday dose, the ultimate coffee alternative, packed with lion's mane and chaga mushrooms, collagen, and L-theanine. This creamy blend supports focus, mental clarity, and overall wellness without the caffeine jitters. But coffee's not your only option. Everyday dose also offers a premium ceremonial grade matcha sourced from Kagoshima Japan and infused with the same ingredients. Whether you go for the mushroom coffee or the matcha everyday dose makes fueling your mind and body a breeze taken together. Everyday dose has the potential to support memory, focus, sleep, nerve regeneration, gut health. Health immunity and reduce inflammation while the collagen gives you healthier skin, hair, nails, joints, and bones If you like, give either these great products a try everyday dose, we'll send you a free starter kit. When you purchase a 30 day supply of coffee or matcha tea, just use my link to save www.everydaydose.com.healthybrain and make healthy brain in all capital. With everyday dose, you can drink smarter, feel better, and power through your day naturally. I love this stuff. I do. I'm gonna have some right now.

Dr. Ken Sharlin: 36:27

Here's another scenario that I think is very interesting, again, to review for folks. We get this global score, but then there are four subscores, neuroinflammation immune modulation. Myelin Biology and neuro axonal integrity. The last one is of great interest to me because to me it reflects the neurodegenerative component that is MS. We have to realize there's an inflammatory component. There's a degenerative component, an earlier stage disease. It tends to be more inflammatory. At least those. Who present with relapsing remitting MS. It can be an inflammatory progressive MS, but oftentimes it's a non-inflammatory progressive, meaning you're getting worse, but your MRI shows no new plaques. No new lesions. And I should add that we need to be, it's probably a separate conversation, but paying a lot more attention to brain volume and not just looking at plaques, because that's where a lot of that degeneration is gonna happen.

Jennifer Chester: 37:31

Yeah.

Dr. Ken Sharlin: 37:32

But you can have a scenario where someone is doing worse or you're just tracking them you're maybe asking a question, are they on the right disease modifying therapy? And indeed their inflammatory scores are low, but their neuro axonal integrity score is high. And that seems to be another interesting pivot point for decision making.

Jennifer Chester: 37:57

Yeah, we, the test was only validated for activity. So new lesions, not progression. Progression is something we're very interested in. And that is the next panel that's in our pipeline.

Dr. Ken Sharlin: 38:08

Nice.

Jennifer Chester: 38:09

plan on having a disease progression panel at some point. And they're in the, an analytical phase of that right now, trying to identify all those different biomarkers that really indicate. Progression independent the relapse activity.

Dr. Ken Sharlin: 38:24

That's very fair. And I would say just on my end, speaking as an independent practitioner if I see high degenerative scores, basically the neuro axonal integrity, I'm gonna say you may be on the wrong drug. Okay. Or we need to find some more solutions for you besides your medication that can ultimately address the degenerative component because by and large, the disease modifying therapies are targeting the inflammatory component. That is MS.

Jennifer Chester: 38:58

Correct.

Dr. Ken Sharlin: 38:59

There's some data on brain atrophy, on reduced, slowing brain atrophy over time. But these are secondary measures in most of the trials. Any thoughts just on the theoretical side against not your test or your company, but this new emerging class of drugs as Bruton. Tyrosine kinase inhibitors. They do, they are out there commercially, but not for MS right now. But we are going to see Sanofi Genzyme commercialize their BTK inhibitor for secondary progressive MS by the late fall, I think. That may be a class and given its mechanism that where there's a special place for those who have progressive disease.

Jennifer Chester: 39:40

Yeah, I think everybody's excited about the prospect of it.

Dr. Ken Sharlin: 39:44

It's an interesting situation because we are involved in we've worked both with Genentech Roche as well as Sanofi Genzyme with Fenebrutinib and Tolebrutinib. And you probably know that several of the trials failed and where they failed focuses at. With relapsing remitting MS, because we have so many treatments you can no longer do a placebo control trial. So all these studies have what are called active controls. And right now the main active control that's being used is a drug called Aubagio and or teriflunomide. And so what ends up happening in these trials, that's considered a low efficacy drug. And in the clinical trial, the, the investigational drug, the BTK inhibitor it's wasn't that it wasn't effective, it just wasn't any more effective than Aubagio or Teriflunomide. And I think there were more or less economic and business decisions that said, look, if we can't be better than Teriflunomide, that it's not worth. Developing this drug further and promoting it. But that being said, given the mechanism where this, these class, this class of drugs acts really within the central nervous system as opposed to the acting on the peripheral, I'm sorry. On the peripheral immune system it may be that. We now have a tool in our toolbox that targets those who've then transitioned to more progressive MS. It is maybe especially an inside out disease, if you will, really active in the brain, less so in the periphery.

Jennifer Chester: 41:17

Right.

