POMC and multiple sclerosis: However, clinical observation of therapeutic effects of Acthar in glucocorticoid-resistant patients with multiple sclerosis [26], prior in vitro observations of direct effects of ACTH preparations on cultured human B cells [13], and the recognition that human monocytes, macrophages, and T and B lymphocytes express specific MCRs [6, 8, 27] have all suggested that some extra-adrenal effects of this corticotropin preparation might be immunomodulatory.