Dr. Ken Sharlin: 41:19

So very exciting, and I hope ultimately that Octave plays a critical role in helping us understand all that. So if, if I have MS and I have health insurance and I want to have this test done, the cost will obviously vary by people's insurance and their copays and their deductibles and all that kind of thing, but by and large, what are we looking at from the point of view of third party payers?

Jennifer Chester: 41:44

We handle all the billing. So once your clinician has ordered the test, you go get it drawn. It gets sent to our lab in California to be run. And when that lab, when that vial of blood is received, our billing department gets notified of the patient information, patient insurance. We will bill to all insurances to see if it could be covered. If it is not covered, then it's just reverted to a cash pay price through our Octave Cares program, and the most out of pocket would be$99.

Dr. Ken Sharlin: 42:14

Wow.

Jennifer Chester: 42:14

Many patients pay less than that, but that would be the max amount. And if it's covered by insurance, then it depends what is the deductible? Do we need to work out a payment plan for that? If it's still too high, then we'll just withdraw that claim and do that cash pay price if no more than$99.

Dr. Ken Sharlin: 42:31

That is fantastic and you're okay in other words, sometimes the stipulations that come through the health insurance we'll only cover this a certain number of times per year, not necessarily your test, but in general I've seen that. And in that case, if they say we're willing to cover it, but only, twice a year, you guys can step in if need be that the patient needs an updated test.

Jennifer Chester: 42:53

Yeah, if they're gonna cover it. We haven't yet. I think it's so new that we haven't been limited on how often yet, but I'm sure that will happen.

Dr. Ken Sharlin: 43:02

Yes. And the other thing that I think is important, most people know they have a blood test. There's at least a couple Major laboratories out there, quest Diagnostics and LabCorp. This is not a Quest diagnostic test. There's not a Quest test code that, you go to your Quest station and say, I want an Octave test. You Octave bioscience is its own company. Is its own lab so that practitioners interested in implementing this test and their office need to take certain steps to make that happen. And

Jennifer Chester: 43:35

Right.

Dr. Ken Sharlin: 43:35

who are practitioners listening or watching, can you tell us what we need to do?

Jennifer Chester: 43:41

Basically they would reach out to us and our neuroscience account executives would get that agreement set up an account, and then work with whatever lab that you're in. If you have a lab there at your practice. Some places use their infusion sites. To draw, or there are some third party labs that we contract with that would be willing to draw for us, and they get a kit. They package it up and send it to us.

Dr. Ken Sharlin: 44:05

Not too complicated to draw the blood and process it?

Jennifer Chester: 44:09

Nope. You draw it, you spin it, put it in the fridge and it gets shipped on ice.

Dr. Ken Sharlin: 44:15

Fair enough. Ooh, I wanted to ask you a question. This has been, you were doing it in 2023. Where is Octave now? Are how geographically in terms of clinics across the United States. Are you in international markets? If somebody's in the UK or where?

Jennifer Chester: 44:31

We're just the United States, but we are approved now in all 50 states. New York was the last one to come on board because they have much stricter lab guidelines, so to get their approval was pretty major. And in the spring, and so now we are in all 50 states.

Dr. Ken Sharlin: 44:48

Wonderful. So as long as you're, you have a a lab or access to a lab that's willing to work with you guys, set up an account, you send the kits. Draw the blood. It's easy to process. I know what I wanted to say. So here's another thing that I just love about what Octave does, and this is really for practitioners. If I were to have just a generic blood test it didn't ma... whatever you want, like a basic metabolic panel, and I'm gonna have that drawn maybe through Quest or LabCorp, no big deal. It's done billions of times, every year they get, your name and your date of birth and your health insurance information so it can billed your health, bill your health insurance and whatever. But that's really, you know about it. What you guys do is completely different for practitioners, and I just love this.

Jennifer Chester: 45:36

Yeah.

Dr. Ken Sharlin: 45:38

Maybe you could share just in more detail all of the data that you're collecting to have this, practitioner facing component as well, and really inform practitioners about what's going on with their MS patients and their practice.

Jennifer Chester: 45:54

Yeah the order form itself, you put, you can put more than just name and date of birth. You can actually put in the year they were diagnosed, you can put the reason why you're doing the test is this for a relapse routine, initiation, what treatment are they currently on? So all that information gets put into our database and we can pull that up and, say, look at all your patients on B-Cell Depleters and see how they're doing. We can break it up by age group and see how your patients are doing. And then we also offer that report review with the clinicians as well. I get notified when my practitioners have. One, test, their first test, and then again after five tests, and then I always offer up that time to sit down and review the reports and see if they have any questions and discuss interesting cases and go from there.

Dr. Ken Sharlin: 46:41

That is so valuable. I mean that I have nothing against Quest of course, but that would not happen with Quest Diagnos. Like it would not happen with LabCorp. But the fact that you can sit down and look at all your data and look at a such high resolution and say, okay, my patients on these meds, my patients on these meds, how do patients with MS. Do in my practice? Litmus test right there, because for practitioners interested in value-based care over fee for service, you have to show your outcomes are better. How are you gonna get better outcomes? That's a whole separate discussion, but you gonna validate that through the MS disease activity test and say, all my patients, have a, on average, have a score of this or less.

Jennifer Chester: 47:25

I'm speaking of outcomes. We're getting ready to launch a prospective study looking at outcomes, and so we're in the process of identifying sites now to participate in the study.

Dr. Ken Sharlin: 47:37

My practice is an integrative neurology practice, and I do everything and hopefully more that the typical practicing neurologist does. But we also bring in. The principles of lifestyle medicine of functional and regenerative medicine. I work very closely with Dr. Terry Wahls who has interviewed you guys for her autoimmune MS summit. Point being just wanna make for folks who might be listening to this, who are very interested in sort of the Wahls protocol or the Sharlin protocol that this test. Does not necessarily, it certainly doesn't tell you what drug to put a person on, but my point is that if I'm tracking someone who's dedicating their journey with their MS to a more Wahls or Sharlin type of approach, the ability to see where things are going, even if you're not taking a drug, is hugely valuable because then we can sit down and we can say. Either things are going exactly where they're supposed to be going, and of course, again, we use other metrics. We do 25 foot walk peg hole tests, fatigue, rating scale, et cetera. But, having that information can really validate the choice to not use disease modifying therapy. To add disease modifying therapy, if you have started on a different journey where you're beginning with more of a functional medicine approach, because let's be honest, we can't control everything all of the time, and everyone with MS is unique and different, and some people do extremely well on a functional medicine, lifestyle medicine type of approach. But some people need the drug, and I would only argue that the people who combine diet and lifestyle with the drug. Generally do way better than the people are just using the drug in general. So it's a really, don't think that this is just all about medicine all about taking a pill or injecting yourself or getting an iv. This really is about understanding where you are with your disease so that you can be in the driver's seat

Jennifer Chester: 49:45

Correct.

Dr. Ken Sharlin: 49:48

I know we've been talking for a little while and I really appreciate your time. I want to ask one last thing because you guys are looking at, some new things and just around the bend, it's been on your website for a while. You were granted$10 million from the Michael J. Fox Foundation. To develop a panel, a blood-based panel for Parkinson's disease. And I know there's probably some things you can't talk about with that, but what can we hopefully look forward to in the near future?

Jennifer Chester: 50:15

We're hoping the panel will be commercially available in 2026 and the focus is on progression of Parkinson's and helping guide treatment decisions and hopefully have some DMT choices someday for Parkinson's.

Dr. Ken Sharlin: 50:31

That is wonderful. Are there other areas of neurology that there is scientific investigative interest in within your company that you're exploring?

Jennifer Chester: 50:41

I think Alzheimer's is something we're exploring, we're that's much further down the pike, right? Parkinson's in the MS disease progression panel would be first, and then maybe down the road. Alzheimer's.

Dr. Ken Sharlin: 50:53

That's great.

Jennifer Chester: 50:54

Yeah.

Dr. Ken Sharlin: 50:54

Jennifer Chester, it's been such a pleasure having you on the Healthy Brain Toolbox. I know folks who've spent their time listening to this interview have gotten tons of valuable information. If you are a provider, I would encourage you to reach out to the company go to their website, contact them through either web based form or phone number, they've been hugely helpful. They will come to your office. They have field reps just like any other company. Just speaking from personal experience, take advantage of the opportunity to get on the phone, on a Zoom call with someone like Jennifer to go over all your data test every single one of your MS patients. And of course, if you have MS. I would only say seek out a practitioner doing this test because we gotta be practicing 21st century medicine and to not include a metric like this is really to be 20 years behind.

Jennifer Chester: 51:53

Very well said.

Dr. Ken Sharlin: 51:55

Thank you again and we look forward to future conversations

Jennifer Chester: 51:59

Thank you.

52:04

Hi everyone. Dr. Ken Sharlin here with the Healthy Brain Toolbox. I'd love to hear from you. If you have general questions about brain health, neurology, or the science of keeping your brain sharp. Send them to questions@healthybraintoolbox.com. I'll be reading your questions on the upcoming episodes. Please remember, these need to be general questions, can't answer personal medical questions, or provide individual medical advice. So if you've ever wondered about brain health strategies, lifestyle tips, new research, or the future of neuroscience, send those questions in. I look forward to hearing from you and who knows? You might even hear your question featured on the show. Thank you for tuning into the Healthy Brain Toolbox podcast. I hope today's conversation gave you new insights to protect and nourish your brain. Be sure to subscribe, leave a review and share this episode with anyone looking to take control of their health. Until next time, stay sharp and keep learning.